When Is It More Than a Stomach Virus? Understanding Abdominal Migraine in Children

Abdominal migraine is a functional gastrointestinal condition seen most often in children. During an episode, children can look quite ill — pale, tired, nauseated, and in significant pain — which is why families often assume it’s a stomach virus.

However, research shows that abdominal migraine episodes follow a distinct pattern that helps separate them from infections

Key clues it may be more than a virus

A stomach virus usually:

• improves over a few days
• spreads to household members or classmates
• causes fever or diarrhea
• happens once, then resolves

>>Related: When norovirus spikes, here's what parents need to know

Abdominal migraine is more likely when:

• episodes repeat over weeks or months: usually, symptoms of at least 2 episodes in 6 months, or 5 episodes in any given time period
• pain often starts early in the morning
• pain is typically around the belly button or midline
• your child looks sick during the episode but is completely well between episodes
• no one else around them gets sick
• testing for infection keeps coming back negative

One of the most important clues is that children with abdominal migraine return to their normal energy level, appetite, and activities in between their episodes of severe abdominal pain.

 

Parents often ask whether repeated vomiting means their child just keeps catching viruses. In some cases, another migraine-related condition called cyclic vomiting syndrome (CVS) could be at play.

The difference comes down to the main symptom:

• Abdominal migraine: pain is the main feature; vomiting may or may not happen
• Cyclic vomiting syndrome: vomiting is the primary and most severe symptom

Both conditions can look dramatic and “viral,” but neither is caused by an infection or spread from child to child. 
 

Common triggers parents should be aware of

Abdominal migraine does not happen randomly. Episodes are often triggered by predictable factors, including:

• stress—both negative (like school pressure) and positive (like a huge event)
• poor or irregular sleep
• dehydration
• missed meals or going a long time without eating
• exercise or physical overexertion
• flashing lights or overstimulation

Some children may also be sensitive to certain foods or additives, such as aged cheeses, processed meats, food coloring, or monosodium glutamate (MSG). Not every child has the same triggers, so looking out for patterns is more helpful than eliminating long lists of foods.

How abdominal migraine is diagnosed

There is no single test for abdominal migraine. Diagnosis is based on:

• the pattern of symptoms
• how episodes start and stop
• how your child feels between episodes
• ruling out other conditions when appropriate

Testing may be done to exclude problems such as inflammatory bowel disease (IBD), ulcers, or other causes of abdominal pain — especially if there are warning signs like weight loss, persistent fever, blood in the stool, or pain that steadily worsens.

Clinical research shows that recognizing the recurrent, typical pattern of abdominal migraine helps avoid unnecessary testing and delays in diagnosis 
 

Consider talking with your child’s pediatrician or a pediatric gastroenterologist if:

• abdominal pain episodes keep returning
• your child misses school or activities due to symptoms
• episodes follow a similar pattern each time
• symptoms are severe or disruptive despite “normal” tests
• you notice clear triggers such as sleep disruption or stress

Seek urgent or emergency medical care if your child has:

• signs of dehydration
• severe or worsening abdominal pain
• blood in vomit or stool
• persistent fever
• new neurological symptoms or confusion

The good news about abdominal migraine

The long-term outlook for abdominal migraine is generally reassuring. Many children improve over time, and some eventually outgrow abdominal symptoms altogether. Others may go on to develop migraine headaches later in adolescence, which can often be managed effectively with appropriate care

Trust the pattern — and your parental instincts

If your child’s “stomach bugs” don’t behave like typical infections, it’s worth asking whether something else could be going on. 

A pediatric gastroenterologist can help determine whether abdominal migraine or another condition may be contributing — and guide your family toward the right next steps.