A prospective observational study on the underdiagnosis of pediatric abdominal migraine

Abdominal migraine is often considered a rare cause of chronic abdominal pain in children, but its true prevalence in specialized care and the specificity of current diagnostic criteria are not well understood. We aimed to determine the frequency of abdominal migraine in a tertiary pediatric gastroenterology clinic and to evaluate the diagnostic challenges posed by symptom overlap.

In this prospective study, 160 children (ages 5-18 years) with chronic recurrent abdominal pain were evaluated and followed for six months. Following comprehensive clinical, laboratory, and endoscopic assessments, patients were assigned to one of three final diagnostic groups: abdominal migraine, other disorders of gut-brain interaction (DGBI), or organic disease.

The cohort of 160 patients was predominantly female (62.5%; mean age 11.6 ± 4.0 years). Abdominal migraine was the final diagnosis in 8.1% (n=13) of patients. Compared to the other groups, abdominal migraine was characterized by significantly longer pain duration (p = 0.001) and a higher prevalence of stress as a trigger. A key finding was the high rate of diagnostic overlap: 14.5% of patients with other DGBIs and 26.8% of patients with organic disease also fulfilled the Rome IV criteria for abdominal migraine. In these cases, a comprehensive evaluation identified a more appropriate primary diagnosis.

Abdominal migraine is a key diagnosis for unexplained pediatric abdominal pain, but its criteria lack specificity due to symptom overlap. A definitive diagnosis, therefore, requires a thorough clinical evaluation that extends beyond a symptom-based checklist to prevent misdiagnosis.