Abdominal migraine is an idiopathic disorder seen mainly in children. The symptoms are of recurrent episodes of midline abdominal pain with attacks lasting one to seventy-two hours and complete normality between episodes. The pain is of moderate to severe intensity and is felt in the midline of the abdomen, usually around the umbilicus, or poorly localised. The attacks of pain are usually accompanied by anorexia and nausea and about half of the patients will vomit with at least some attacks. Marked pallor is commonly noted during the attacks although some patients may appear flushed. The pain is severe enough to interfere with normal daily activities and many children describe their mood during the attack as one of intense misery. The attacks are self limiting and resolve spontaneously and patients are completely well and symptom free between attacks.

The onset of attacks of abdominal pain may be at any time of day but occurs most frequently first thing in the morning on waking. Associated symptoms include photophobia (sensitivity to light), phonophobia (sensitivity to sound) and dizziness in many children.

The symptoms of abdominal migraine normally appear in childhood before puberty, reaching a peak at the age of twelve years and thereafter falling rapidly. In most patients the symptoms of abdominal migraine will resolve with age but in one third of patients the symptoms will persist until the teenage years. Most patients will develop migraine headaches. Very occasionally the onset of symptoms may be during the teenage years or in adults.

Recurrent abdominal pain is a common problem in children although most do not have abdominal migraine. The diagnosis should only be used where the specific features of the condition are present.

Acute attacks of abdominal migraine are usually treated by rest and the condition frequently resolves with sleep. Patients should be allowed to lie down undisturbed in a quiet and dark room. Simple analgesic drugs may be helpful in relieving attacks.

There is good evidence from a controlled clinical study that Pizotifen may reduce the frequency and intensity of attacks when given regularly as a prophylactic agent. It has been suggested that Propranolol may also be effective but no controlled clinical trials have been carried out.

Inheritance patterns
A family history of migraine is frequently seen in abdominal migraine and as with other forms of migraine, the condition appears more commonly to be inherited from the mother.

Prenatal diagnosis
None.

Medical text written October 2002 by Dr D N K Symon. Last updated June 2007 by Dr D.N.K. Symon Consultant Paediatrician, University Hospital of Hartlepool, Hartlepool, UK.

There is no support group specifically for Abdominal Migraine but support and information can be obtained from the Migraine Action Association or the Migraine Trust (see entry, Migraine). Families can also use Contact a Family's Freephone Helpline for advice and information on any aspect of caring for their child.