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:
A. At least five attacks of abdominal pain, fulfilling criteria B–D
B. 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

C. During attacks, at least two of the following:

    1. anorexia
    2. nausea
    3. vomiting
    4. pallor

D. Attacks last 2-72 hr when untreated or unsuccessfully treated
E. Complete freedom from symptoms between attacks
F. Not attributed to another disorder1.

Note:
1. 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, if 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.