Abdominal migraine: recognising episodes and getting help

It is seen mainly in children, although adults can be affected. Headache may be absent during the abdominal episode, so diagnosis depends on the recurring pattern and on excluding other explanations for the pain.

The pain is usually felt around the middle of the abdomen and can be dull or severe enough to interrupt normal activity. Episodes have a similar pattern each time, with a return to usual health between them. A personal or family history of migraine can support the diagnosis but is not required.

There is no single test that confirms abdominal migraine. A clinician reviews the timing, associated symptoms, medicines, diet and bowel pattern, then examines the abdomen. Tests may be used when the story or examination suggests infection, inflammation, urinary disease or another cause.

During an episode, resting in a quiet, dim room may ease discomfort. Offer small sips of fluid if nausea is present and use only pain or anti-nausea medicines recommended for that person. A symptom diary can record sleep, missed meals, stress, travel, foods, pain location and associated vomiting.

Regular meals, dependable sleep and good hydration may reduce avoidable triggers. If episodes are frequent or disruptive, a clinician may discuss migraine-directed treatment for attacks or prevention. The choice depends on age, other conditions, current medicines and the pattern of symptoms.

Get urgent help for sudden severe pain, a hard or swollen abdomen, green vomit, blood in vomit or stool, fainting, confusion, breathing difficulty or marked difficulty waking. Pain that settles in the lower right abdomen, or severe pain after an injury, also needs urgent evaluation.

Arrange medical review for a first episode, unexplained weight loss, persistent fever, pain that wakes the person repeatedly, ongoing diarrhoea, pain during urination or symptoms that are changing rather than repeating predictably. Repeated vomiting deserves prompt advice because dehydration can develop.

Bring the episode diary and ask which features support abdominal migraine, what other causes need checking, which medicine should be taken at the first sign, and how to handle vomiting. Clarify when the care plan should be reviewed if the pattern changes.