Practice Clinical updates

Abdominal migraine

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k179 (Published 19 February 2018) Cite this as: BMJ 2018;360:k179
  1. Heather Angus-Leppan, consultant neurologist1 2 3,
  2. Defne Saatci, paediatric trainee4,
  3. Alastair Sutcliffe, professor of general paediatrics and honorary consultant paediatrician4,
  4. Roberto J Guiloff, consultant neurologist and professor of neurology5 6
  1. 1Clinical Neurosciences, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
  2. 2Institute of Neurology, University College London
  3. 3Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
  4. 4University College London and Great Ormond Street Institute of Child Health, University College London
  5. 5Imperial College London
  6. 6Faculty of Medicine, University of Chile, Santiago, Chile
  1. Correspondence to: H Angus-Leppan heather.angus-leppan{at}nhs.net

What you need to know

  • Abdominal migraine is episodic central abdominal pain occurring with other features of migraine and associated with other episodic syndromes (particularly cyclical vomiting and migraine limb pain)

  • Abdominal migraine usually starts in childhood, though it may occur in adults, commonly with a family history of migraine

  • The person is well between episodes with a normal physical examination and developmental milestones

  • Abdominal migraine is a positive clinical diagnosis and requires no further investigation once “red flags” are excluded

  • To manage abdominal migraine, provide an explanation of the diagnosis and discuss available acute and preventive treatments with the patient and family

Abdominal migraine is an important, common, and under-recognised cause of recurrent abdominal pain in children. It may be associated with, or followed by, other forms of migraine, and it predicts adult migraine.1234A positive diagnosis of abdominal migraine allows appropriate management and avoids unnecessary investigations and incorrect treatments.35 Although the evidence base is limited, acute and preventive treatments are available. This article highlights the diagnosis and management of abdominal migraine for non-specialists.

Sources and selection criteria

We performed a Medline search and search of Cochrane Collaboration and Clinical Evidence databases, using the terms “abdominal migraine,” “episodic (periodic) syndromes,” “childhood migraine,” “recurrent abdominal pain,” “functional abdominal pain.” We gathered evidence on the treatment of childhood migraine and childhood pain from the Cochrane Collaborations, particularly with regard to safety of acute treatment of migraine in children. Guidelines of the Rome Foundation, International Headache Society and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition informed discussion of definitions and management. These sources were supplemented by our personal archive of references, cited references from these, and discussions with other experts.

What is abdominal migraine?

Abdominal migraine is a functional disorder in the broad sense (a disorder without recognised structural or biochemical diagnostic abnormality6). It is an …

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