Abdominal Migraine: Clinical Presentation
Abdominal migraine presents as recurrent, stereotypic episodes of severe paroxysmal abdominal pain with associated migrainous features including nausea, vomiting, anorexia, pallor, and photophobia, with complete wellness between episodes. 1, 2, 3
Core Clinical Features
Pain Characteristics
- Severe, paroxysmal abdominal pain that is the dominant symptom, occurring in discrete attacks 2, 3
- Pain episodes last hours to a few days (typically several hours) 4
- Complete symptom freedom between episodes is a defining characteristic that distinguishes this from other chronic abdominal pain conditions 1, 2, 3
- Pain location, quality, and severity should be documented as part of the diagnostic evaluation 5
Associated Symptoms During Attacks
- Nausea and/or vomiting are prominent features 2, 3, 4
- Pallor (facial paleness) is characteristic 2, 3
- Anorexia (loss of appetite) commonly accompanies attacks 6, 3
- Headache may occur during episodes 3
- Photophobia (light sensitivity) can be present 3
Epidemiologic and Historical Features
Patient Demographics
- More commonly diagnosed in children (affecting 0.2% to 4.1% of pediatric population) rather than adults 3
- When occurring in adults, most published cases describe females with long-standing history of refractory abdominal pain 7
- Onset typically in childhood or adolescence, though can present for first time in adults 4
Family History
- Strong family history of migraine is a critical diagnostic feature that significantly strengthens the diagnosis 1, 5, 2
- Patients often report similar episodic abdominal pain patterns in family members with migraine 7
Natural History
- Children with abdominal migraine often progress to develop typical migraine headaches when older 4
- This evolution supports the concept of abdominal migraine as a "migraine equivalent" 4
Diagnostic Pattern Recognition
Stereotypic Nature
- Episodes follow a consistent, recognizable pattern for each individual patient 1, 2
- The stereotypic quality helps distinguish abdominal migraine from other causes of recurrent abdominal pain 1
Refractory to Conventional Treatment
- History of extensive gastrointestinal workup with normal findings is typical in adults 7
- Symptoms persist despite treatment with standard analgesics and antiemetics during acute episodes 7
- Multiple previous admissions with similar symptoms and negative investigations are common 7
Clinical Pitfalls
Abdominal migraine is likely underdiagnosed because clinicians may not consider it in the differential diagnosis of recurrent abdominal pain, particularly in adults 3. The key to diagnosis is recognizing the pattern of stereotypic attacks with complete wellness between episodes, combined with a positive family history of migraine and normal gastrointestinal investigations 1, 2, 7.