Abdominal Migraine vs Cyclic Vomiting Syndrome
Though they’re often mistaken for the same condition, there are differences between Abdominal Migraine and Cyclic Vomiting Syndrome.
Cyclic vomiting syndrome refers to waves of intense nausea, vomiting, and other stomach problems for no obvious reason. Cyclic vomiting syndrome may also last up to 10 days, compared to 3 days for Abdominal Migraine. While you may experience nausea and vomiting as a symptom of Abdominal Migraine, Abdominal Migraine is often experienced purely as abdominal pain.
In both cases, sufferers can experience loss of appetite and pale skin during an attack.
Sensitised Brainstem
In those individuals that may be suffering from Abdominal Migraine and have no underlying pathology or disorder that can be recognised, another known cause may be due to a sensitised brainstem.
A sensitised brainstem will perceive non-threatening stimuli (such as eating certain foods) and create pain to be felt where the sensory information was originally detected. This hyper-excitability of the pain sensation is due to the heightened arousal and sensitive brainstem. A sensitive brainstem will relay the sensory information to the brain but will heighten the sensation so that the brain perceives the information as painful.
How is Abdominal Migraine Diagnosed?
Diagnosing abdominal migraine involves a structured clinical approach, guided by the International Classification of Headache Disorders (ICHD-3). The criteria require at least five attacks of abdominal pain that are moderate to severe in intensity, with specific features: the pain tends to be centred in the midline, around the belly button (periumbilical), or poorly localised. It often has a dull or “just sore” quality.
To support a diagnosis, at least two associated symptoms must occur alongside the pain—these may include: nausea, vomiting, pallor (a pale appearance), or a noticeable loss of appetite (anorexia). Each episode typically lasts between 2 and 72 hours and is followed by complete symptom resolution until the next attack. Crucially, other gastrointestinal or systemic disorders must be ruled out.
Given the overlap with conditions like irritable bowel syndrome and cyclic vomiting syndrome, clinicians rely heavily on detailed patient histories, symptom patterns, and the exclusion of alternative causes. A headache diary can be an invaluable tool for tracking episodes and identifying potential triggers such as stress, poor sleep, or dietary factors.
At Sydney Headache and Migraine Clinic™, we go beyond surface-level symptoms. Our assessments consider potential central nervous system involvement—particularly sensitisation of the brainstem and spinal neurons, which may contribute to abdominal pain patterns seen in these cases. This neurophysiological lens helps us build a more precise clinical picture and guide targeted management strategies.
Abdominal Migraine in Adults
While abdominal migraine is most commonly diagnosed in children, adults can also experience this condition. Abdominal migraine in adults may be underdiagnosed due to its similarity to other gastrointestinal disorders like irritable bowel syndrome or Crohn’s disease. Recurrent episodes of abdominal pain in adults, particularly when accompanied by nausea, vomiting, or a pale appearance, may indicate an abdominal migraine.
Triggers such as stress, poor sleep, certain foods including monosodium glutamate (MSG), and prolonged fasting can increase the risk of developing abdominal migraine attacks. Adults may also report headache pain or other migraine symptoms during or following an abdominal migraine episode, reinforcing the link between this condition and broader migraine headaches.
A thorough assessment, including a review of family history and lifestyle factors, is key to diagnosing abdominal migraine in adults. Tracking symptoms in a headache diary can also help identify common triggers and support abdominal migraine management aimed at relieving symptoms and preventing future attacks.
