Clinical features of abdominal migraine: a systematic review and summary of data from 662 patients

Abdominal migraine (AM) is an episodic syndrome characterized by recurrent, self-limiting episodes of abdominal pain with autonomic features, now recognized to affect both children and adults according to ICHD-3 criteria. Its diagnosis is clinical and requires the exclusion of organic gastrointestinal or renal diseases, yet no standardized treatment exists, leading to therapeutic approaches often adapted from migraine management. Challenges in diagnosis, due to difficulties in symptom description by children and cognitive biases in adults, frequently result in underdiagnosis, repeated consultations, and diminished quality of life. This study aims to analyze the clinical characteristics, diagnostic and therapeutic approaches, and outcomes of AM in pediatric and adult patients based on a large case series.

A systematic literature review was conducted per PRISMA guidelines. Major databases were searched from inception to June 2025 for case reports and clinical studies on AM. Data on demographics, clinical presentation, treatment, and outcomes were extracted and analyzed.

We included 662 patients (629 children, 33 adults) from 63 studies. The female-to-male ratio was 1.6:1. The median age at onset was 4.2 years in children and 31.0 years in adults, with diagnostic delays of 3.1 and 4.0 years, respectively. Among cases with specific data, periumbilical pain was reported in 43.3% (of 223), while nausea (66.1%), vomiting (53.6%), and headache (47.1%) were common in a cohort of 448 cases. Photophobia, pallor, and anorexia were also frequently observed. Triptans showed the highest acute efficacy (98.04%, 50/51), versus 62.5% (5/8) for NSAIDs. Prophylactics were highly effective: anticonvulsants (95.0%, 19/20), beta-blockers (100%, 12/12), and antihistamines (92.8%, 64/69). These exceptional rates likely reflect reporting bias and require prospective validation.

AM presents with significant clinical heterogeneity but shares core features with migraine disorders. Early diagnosis and management, potentially incorporating agents used in migraine (such as triptans and prophylactics) based on preliminary evidence, may improve outcomes, though this requires confirmation in controlled studies. Increased awareness of non-gastrointestinal symptoms and migraine history is essential for accurate diagnosis.