1. Background information

a. Definition

A functional episodic pain syndrome, typically in children, characterised by recurrent episodes of central abdominal pain with features similar to migraine and complete resolution between attacks.

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b. Clinical classification

Falls under:

• Childhood periodic syndromes (migraine equivalents), including:
  • Abdominal migraine
  • Cyclical vomiting syndrome
  • Benign paroxysmal vertigo

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c. Etiopathophysiology

• Not fully understood (AKT: “functional disorder”)
• Likely shared mechanisms with migraine:
  • Gut–brain axis dysfunction
  • Altered serotonin signalling
  • Visceral hypersensitivity

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Risk factors / associations

• Personal or family history of migraine
• Often progresses to typical migraine in adolescence

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2. Assessment

a. Clinical presentation (AKT classic)

Core features (diagnostic pattern)

• Recurrent episodes of central (periumbilical) abdominal pain
• Lasting 1–72 hours
• Complete normality between episodes

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Associated features (≥2 typical)

• Nausea/vomiting
• Pallor
• Anorexia
• Headache/photophobia (sometimes)

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AKT diagnostic clues

• Well child between episodes
• Normal growth and development
• Family history of migraine

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Red flags (→ think alternative diagnosis)

• Weight loss
• GI bleeding
• Persistent diarrhoea
• Localised (non-central) pain
• Abnormal examination

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b. Relevant investigations

NICE CKS approach: clinical diagnosis

• No routine investigations if typical features and no red flags

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If atypical / red flags:

• Urinalysis
• Bloods (FBC, CRP, coeliac screen)
• Imaging only if indicated

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AKT pearl

• Over-investigation is common → diagnosis is clinical

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3. Management (UK NICE CKS-based)

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a. Emergency care

• Not typically required

If severe acute episode:

• Exclude surgical causes (appendicitis, obstruction)
• Supportive care:
  • Analgesia
  • Oral/IV fluids if needed

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b. Referral

Refer if:

• Diagnostic uncertainty
• Red flag symptoms
• Poor response to treatment
• Significant impact on daily functioning

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c. Primary care management

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1. Education & reassurance (first-line)

• Explain benign, self-limiting nature
• Often resolves with age
• Link to migraine spectrum

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2. Trigger management

• Identify triggers:
  • Stress
  • Sleep disturbance
  • Certain foods

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3. Acute treatment (limited evidence)

• Simple analgesia (paracetamol/ibuprofen)
• Antiemetics if needed

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4. Preventative treatment (specialist-led if frequent/severe)

Options (AKT awareness level):

• Pizotifen (commonly used in UK children)
• Propranolol
• Amitriptyline

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5. Follow-up

• Monitor frequency and severity
• Assess school attendance / QoL

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AKT Exam Pearls

• Child with recurrent central abdominal pain + well between episodes = abdominal migraine
• Strong family history of migraine
• No investigations needed if classic presentation
• Always exclude red flags
• Often progresses to typical migraine later