Abdominal Migraine in Children and Adolescents at a Single Tertiary Pediatric Gastroenterology Center: A Twelve-yea Experience on Clinical and Therapeutic Findings

Background: Abdominal migraine (AM) may be underdiagnosed and represent a substantial problem for children and their families. Aim: Evaluate the clinical characteristics and the response to prophylactic therapy with Cyproheptadine in children and adolescents with AM. Methods: Observational, retrospective cohort single-center study in consecutive cases of children and adolescents, referred for initial evaluation of chronic abdominal pain at the Pediatric Gastroenterology Outpatient Clinic. Inclusion criteria: Age between 4 and 17 years; Diagnosis of AM defined from structured questionnaires according to three consensus criteria (Rome III, Rome IV criteria, and The International Classification of Headache Disorders). Exclusion criteria: mild symptoms lasting less than one hour and not interfering with daily activities, burning pain, symptoms suggestive of organic disease, or persistence of symptoms between attacks, chronic organic diseases that compromise growth and development include inflammatory bowel disease, celiac disease, and cystic fibrosis. The diagnosis was reviewed during the minimum 6-month follow-up. Results: One hundred forty-seven consecutive patients were diagnosed with AM during the twelve-year study and experienced periodic attacks of abdominal pain, a high proportion in the midline, and intervals of complete absence of symptoms. The most frequently associated symptoms with pain attacks were headache and vomiting. The medians of ages at first visit (8.8 years), age at onset of symptoms (6.5 years), and duration of symptoms (18 months). Positive history of migraine in the mother and family members were 27% and 25%, respectively. Cyproheptadine was the first choice in 81 patients, with appropriate treatment performed in 65 patients and complete resolution in 80%. Conclusions: The current study confirms that a comprehensive history, physical examination, and thoughtful diagnostic criteria are robust for well-defining AM. The findings also reaffirm that prophylactic therapy with Cyproheptadine is highly effective and safe for managing AM in children and adolescents, reassuring the medical community and families of affected children.