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    Rome IV Diagnostic Criteria for Child Abdominal Migraine

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

    INSTRUCTIONS

    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.

    When to Use
    Pearls/Pitfalls
    Why Use

    Children or adolescents presenting with symptoms suggestive of abdominal migraines for at least 6 months. The diagnosis of abdominal migraine should be made by clinical history, positive symptom criteria, physical examination and minimal testing. Additional diagnostic testing should be done only if clinically indicated.

    • Abdominal migraine (AM) is a positive diagnosis and not a diagnosis of exclusion. It should be evaluated and treated in the context of the biopsychosocial model.

    • AM presents as paroxysmal and stereotypical events which are clearly separated by weeks or months of usual health. Most patients are asymptomatic with no abdominal pain between episodes, while some may still experience mild, chronic baseline gastrointestinal symptoms. The latter may be due to another disorder of the gut-brain interaction like Irritable Bowel Syndrome

    • AM and migraine headaches often coexist. Both present as paroxysmal, stereotypical episodes that self-resolve. As with migraine headaches, nonspecific prodromal symptoms can occur, such as behavior and mood changes, photophobia or vasomotor symptoms. Both share triggers that can precipitate an episode, such as psychological stress, physical exhaustion, poor sleep, prolonged fasting, dietary triggers and have similar associated symptoms (nausea, vomiting, anorexia) and relieving factors (rest, sleep) during an episode. 

    • There is also considerable overlap with cyclic vomiting syndrome (CVS, see Calculator on Child Cyclic Vomiting Syndrome). 

    • If both vomiting and abdominal pain are present during an episode, the more severe symptom should determine the diagnosis of AM (pain) or CVS (vomiting).

    • Patients are typically quite ill during episodes and unable to participate in normal activities.   

    • Abdominal pain during an episode can be midline, periumbilical, or diffuse.

    • Patients with AM respond to migraine headache treatment consisting of abortive treatment for acute episodes and prophylactic treatment in case of frequent recurrence or severe episodes. 

    • Given frequent comorbidities and significant role of social and environmental stressors in the frequency and severity of AM episodes, these should be addressed. 

    • AM rarely persists into adulthood. While AM completely resolves in some patients, it is generally considered a precursor of headache migraines in adulthood.

    • Used to establish the diagnosis of abdominal migraine in patients who present with episodic abdominal pain.

    • Making a diagnosis will help avoid unnecessary testing, allows for appropriate education and for targeted treatment early on.

    Must have the following:

    ≥2 occurrences at least 6 months prior

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH