Abdominal migraine (AM) is an episodic syndrome associated with migraine, predominantly affecting children but increasingly recognized in adults. Characterized by recurrent moderate-to-severe midline abdominal pain accompanied by vasomotor symptoms such as nausea, vomiting, pallor, and anorexia, AM remains underdiagnosed due to overlapping clinical features with other gastrointestinal disorders. The diagnosis relies on clinical criteria defined by the third edition of the International Classification of Headache Disorders (ICHD-3) and the Rome-IV criteria for functional gastrointestinal disorders. Although the exact pathophysiology is not fully elucidated, current theories suggest a complex interplay involving gut–brain axis dysfunction, visceral hyperalgesia, altered gastric motility, immune responses to dietary allergens, neurotransmitter imbalances, and genetic and psychosocial factors. Management focuses on symptomatic relief with analgesics and antiemetics, lifestyle modifications, and prophylactic pharmacological interventions, including antiepileptics, beta-blockers, and emerging therapies such as CGRP (calcitonin gene-related peptide) monoclonal antibodies. Non-pharmacological treatments like cognitive-behavioral therapy and stress management also play supportive roles. Early diagnosis and individualized treatment strategies are crucial for improving patient outcomes and quality of life. Further research is needed to deepen understanding of AM’s mechanisms and to optimize therapeutic approaches.