Abdominal Migraine Treatment Guidelines

Acute Treatment Options

The American College of Physicians recommends NSAIDs (aspirin, ibuprofen, naproxen sodium, diclofenac potassium) as first-line therapy for abdominal migraines, with treatment beginning as early as possible during an attack for maximum efficacy 1, 3
The American Academy of Neurology suggests that triptans (sumatriptan, rizatriptan, naratriptan, zolmitriptan) should be added to NSAIDs or acetaminophen if first-line treatments are ineffective, with non-oral triptans and antiemetics considered for patients with severe nausea or vomiting 1, 2, 3
Prokinetic antiemetics such as domperidone and metoclopramide are useful adjuncts for managing nausea and vomiting during attacks, as recommended by the American Gastroenterological Association 2

Prophylactic treatment should be considered when abdominal migraines occur frequently (≥2 days per month) or significantly impair quality of life despite optimized acute therapy, according to the American Academy of Neurology 2

The American College of Physicians advises avoiding opioids and butalbital-containing medications for abdominal migraines due to questionable efficacy, adverse effects, and risk of dependency 1, 2, 3
The American Academy of Neurology recommends being aware of medication overuse headache risk when acute treatments are used too frequently (≥15 days/month with NSAIDs or ≥10 days/month with triptans) 1, 3

The American Heart Association suggests counseling patients on important lifestyle modifications that may help reduce frequency and severity of abdominal migraine attacks, including maintaining adequate hydration, sufficient and consistent sleep, regular physical activity, stress management techniques, and weight loss if overweight or obese 1, 2, 3