1.6.1.2 Abdominal migraine

Description:

An idiopathic disorder seen mainly in children as recurrent attacks of moderate to severe midline abdominal pain, associated with vasomotor symptoms, nausea and vomiting, lasting 2-72 hours and with normality between episodes. Headache does not occur during these episodes.

Diagnostic criteria:
  1. At least five attacks of abdominal pain, fulfilling criteria B–D
  2. Pain has at least two of the following three characteristics:
    1. midline location, periumbilical or poorly localized
    2. dull or “just sore” quality
    3. moderate or severe intensity
  3. At least two of the following four associated symptoms or signs:
    1. anorexia
    2. nausea
    3. vomiting
    4. pallor
  4. Attacks last 2-72 hours when untreated or unsuccessfully treated
  5. Complete freedom from symptoms between attacks
  6. Not attributed to another disorder1.
Note:

In particular, history and physical examination do not show signs of gastrointestinal or renal disease, or such disease has been ruled out by appropriate investigations.

Comments:

Pain of 1.6.1.2 Abdominal migraine is severe enough to interfere with normal daily activities.

In young children the presence of headache is often overlooked. A careful history of presence or absence of headache must be taken and, when headache or head pain during attacks is identified, a diagnosis of 1.1 Migraine without aura should be considered.

Children may find it difficult to distinguish anorexia from nausea. Pallor is often accompanied by dark shadows under the eyes. In a few patients, flushing is the predominant vasomotor phenomenon.

Most children with abdominal migraine will develop migraine headache later in life.