Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
182 Doctors are Online

Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do?

User rating for this question
Very Good
Answered by

Allergist and Immunologist
Practicing since : 1999
Answered : 584 Questions
Question
I have been have weird symptoms for the last four years. I get pain in the left side pelvic/hip area after meals. When the pain in that area disappears it moves to my head around the temple forehead region. Also there is mild irritating pain around the head. So I'm constantly in some sort of pain or the other and it has to do with food. When I have beverages like tea, coffee, juice or sometimes even plan water I get a tingling sensation instantaneously in the forehead temples region. This is the weirdest part. I have done colonoscoply, gastroscopy and for head MRI scan but they are all normal. What do you reckon it might be. It has been four years and it is destroying my life? Doctors are totally baffled
Posted Wed, 19 Dec 2012 in General Health
 
 
Answered by Dr. Sujoy Khan 3 hours later
Hello,
Thanks for writing to us.

The pelvic pain after meals with food do suggest an tingling feeling in the forehead after beverages may be related to sensitivity to salicylates, while some people get a similar feeling after wine in those with sulphite sensitivity. Such intolerances are difficult to prove as there are no blood tests available and scans are generally normal.
Medications for IBS are available and a period of 4-6 weeks is recommended at the start to see the difference.
I hope you have been to a neurologist and the possibility of atypical migraine has been considered or excluded.
Sodium chromoglycate tablets taken four times a day before meals does help with a lot of GI intolerances where the exact food trigger remains elusive.
I hope this helps and will be happy to answer any further queries that you may have.
Thanks.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 14 hours later
Hi

Thanks for your mail.

My motions are regular so hard to say whether it is constipation. But GP's here have diagnosed the pain as IBS, but they are baffled with the head pain and the movement of pain between pelvic and the head region. Prior to the onset of these symptoms in 2008, I suffered from chronic gas problems.

What are the medications for IBS, is the IBS and sensation/pain that I feel my head related? Will the Sodium Chromoglycate tablets relieve pain in the pelvic and head areas and will it counter the salicylates sensitivity that you think I might be having?

I have been to the neurologist and she has ruled out migraine, the type of head pain more resembles tension headache after food. I also get the pain in my head region and pelvic area after eating citrus fruits for some reason. The other day I had lemon I had a problem. Is this to do with salicylates. I also have problems with many other foods including raw garlic (gives me a headache), alcohol (including wine), sensitivity to mainly supplements etc

I have sleep issues, disturbed sleep with frequent urination at night time. I get up feeling tired in the morning. I have done all the tests in the world and all of them have been negative. No celiac disease and I think there is no lactose intolerance because I have been having milk since childhood. However I've stopped having dairy for the past six months including yogurt.

I will try the medicines you have suggested above.

I'm currently on probiotics and a very very restrictive diet, and I'm finding little relief but I'm not symptom free.

Are you able to connect the dots and sort of figure out what might be exactly wrong with me.
I must also add that I've had chronic allergy rhinitis problem for around 14-15 years right since I was a teen. These days it is not so acute but I do get bouts of hay fever occasionally

Regards
XXXXXXX
 
 
Answered by Dr. Sujoy Khan 7 hours later
Hello,

Thanks again for writing back.

1. Many a times there are atypical presentation where there are no reports of such presentation. So at this point of time I am unable to relate the headaches to IBS. If headaches resolve with IBS treatment, we cannot deny the relations. There are anticholinergic preparations such as dicyclomine for constipation; bisacodyl; tricyclic antidepressants and new rifaximin that work quite well in treating IBS. Discuss with your treating doctor.

2. I would suggest strongly that you broaden your diet as the tiredness and other non-specific symptoms will be related to the decreased intake of vitamins, minerals, aminoacids, etc. So get in touch with a dietician and discuss your current diet and make sure you get the right amount of protein, fats, and carbs in your meal.

3. The sodium chromoglycate will lower the pain but will have minimal effect on the salicylate sensitivity. There are few websites that offer a salicylate free diet; but I would not recommend this for now as you are already on a restrictive diet.
Once the sodium chromoglycate is started, try to broaden the diet in consultation with the dietitician.

4. Stress and psychological conditions can interfere with multiple conditions including IBS and chronic headaches. It is important to keep these factors in control. If these symptoms are affecting your physical as well as mental capabilities, it might be worth to see a psychologist.

5. For the allergic rhinitis, antihistamines such as loratidine or levocetirizine will work in conjunction with the sodium chromoglycate. Discuss with your treating doctor.

Hope this all helps. Let me know if you have other doubts.

Best Wishes
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 1 hour later
The reason why I went on a restrictive diet was a lot of food items were bothering me. I used to feel very tired in the morning even when I wasnt on a diet and the symptoms were worse. The change in the diet, albeit more restrictive, has to some extent helped. So I would not say that the tiredness ect is due to the lack of vitamins etc. The diet that I was having before made me feel sick, bothered me in terms of pain in the head and pelvic area and also caused sleep issues and tiredness.

I understand the restrictive diet is not good, but what do I do. I'm in a quandary, if I go back to my normal diet I'll experience even more trouble. Someone suggested I had candida and that I should follow a anti candida diet and that is what I have been following without much success. But is better than what it was before.

Can you give me a suggestion because I really want to eat well and be symptom free but I cannot. DO you recommend any further tests. I read that people with Mast Cell disorders or mastocytosis have allergic reactions to food etc. As I said I also have allergy rhinitis. Do you suggest I do a test for mastocytosis through an immunologist here. Do you think I could be suffering from that disorder?

Disappointing to here that sodium chromoglycate wont counter saliclyate sensitivity. Practically all fruits cause tingling sensation, headaches and pelvic pain instantaneously after consuming them. I'm missing out on vitamins because of that but what to do I would like to reduce the pain and discomfort so have to make those sacrifices. This is my story at the moment. Any suggestions
 
 
Answered by Dr. Sujoy Khan 7 hours later
Hello,

Thanks for the follow up.

1. A few people have reported being on the anti-candida diet with varying degrees of success, so it is a very individual thing and although the best suggestion would be as normal, a diet as possible you can try to avoid the 'worst' foods on your list.
Try to introduce the food that caused the 'least' symptoms according to your knowledge, and start introducing others slowly. I would recommend introducing one food item a week.

2. There is a blood test available for mastocytosis and you get it done through a GP through an Allergist/Immunologist. The test is mast cell tryptase levels in peripheral blood (you do not have to undergo an overnight fast). High levels would suggest a degree of mastocytosis and if gut biopsies were done before, the pathologist can stain for tryptase/mast cell markers.

I hope I was of some help. Hope I answered all your questions. Please use any answer clarification before closing and rating this answer. I will be happy to explain or expand on any issue you may have.

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 4 hours later
Hi there

Thanks for your answer and your suggestions.

A couple of questions, I have done colonoscopy but I dont remember doing gut biopsies. Do you recommend I do gut biopsies along with the blood test for mastocytosis. If there is a mastocytosis disorder then what is the solution, do I need to take drugs and which ones to counter the disorder.

If it is a mast cell disorder then could sodium chromoglycate help in alleviating the symptoms? What is the difference between ketotifen and sodium chromoglycate and which one is better?

Do you think the gas problems, crampy pain in the pelvic, allergy rhinitis and instantaneous reactions to food could suggest a mast cell disorder. I know you mentioned salicylate sensitivity. But could the problem be deeper then that?
The crampy pain on the left side in the lower abdomen/pelvic/hip area can also occur instantaneously. Like the other day I was having an XXXXXXX and within minutes I started feeling crampy. Definitely sounds like food allergy and you are probably right in concluding that it could be salicylate sensitivity. The point is whether this is a mast cell disorder as well

Thanks
XXXXXXX

 
 
Answered by Dr. Sujoy Khan 10 hours later
Hello,

Mast cell disorders have varying presentations as there are several types of mast cell disorders (includes pelvic pain, severe 'allergic' reactions to foods, pollens, insect stings etc). The first test would be the blood test for mast cell tryptase. If normal, it excludes a systemic mastocytosis that involves various organs like gut, liver, spleen, bone marrow etc.

Gut mastocytosis can be definitely said on colonic biopsies but the tissue needs to be specifically stained to know if there is a problem. Occasionally mast cell numbers are easily identified and the cause then ascertained.

As far as your fruit allergies are concerned, I would definitely get blood tests to exclude birch pollen allergy as severe birch or tree pollen allergy causes tingling in the mouth, lips as the immune system thinks you have eaten the pollen. Outer coating of fruits has a similar allergen to tree pollens that confuses the immune system and hence you get the immediate symptoms.

If this blood test (specific IgE against tree pollen mix, birch pollen, XXXXXXX etc) is negative, then salicylate sensitivity will be next on the cards.

Ketotifen and sodium chromoglycate have similar actions as mast cell stabilizers, and either one will be fine to start with.
I hope this helps and will be happy to answer any further queries that you may have.

Regards
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 3 days later
Hi there,

I've just started taking sodium Chromogylcate, This is my second day in fact. I find that the medicine is a) increasing pain around the nose/temple area-feels like constant pressure pain and is uncomfortable b) makes me feel fatigued c) Constant mucous in the nose, which I've got to keep clearing and c) feel a little constipated

On the positive side it has reduced the left side pelvic/abdominal pain symptom.

As I said early days but do you think the pain and other symptoms might subside/settle after a while
After starting chromogylcate have also been experiencing acute nasal congestion which is quite bothersome. Is this normal and do you expect it to get better overtime

Regards
XXXXXXX
 
 
Answered by Dr. Sujoy Khan 5 hours later
Hello,

So I presume that the blood test for mast cell tryptase was normal.

It is very early days and before a full 6-week trial, it will be difficult to judge whether it has helped or not.

Nasal congestion is unusual as a side effect, although it is a symptom that you had to some extent before the sodium chromoglycate was introduced. There is in fact a sodium cromoglycate nasal spray as well that works for nasal congestion; you can either try that or a different spray like azelastine.

Hang in there, but please also keep your doctor who prescribed the sodium chromoglycate tabs informed of all your queries.

Best Wishes
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 3 hours later
Hi there,

The blood test results will be out on Tuesday, I'm currently taking 100mg capsules of sodium cromoglycate three times a day before each meal. That is what the doctor has prescribed at the moment. Does that seem a lot?

Regards
XXXXXXX
 
 
Answered by Dr. Sujoy Khan 1 hour later
Hello XXXXXXX,

That is exactly the same dose that I prescribe to my patients as well.
It is also the same dose and frequency as recommended by the British National Formulary (BNF).

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 41 hours later
Hello Sujoy

I want to ask you about Histamine Intolerance, what is it and whether sodium cromoglycate hinders or helps it?

I suspect I could be having histamine intolerance along with saliclycate and probably sulphite intolerance as well.

Is there a reliable test to detect histamine intolerance

Regards
XXXXXXX
 
 
Answered by Dr. Sujoy Khan 1 hour later
Hello,

Histamine intolerance is the inability to breakdown down histamine after it is formed by the body. It is not possible to STOP histamine production and antihistamine tablets only work by preventing histamine from attaching to the receptor. So the body continues to produce histamine and unless you have histamine breakdown enzymes working you start developing the intolerance. You can read more on this at WWW.WWWW.WW uk
It is therefore possible that one can have an'overlap' of different degrees of intolerance to salicylates, sulphites or histamine.
As far as sodium chromoglycate is concerned, it stabilises mast cells and prevent their breakdown, so you do not 'generate' any more histamine. It therefore helps people with most types of intolerances, be it histamine/salicylate/sulphites.
It is not possible to diagnose these intolerances with blood tests, as the enzymes that can be tested for their levels (like liver enzymes) are not available in most laboratories.
The amount of histamine present in your blood or urine can be measured, although available only at select (research-based) centers.

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 58 minutes later
Thanks Sujoy

Just another follow up question, is there a supplement available like an enzyme or enzymes which if taken will resolve these intolerances or is sodium chromoglycate the only way out?

The other thing is that my blood test for tryptase was normal.

Regards

XXXXXXX
 
 
Answered by Dr. Sujoy Khan 3 minutes later
Hello,

A normal mast cell tryptase is good news for several reasons.

There are a lot of herbal 'remedies' and over-the-counter preparations that claim to cure multiple intolerances. I have never prescribed any of them nor recommended, so would not do that for you.
Try and see what the sodium chromo does and introduce the foods that we discussed in detail previously.

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 1 hour later
Thank you,

I've uploaded a photograph of my knee. I've been having this white crusty patch on the left knee for the last many years (can't remember when I did not have it!). It does not itch but I find that sometimes it get worse in terms of the size and intensity of the patch while sometimes it fades. Surprisingly the right knee is normal. I also have this on my elbow

Is this a symptom of food allergy or intolerance as well. I read some websites which points to eczema and psoriasis. However as I said it does not itch, it just looks bad.


Regards
XXXXXXX
 
 
Answered by Dr. Sujoy Khan 17 minutes later
Hello,

An eczematous patch is likely.
You can apply moisturiser cream or a low potency steroid cream such as 1% hydrocotisone and see if that helps.

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 1 hour later
Thanks again,

Just another question on sodium cromoglycate, I understand it works best before meals. However since I have problems with tea and coffee (causes pelvic discomfort, along with fatigue/headache etc I guess due to salicyclate intolerance) do I need to take it every time have the odd tea or coffee to keep those discomforts at bay? Currently for example I'm just taking it before main meals i.e. breakfast, lunch and dinner.

Regards
XXXXXXX
 
 
Answered by Dr. Sujoy Khan 2 hours later
Hi,

No, you do NOT need to take it before everything you eat; just the 3 main meals.
It continues to work in the background but since the main meals will have more effect on gut mast cells, you need to take it 30 mins before the meal.

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 7 hours later
Thanks Sujoy

What do you recommend for people with lactose intolerance, will sodium cromo work as well?
 
 
Answered by Dr. Sujoy Khan 10 hours later
No, I do not recommend sodium chromo for lactose intolerance.

Avoiding lactose in significant amounts is the best strategy in the case of lactose intolerance, as little amounts such as in tea or coffee usually does not lead to significant GI problems.

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 24 hours later
Thanks Sujoy

I've uploaded my blood tryptase test. Just a follow up on intolerances, what are the other intolerances apart from lactose that sodium chromo is not able to treat or won't be effective.

For lactose intolerance there is an enzyme called lactase would you recommend that. I'll be doing a hydrogen breath test next week to determine whether I have lactose intolerance or not, is that a reliable test in your view.

Regard
XXXXXXX
 
 
Answered by Dr. Sujoy Khan 44 minutes later
Hello,

Thank you for uploading the results of the mast cell tryptase that is completely normal.

Sodium chromoglycate has been tried for 'food intolerances' in general to stabilise the mast cells, and prevent their breakdown. There is no direct evidences to say that it works or does not work for specific intolerances such as salicylates, sulphites etc. So the best plan would be to give it some time.

I have not given lactase as a supplement for lactose intolerance, so have no experience in this regard. The hydrogen breath test is perhaps the only test that is still available, but the sensitivity and specificity (i.e., can you just rely on this test to prove or disprove) of this test is low.

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 15 hours later
Thanks for your reply

I've attached my report from the gastro whom I visited way back in 2009. I was in agony then and that situation has not changed. Bloating and pressure pain/discomfort on the left side near the pelvic/hip region occurs instantaneously during meals. The pain lasts for a long time and because of that I'm unable to concentrate or do my work properly. Every time I eat I get that sensation regardless of what I eat, some foods cause less pain some more. For me eating food has become a nightmare as I have to brace for the unpleasant feeling afterwards. When I'm sitting down the pain is in the hip region and when I stand up the pain/discomfort moves to the head region and it is like a pressure pain around the head/temple/forehead areas mostly but can move to the neck as well. I'm constantly in some discomfort or the other and rarely pain free as such.

I think your logic about food intolerances makes complete sense to me. I'm angry at myself for overlooking it for the last so many years. I'm also angry at my GP and other specialists I visited for not considering food intolerances as one of the possibilities. I' hoping that the diet program and the medications I'm currently taking alleviate my symptoms so that I can lead a normal life.

However I wonder whether I have done irreparable harm to my body by subjecting it to the offending foods. I feel that I have been having multiple food intolerances for the last 10-15 years if not more. Before the symptoms got worse in 2008/09 I suffered from acute hay fever and gas problems for the last several years. So that is my biggest fear that for so long I have been eating the wrong stuff (not realizing I was intolerant to a variety of foods) and in the process wrecking my system. I hope I can reverse it.

Do you think my worry is overdone?
I must also add that over the last four years I have taking antidepressants like amitryptyline at high does, anti anxiety medicines and various herbal medicines to no avail. They just did not work
 
 
Answered by Dr. Sujoy Khan 6 hours later
Hello XXXXXXX,

Thank you for uploading the detailed Gastro report that was indeed very helpful. It was also very reassuring to know that my initial thoughts and the presumed diagnosis about your symptoms that is very suggestive of IBS, is in similar line with the Gastroenetrologist.

Two very pertinent points were raised or answered, (1) that a very low dairy diet did little to improve your symptoms; (2) the possibility of small intestinal bacterial overgrowth (SIBO).
I think you have not harmed yourself in any way by not knowing of possible intolerances but would not recommend high dose tricyclic antidepressants as they do not help the bowel symptoms at that doses. In fact, low doses are much better to start with and can be tapered down and stopped if required. Whereas, if you are on high doses, it makes it more difficult to get you 'off' the drug.

I would think that you continue with the sodium chromoglycate for now, but do keep in touch with the Gastro Dept and discuss on the possibility of excluding SIBO if nothing works.
The allergy tests for grass and tree pollen also need to be done at some point along with the others I had previously mentioned. So please feel free to ask when you have the results.
I will be out of station for the next 2 weeks, and will update my status on my return.

Best Wishes.
Above answer was peer-reviewed by
 
Follow-up: Getting pain in pelvic and tingling sensation in forehead. MRI scan normal. What should I do? 46 minutes later
I'm not taking antidepressants any more. When I took it I started off with a lower dosage of 10mg gradually increasing it to 40mg. But that did not work and I gradually decreased it and then stopped it.

I just wanted to ask you a question on sodium chromoglycate. I lot of websites refer to this drug for food allergies but I have not found anything about the drug that relates to food intolerance. However as I understand it (and you can correct me) there is a difference between allergy and intolerance isn't it?.

So the question is does this work for intolerance as well?
 
 
Answered by Dr. Sujoy Khan 10 minutes later
Yes, the basic difference between allergy and intolerance is the amount of 'allergen' required to elicit the reaction. With allergy, a little amount provokes a big reaction while with intolerances, a bigger amount is required.

No systematic trials with sodium chromoglycate and intolerances exist (as far as I know). But in most people, salicylate/sulphite intolerance AND allergy is a fine line, so this drug is usually used to see an objective response.

Best Wishes.
Above answer was peer-reviewed by
 
Share on Facebook
Share on Twitter
Share on Google+

The user accepted the expert's answer

Ask a Doctor Now

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor