Abdominal migraine

Abdominal migraine is an unusual medical condition that sits at the intersection of neurology and gastroenterology. It causes recurrent belly pain without an obvious source, leaving many parents and patients searching for answers [2]. Recognized by doctors for over a century yet still frequently missed in diagnosis, it mainly affects children, though adults can experience it too [1].

What is abdominal migraine?

Abdominal migraine is a condition characterized by recurring episodes of moderate to severe abdominal pain, typically centered around the belly button [5]. Unlike typical stomach aches, these attacks follow a pattern similar to classic migraines and often occur in people with a family history of migraines [3].

The International Classification of Headache Disorders (ICHD-3), updated in 2018, formally classifies it as a childhood periodic syndrome that may occur before or alongside regular migraines [4]. The condition shares the same underlying mechanisms as head migraines but manifests primarily in the gut [3].

Historical background

The story of abdominal migraine goes back to the early 1900s. Physicians like Liveing and Buchanan documented cases of periodic abdominal pain in children that showed patterns matching migraines [5]. By the 1920s, doctors began calling it the “abdominal equivalent of migraine,” noting its tendency to run in families and often resolve around puberty [11].

Who gets abdominal migraine?

Children

• Affects 2-4% of children overall [2]
• Slightly more common in girls [5]
• Peak onset around age 7 [6]
• Can start as early as age 3 [2]
• A 2010 review in the journal Headache found that 15% of children with recurrent abdominal pain met the criteria for this condition [2]

Adults

• Much rarer, affecting 1-2% of people with migraines [1]
• Usually have a history of abdominal migraine or migraines in childhood [10]
• Peak occurrence between ages 20-40 [1]

Family connection

Family history plays a major role. Up to 90% of children with abdominal migraine have a parent or sibling who experiences migraines [5]. This strong genetic link helps doctors identify the condition [3].

Geographic patterns

Rates vary by location. A Turkish study found higher rates in urban areas, possibly connected to stress levels or dietary factors [2].

What causes abdominal migraine?

The brain-gut connection

Abdominal migraine stems from the same mechanisms as classic migraines, including [3]:

• Cortical spreading depression: a wave of electrical disturbance that travels across the brain’s surface [14]
• Trigeminovascular activation: Activation of nerve pathways that can cause pain [3]
• Altered serotonin signaling: Low serotonin levels during attacks may cause blood vessels in the abdomen to dilate and create pain [14]

A 2015 study in Cephalalgia used functional MRI scans to show increased activity in brain regions like the insula and hypothalamus during episodes, confirming a central nervous system origin [3].

Genetic factors

Ion channel problems in genes like CACNA1A or ATP1A2, which are seen in some types of familial migraines, may also play a role in abdominal migraine [12].

The gut-brain axis

The connection between the gut and brain is central to understanding this condition [14]. Factors that amplify pain signals include:

• Imbalances in gut bacteria [14]
• Increased intestinal permeability
• Heightened sensitivity of gut nerves [3]

Common triggers

Several factors can set off an episode [2]:

Dietary triggers:

• Aged cheeses
• Processed meats
• Foods containing tyramine
• MSG (monosodium glutamate)
• Nitrates
• Aspartame
• Chocolate
• Caffeine withdrawal

Lifestyle triggers:

• Sleep deprivation or irregular sleep patterns [6]
• Emotional stress [5]
• Skipping meals [2]

Other triggers in adults:

• Hormonal changes [1]
• Alcohol consumption [10]

These triggers activate cascades involving calcitonin gene-related peptide (CGRP), a key molecule in migraine development [3].

Symptoms

During an attack

Pain characteristics:

• Located around the belly button (periumbilical) [4]
• Described as cramping or stabbing [2]
• Moderate to severe intensity [5]
• Interferes with daily activities [4]
• Does not get worse with movement (unlike appendicitis or peritonitis) [2]
• Lasts anywhere from 2 to 72 hours [6]

Associated symptoms

At least two of these symptoms accompany the pain [4]:

• Loss of appetite (anorexia)
• Nausea
• Vomiting (occurs in about half of cases) [2]
• Pale skin (pallor) – seen in 70-80% of cases [5]
• Sensitivity to light (photophobia) [3]
• Sensitivity to sound (phonophobia) [3]
• Sometimes mild headache [2]

Before an attack (Prodrome)

A 2012 study in Pediatric Neurology documented warning signs that can appear hours before pain starts [13]:

• Irritability
• Yawning
• Changes in mood or behavior

After an attack (Postdrome)

• Fatigue lasting up to a day [2]
• Gradual return to normal

People feel completely normal between episodes, with pain-free intervals lasting weeks to months [4].

How is it diagnosed?

Diagnosis relies on medical history and ruling out other conditions [2]. There is no specific blood test or imaging study that confirms abdominal migraine [4].

Initial evaluation includes:

• Detailed history of symptoms and family medical history [5]
• Physical examination (should be normal between episodes) [2]
• Pattern recognition (recurring attacks with pain-free intervals) [4]

Tests to rule out other conditions:

• Ultrasound or CT scan if red flags are present [2]
• Blood tests checking electrolytes, liver function, and celiac markers [5]
• EEG during attacks (sometimes shows brain wave slowing) [6]

Conditions to rule out

Doctors must exclude other serious causes of abdominal pain [4]:

Gastrointestinal issues:

• Appendicitis
• Intussusception
• Inflammatory bowel disease
• Celiac disease

Metabolic disorders:

• Porphyria

Urological problems:

• Kidney stones

Gynecological issues (in teens):

• Ovarian cysts
• Endometriosis

Neurological conditions (rare):

• Epilepsy
• Brain tumors

Red flags requiring immediate evaluation:

• Fever
• Unintended weight loss
• Bloody stools
• Pain that changes pattern or worsens
• Abnormal physical examination findings

In uncertain cases, doctors may try migraine prevention medication. If it works and reduces attacks, this supports the diagnosis of abdominal migraine [2].

A 2018 meta-analysis in the Journal of Pediatric Gastroenterology and Nutrition reviewed 15 studies and found that over-reliance on imaging leads to unnecessary radiation exposure [2]. In most cases, a thorough medical history is sufficient for diagnosis [4].

Treatment

Management has two main approaches: treating acute attacks and preventing future episodes [5].

Treating acute attacks

Non-medication approaches:

• Rest in a quiet, dark room [2]
• Oral rehydration with water or electrolyte solutions [5]
• Avoiding food until nausea passes [2]

Medications:

• Pain relief: Ibuprofen (10 mg/kg) or acetaminophen [5]
• Anti-nausea: Ondansetron to control vomiting [2]
• Severe cases: Intravenous fluids or sumatriptan nasal spray (for children over 6) [5]

A randomized trial in Pediatrics (2009) found sumatriptan effective in 60% of episodes compared to 30% with placebo [2].

Preventive treatment

Prevention is recommended for children having attacks more than twice per month [5].

Beta-blockers:

• Propranolol (1-2 mg/kg/day) [5]
• Success rate of 70-80% according to a 2014 study in European Journal of Pediatrics [5]

Anticonvulsants:

• Topiramate: Reduced attack frequency by 50% in studies [2]
• Valproate: Alternative option [5]

Tricyclic antidepressants:

• Amitriptyline: Particularly helpful when anxiety is present [2]

Newer treatments for adults:

• CGRP antagonists like erenumab: A 2020 case series in Neurology showed good response in 20 adults [10]

Non-medication approaches

Cognitive behavioral therapy (CBT):

• Teaches coping strategies
• A 2017 trial in Journal of Pediatric Psychology found a 65% reduction in attacks [2]

Dietary modifications:

• Avoid identified trigger foods [5]
• Maintain regular meal schedules [2]
• Consider elimination of MSG, nitrates, and aspartame [6]

Lifestyle changes:

• Keep consistent sleep schedules [2]
• Practice stress management techniques [5]
• Stay well-hydrated [2]

Other therapies (limited evidence but may help):

• Biofeedback [13]
• Acupuncture [13]

What to expect: prognosis and long-term outlook

In children

The outlook is generally positive [5]:

• 60-70% of children outgrow the condition by age 14 [2]
• However, 30-50% develop classic head migraines as they get older [12]
• Regular follow-up helps catch the transition to other migraine types [5]

The condition itself causes minimal complications, but recurring pain can affect [2]:

• School attendance
• Participation in activities
• Overall quality of life
• Family stress levels

In adults

• Less common than in children [1]
• May persist from childhood or develop later [10]
• Often triggered by hormonal changes or stress [1]
• Responds well to newer CGRP medications [10]

Practical tips for managing abdominal migraine

• Keep a symptom diary: Track when attacks occur, what happened beforehand, foods eaten, sleep patterns, and stress levels [2]
• Maintain routines: Regular sleep schedules and meal times help prevent attacks [5]
• Identify triggers: Use the diary to spot patterns and avoid specific triggers [2]
• Build a care team: Work with pediatric neurologists or gastroenterologists who understand the condition [4]
• Educate teachers and caregivers: Make sure people around your child understand the condition [5]

When to seek medical care

• Abdominal pain that recurs without clear cause [4]
• Pain with migraine-like features (pallor, nausea, vomiting) [2]
• Pattern changes in existing abdominal migraine [4]

When to seek urgent care

• Pain that suddenly changes pattern or becomes much worse [4]
• Presence of fever, weight loss, or bloody stools [2]
• Severe dehydration from vomiting [5]
• Any concerning new symptoms [4]

Key Takeaways

Abdominal migraine is a real medical condition that:

• Mainly affects children but can occur in adults [1]
• Causes recurring episodes of severe belly pain lasting hours to days [6]
• Shares mechanisms with classic migraines but manifests differently [3]
• Runs strongly in families with migraine history [5]
• Usually resolves by adolescence, though some people transition to typical migraines [12]
• Requires ruling out other causes of abdominal pain for proper diagnosis [4]
• Responds well to treatment combining trigger avoidance, lifestyle changes, and medications when needed [5]
• Can disrupt daily life but is manageable with proper recognition and care [2]

References

1. Ibrahim, M., Elkins, I. and Herman, M. (2023) ‘Abdominal migraines: a rare adulthood manifestation of a typical childhood disease’, Cureus, 15(3), p. e36451. doi: 10.7759/cureus.36451.
2. Azmy, D.J. and Qualia, C.M. (2020) ‘Review of abdominal migraine in children’, Gastroenterology & Hepatology, 16(12), pp. 632–639. doi: 10.1097/01.mpg.0000154661.39488.ac.
3. LenglarT, L., Caula, C., Moulding, T., Lyles, A., Wohrer, D. and Titomanlio, L. (2021) ‘Brain to belly: abdominal variants of migraine and functional abdominal pain disorders associated with migraine’, Journal of Neurogastroenterology and Motility, 27(4), pp. 482-494. doi: 10.5056/jnm20290.
4. Angus-Leppan, H., Saatci, D., Sutcliffe, A. and Guiloff, R.J. (2018) ‘Abdominal migraine’, BMJ, 360, p. k179. doi: 10.1136/bmj.k179.
5. Scicchitano, B., Humphreys, G., Mitton, S.G. and Jaiganesh, T.T. (2014) ‘Abdominal migraine in childhood: a review’, Pediatric Health, Medicine and Therapeutics, 5, pp. 73–81. doi: 10.2147/PHMT.S25480.
6. Wang, S.-J. (2025) ‘Abdominal migraine’, MedLink Neurology. doi: 10.18725/MD-ABDOMINAL-MIGRAINE.
7. Morozova, O.G. (n.d.) ‘Migraine: modern concepts of classification, diagnosis, therapy and prevention’, Journal.
8. Pypa, L.V., Polishchuk, V.A. and Svistelnik, R.V. (2011) ‘Abdominal migraine in children: concepts of the disease and treatment options’, Health of the Child, 3, pp. 3-8.
9. Morozova, O.G. (2012) ‘Migraine: modern concepts of classification, diagnosis, therapy and prevention (part 1)’, Emergency Medicine, 4, pp. 12-18.
10. Tency, N.K., Roy, A., Krishnakumaran, N. and Thomas, A.M. (2023) ‘Unraveling abdominal migraine in adults: a comprehensive narrative review’, Cureus, 15(8), p. e43760. doi: 10.7759/cureus.43760.
11. Wikipedia contributors (2025) ‘Abdominal migraine’, Wikipedia, The Free Encyclopedia.
12. Gelfand, A. (2018) ‘Episodic syndromes of childhood associated with migraine’, Current Opinion in Neurology, 31, pp. 281-285.
13. Lagman-Bartolome, A.M. and Lay, C. (2015) ‘Pediatric migraine variants: a review of epidemiology, diagnosis, treatment, and outcome’, Current Neurology and Neuroscience Reports, 12, pp. 1-14.
14. Doulberis, M., Saleh, C. and Beyenburg, S. (2017) ‘Is there an association between migraine and gastrointestinal disorders?’, Journal of Clinical Neurology, 13(3), pp. 215-226. doi: 10.3988/jcn.2017.13.3.215.