MDCalc

Rome IV Diagnostic Criteria for Child Abdominal Migraine

Official Rome IV criteria for the diagnosis of child abdominal migraine.

Use in patients with symptoms suggestive of abdominal migraine such as intense, paroxysmal, stereotypical episodes of abdominal pain severe enough to interfere with activities, separated by weeks or months of usual health.

Patients with any of the following alarm features must be evaluated clinically for other diagnoses even though abdominal migraines may be present:

  • Persistent right upper or right lower quadrant pain.

  • Pain radiating to the back.

  • Dysphagia.

  • Odynophagia.

  • Persistent or bilious vomiting.

  • Gastrointestinal blood loss.

  • Chronic and unexplained diarrhea.

  • Nocturnal pain or diarrhea.

  • Arthritis.

  • Perirectal disease.

  • Involuntary weight loss.

  • Deceleration of linear growth.

  • Delayed puberty.

  • Recurrent or unexplained fever.

  • Dysuria or Hematuria.

  • Family history of inflammatory bowel disease, celiac disease, or peptic ulcer disease.

Must have the following:

≥2 occurrences at least 6 months prior

Anorexia, nausea, vomiting, headache, photophobia, or pallor

Diagnostic Result

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Advice

If diagnosis not met (negative):

Current symptoms are unlikely to be caused by abdominal migraine. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above. 

If meets diagnosis (positive):

Likely diagnosis of abdominal migraine. Consider initiating treatment.

Management

Management of abdominal migraine is similar to the management of migraine headaches. Treatment is determined by the frequency, severity, and impact of the symptoms on the daily life of the patient and family. It consists of nonpharmacologic and pharmacologic interventions. A multidisciplinary treatment approach should be considered.  

Management includes: 

  • Education about disorders of the gut-brain interaction and the biopsychosocial model of disease. 

  • Reassurance.

  • Identifying patient-specific triggers of abdominal migraine episodes so these can be avoided. 

  • Psychological treatments (e.g. CBT, learning of coping strategies).

  • Abortive treatment for acute episodes (e.g. Intranasal sumatriptan, IV valproic acid, IV dihydroergotamine).

  • Prophylactic treatments in case of frequent and/or severe episodes (e.g. Amitriptyline, propranolol, cyproheptadine, pizotifen).

  • Other pharmacologic treatments aimed at relieving symptoms: antiemetics (e.g. Ondansetron) and/or analgesics (e.g. Tylenol, ibuprofen, IV ketorolac).

No pediatric clinical guidelines for evaluation or treatment of child abdominal migraine are available. 

The choice of therapy is outside the scope of this calculator and will depend on clinical context.

Critical Actions

This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.

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