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Suffering from migraine, abdominal cramps, diarrhea and elevated billirubin levels. Proper cure?

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Allergist and Immunologist
Practicing since : 1999
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I am a 27 year old female with no significant health history. I have been suffering from migraines, abdominal cramping, diarrhea and elevated billirubin levels for the past year. I have no energy and have seen several specialists with no answers. In the past year I have had CT scans of my head, abdomen, and sinuses. I have also had a exploratory endoscopy of my abdomen and colon. I have tried beta blockers and numerous medications with no results. What could I possibly have? Next steps?
Posted Tue, 11 Dec 2012 in General Health
Answered by Dr. Sujoy Khan 42 minutes later

Thank you for writing to us.

Your symptoms of migraine, abdominal cramps, diarrhoea and elevated bilirubin levels do not fit into one diagnosis and would therefore need to be discussed at several different levels.

Nausea and vomiting are features of a migraine attack and occasionally cyclical vomiting (in children), abdominal pain (abdominal migraine) or reflux disease or diarrhea are also seen. Headaches were reported to be higher in patients with migraine who get more abdominal symptoms. Hence your symptoms of migraine, diarrhoea and abdominal cramps fit into one diagnosis of migraine (classical if you get visual symptoms) and abdominal migraine.

Elevated bilirubin levels on its own does not point to a pathology; gall bladder or liver pathology must be excluded if there is raised liver enzymes (SGOT/SGPT or AST/ALT) and alkaline phosphatase (seen in GB stone disease).
If only the total bilirubin is raised, you need to get conjugated bilirubin and unconjugated bilirubin levels done. If unconjugated levels are high, then you may have XXXXXXX syndrome that is quite common.
Bilirubin levels go up in Gilberts when you are stressed and there is no liver/GB pathology. It is an inherited condition that usually requires no treatment but awareness of this condition lest interventions are unnecessarily done.

As investigations have been normal, you should feel reassured that there is no significant pathology to worry about. You must get in touch with your Neurologist to discuss on this abdominal migraine and treatment options in detail.

I hope that was useful. Let me know if there are other concerns.

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