Abdominal migraine in adults: symptoms, diagnosis and treatment

Abdominal migraine is a migraine variant in which the main symptom is abdominal pain rather than headache. The Migraine Trust describes it as a common migraine condition that affects 4 in 100 children as well as some adults. It is described as idiopathic, meaning it is not understood why people get it, and it has possible associations with other conditions such as cyclical vomiting, migraine limb pain, benign paroxysmal vertigo, infantile colic, Raynaud’s disease and hypermobility syndrome.

The 2023 Cureus narrative review says abdominal migraine is a frequently overlooked cause of recurring abdominal pain, first identified in children, and that its occurrence in adults is often overlooked because of limited literature. It notes that the pathophysiology is thought to involve the gut-brain axis, blood vessel regulation, central nervous system changes, gut motility and genetic factors, overlapping with migraine and cyclic vomiting syndrome.

The Migraine Trust lists the pattern as regular attacks of moderate to severe stomach pain that last from 2 to 72 hours, feeling sick and vomiting during the attacks, no headache during the attacks and feeling normal between attacks. The Cureus review gives the typical pain location as central, around the navel or poorly localised, with a dull or just sore quality, and associated features such as loss of appetite, nausea, vomiting and pallor.

The review notes that when headache is present during the attacks, migraine without aura should be considered instead. It also says diagnosis is difficult in adults when migraine presents only with gastrointestinal symptoms, which leads to delays and frustration, and that a correct clinical diagnosis can spare patients unnecessary treatments and investigations.

There is no blood test or scan that diagnoses abdominal migraine. The Migraine Trust says the doctor needs to take the medical history and physically examine the patient to rule out or diagnose other diseases, which in adults means looking for causes such as gastrointestinal, gynaecological and urological disease. Tests are chosen according to symptoms.

The review compares two sets of criteria. The International Classification of Headache Disorders (ICHD-3) requires at least five attacks of 2 to 72 hours with midline, periumbilical or poorly localised pain of moderate to severe intensity, with at least two of anorexia, nausea, vomiting and pallor, and complete freedom from symptoms between attacks. The Rome IV criteria require at least two episodes of pain lasting one hour or more. The review recommends future research to identify diagnostic criteria specifically for adults.

The Migraine Trust says treatment is often similar to that for other types of migraine and usually includes acute treatments, such as simple painkillers, and preventive treatments to reduce how often the attacks occur and how severe they are. It also says it can be helpful to review triggers such as bright light, poor sleep, travel or hunger, and that stress and difficult emotions can be triggers.

The NHS describes migraine treatment in general: painkillers such as ibuprofen and paracetamol, triptans and gepants, and medicines that stop you feeling sick; preventive options include beta blockers, antidepressants and epilepsy medicines, acupuncture, relaxation and CBT, and vitamin B2, with lifestyle measures such as regular meals and less caffeine. The NHS warns that taking painkillers for more than 2 days a week can cause more headaches. Which of these suits abdominal migraine is a decision for your doctor, because the evidence in adults comes from case reports.

The Cureus review reports case-report experience with medicines such as pizotifen, amitriptyline, triptans and topiramate, and says acute treatment involves rest and simple analgesics. It acknowledges the scarcity of adult literature and recommends controlled trials to establish treatment guidelines.

See a GP if you have repeated attacks of unexplained abdominal pain, particularly if you also have weight loss, blood in your poo or vomit, persistent vomiting, fever or pain that wakes you at night, because these point to other causes that need to be excluded first. Do not assume attacks are abdominal migraine without having seen a doctor.

The NHS migraine page says to call 999 for a sudden extremely painful headache, problems speaking, vision loss, drowsiness or confusion, a seizure, a very high temperature with symptoms of meningitis, or weakness on one side of the body. Severe, constant or worsening abdominal pain, or pain with a rigid tummy or fainting, needs emergency assessment.

The Migraine Trust says children usually stop getting abdominal migraine by the time they grow up but often develop migraine headache later in life. The review adds that a minority of adults have both migraine headaches and recurrent abdominal pain, and that the prevalence and characteristics in adults have not been extensively studied. Keeping a diary of attacks, triggers and treatments helps your doctor and is the practical step most likely to speed diagnosis.