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Suggest treatment for migraine and stomach pain

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Posted on Sat, 5 Dec 2015
Question: What is your knowledge of migraine stomach pain and its treatment?
Daughter is 44; diagnosed nearly two years ago, after four years of pain and no "answers". Pain is severe and spikes which has meant MANY trips to the ER.
What are you thoughts? Ideas for treatment / control???

Thanks, XXXXXXX
doctor
Answered by Dr. Mukund Savaskar (1 hour later)
Brief Answer:
Migrain with Stomach pain/Under Treatment Evaluation

Detailed Answer:
Brief Ans-Migrain with Stomach pain/Under Treatment Evaluation

Hi,Dear Thanks for your query to HCM.
Dear,I read your query in all the details given by you for your daughter and under stood her health concerns.

Update following more information-
What is the trigger factor for Migraine attacks with your daughter?
What is the type of pain in stomach?Is it of Burning Type of Stomach Pain?
Any specific food trigger is there to start it?
Does she have acidity / anxiety? What is her job schedule and life style with it?
What is her diet schedule and daily dietary intake?
Any high blood pressure / obesity / diabetes is accompanied with it?
Is she under job / home work or / mental anxiety and stress?
Any tea,coffee,alcohol,smoking,tobacco chewing excesses?
Update any investigation reports done so far?
Does she suffer from Chronic on Acute Sinusitis repeatedly?
Any CT /X-ray Skull and Sinuses done? pls update its reports?
Does she eat the outside food frequently?
Does she have frequent diarrhea/dysentery complaints?
What is her obstetric / pregnancy history?How many kids she has?
Does she take analgesics/NSAIDs/painkillers frequently?
Does she get 8 hrs sleep?Does she have travelling or office-sedentary job?
Await more information as asked above and any information related to her Migraine disease.

Suggested Plan-for the time being
Be on Bland non-spicy /non-fried diet
Take-sweet Butter Milk with Banana Shakes-2 times per day.
Reduce on tea/coffee/alcohol/tobacco immediately.
Sweet Yogurt with Milk -2 times per day-especially when the aura of the Migraine starts.
Avoid Citrus Food.
Plenty of fluids / Low Fat-Low Carbo-Low Protein diet-weight reduction diet plan
Jogging x 20 mts per day x for body fitness.

Hope this would start the correction of the body interior.

Welcome for any further query in this regard,to be replied in next session.

Good Day!!

Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS

Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Mukund Savaskar (1 hour later)
Update following more information-
What is the trigger factor for Migraine attacks with your daughter? Occur frequently when about to start her period
What is the type of pain in stomach?Is it of Burning Type of Stomach Pain? Sharp, Severe Pain
Any specific food trigger is there to start it? Quantity can be an issue; also, more difficult to digest foods
Does she have acidity / anxiety? What is her job schedule and life style with it? MUCH stress as single Mom since Dad abandoned one child and virtually abandoned second.
What is her diet schedule and daily dietary intake? Recently dropped dairy & chocolate from diet.
Any high blood pressure / obesity / diabetes is accompanied with it? No
Is she under job / home work or / mental anxiety and stress? MUCH stress with highly intense, deadline-ridden job (which she loves).
Any tea,coffee,alcohol,smoking,tobacco chewing excesses? Coffee, Pepsi
Update any investigation reports done so far?
Does she suffer from Chronic on Acute Sinusitis repeatedly? Unknown
Any CT /X-ray Skull and Sinuses done? pls update its reports?
Does she eat the outside food frequently? Moderately
Does she have frequent diarrhea/dysentery complaints? Some; more apt to be constipated
What is her obstetric / pregnancy history?How many kids she has? Gave birth to now child; second is adopted.
Does she take analgesics/NSAIDs/painkillers frequently? Frequently treated with opiads at ER
Does she get 8 hrs sleep?Does she have travelling or office-sedentary job? Less than 8 hrs; off-sedentary job.
doctor
Answered by Dr. Mukund Savaskar (14 hours later)
Brief Answer:
Stress Induced Abdominal/Stomach Migraine?/Under Investigations

Detailed Answer:
Brief Ans-Stress Induced Abdominal/Stomach Migraine?/Under Investigations

Hi,Dear,Thanks for the Updates.

I studied your query with all the details of the updates.I reviewed your query which mainly stresses on the severe sharp stomach pains.No where you mentioned about the vomiting and nausea with this pain,which has to accompany if it is to be labelled as -Stomach Migraine

So I doubt about it being Migraine of the Stomach / Abdomen.
Have You checked with Neurologist for this diagnosis?
It seems that you have no relief with all those migraine drugs-like propranolol/nortryptiline/zofran/zoloft/.dilaudid with benadryl

Your clear submission that-it has not given any answer to your stomach pains over the last 2 years, suggests clearly that the diagnosis needs to be reviewed.

Re-Evaluating your Case-On My thoughts-
When I read all these facts of your query with the updates replies from You, on My leading questions,You seem to suffer from Acute Job/Mental Stress with Anxiety with Excess of Coffee and Pepsi with less than 8 hrs sleep/with occasional diarrhea/ more often constipated,with Severe Sharp Stomach Pains prior to Menstrual Periods.
Stomach Migraine has to be with vomitting /severe nausea/ with severe abdominal / Stomach pains.
All these complaints can occur with ?Duodenal Ulcer or / with Gall Stones.
When there is no acute vomiting /severe nausea -as expressed in your query,Why not to investigate by OGD-Oesophago-Gastro-Duodenoscopy /CT Abdomen?

Update More Information -in context to above loop holes in your case-

To label your case as Stomach Migraine-,Do you get Severe Sharp Pains with start of the periods?
Do you have accompanied severe vomiting / and severe nausea with it ,Which you never mentioned in your query ?
Do you get these complaints besides the periods?or When you are under lot of stress/ ? or when You have worked late hours / or? have taken spicy diet with lots of coffee and Pepsi for any of the days?
Please tell me do you get any aura of visual disturbances any time?
Do you get any Bilateral Temporal Headaches with severe nausea and vomiting?
How this severe nausea gets relieved?does it relieves by Vomiting out the stomach contents?
Did your doctor while labeling your case as -Stomach/Abdominal Migraine did rule out the Surgical Causes as -Duodenal Ulcer/ or Acute Cholecystitis by Second Opinion from a Surgeon.

Hence In My Opinion, I would suggest you as follows -
-To get the OGD scopy done
-To get the Abdominal CT done to rule out any abdominal or Gynec cause of the severe/sharp abdominal pain in your case.
-To update to ME all the information as asked above soon,to be replied in next session.
-To get the Gynec causes to be ruled out for the Sharp Sever abdominal Pain/ with nausea.
I would reply on the plan of treatment,after evaluation of your Stomach Migraine is over.
Keep Me updated on the above things to be replied in next session.

Hope this reply would help you to plan further treatment with your doctors treating you there at your place.
Await your updates on the above information till next session.


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Mukund Savaskar (17 hours later)
Hello -- replies to your questions:
To label your case as Stomach Migraine-,
Do you get Severe Sharp Pains with start of the periods? Yes
Do you have accompanied severe vomiting / and severe nausea with it ,Which you never mentioned in your query ? Yes - spike in pain causes nausea & vomiting
Do you get these complaints besides the periods?or When you are under lot of stress/ ? or when You have worked late hours / or? have taken spicy diet with lots of coffee and Pepsi for any of the days? Yes - Definitely occur at other times; experiencing a LOT of stress. (My Mom speaking::: puts needs of children and job ahead of caring for herself!)
Please tell me do you get any aura of visual disturbances any time?
Do you get any Bilateral Temporal Headaches with severe nausea and vomiting? Occasional migraine headaches; some nausea and usually no vomiting
How this severe nausea gets relieved?does it relieves by Vomiting out the stomach contents? Medication - typically zofran
Did your doctor while labeling your case as -Stomach/Abdominal Migraine did rule out the Surgical Causes as -Duodenal Ulcer/ or Acute Cholecystitis by Second Opinion from a Surgeon. No. Result of rectal prolapse / bi=section in May, 2009 - subsequent surgeries for adhesions.

Current CAT Scan revealed inflammation of colon --- lower left side.

Lower left side, stabbing and spiking of pain continues with nausea (brought on my pain) and vomiting.

Thank You!
doctor
Answered by Dr. Mukund Savaskar (13 hours later)
Brief Answer:
Abdominal/Stomach Migraine?/Under Investigations

Detailed Answer:
Brief Ans-Brief Ans- Abdominal/Stomach Migraine?/Under Investigations

My Impression -about your Daughter's Case-
Revision in diagnosis of your case- to -Recurrent-Adhesive Partial Intestinal Obstruction With Colitis


Ans-Dear,I reviewed Your first query and the following 2 updates in context of your Stomach Migraines.
I studied all the details meticulously and gave a deep thought with My expertise and long experience.

Your case is getting More complicated, session by session, with so many clinical facts coming forward, making it More of –a challenging case ,Which I definitely would suggest to review for correcting the Wrong Diagnosis-of Stomach Migraine.

Defination of Stomach Migraine-
Typically the Stomach / Abdominal Migraine in Women- is a Vaso-spastic disease with Spikes of Abdominal Pain(instead of Headaches) accompanied by Severe Vomiting and intractable nausea. Besides this Stomach Migraines are –Uncommon in adults(only 2-4%),as its Mostly a disease of Children.

Points against Stomach Migraine in your case-

Besides this in your case-Mental and physical stress with life style causes of –excess of coffee and pepsi(expediting factors in your case) / and Section in 2009, with recent CT with Colonic inflammation/ and your candid submission that the pain is in the Left lower Quadrant-Strongly negates the-Stomach Migraine –

Diagnosis in your case.
-Your case In My Opinion does not seem to be –of “Stomach Migraines”- as your symptom complex -are not suggestive of Stomach Migraines-
-Migraines -for all practical purposes are the result of the symptom complex caused from the Vaso-spastic ailment causing-Severe Abdominal Pains characterized by Sever Vomiting(your case has occasional vomiting-?from adhesive partial obstruction) and nausea-(the result of the reflex pyloric dystonia due to the recurring partial adhesive intestinal obstruction-in your case).
Typically these vaso-spastic symptoms leading to Migraine in Women-are exaggerated / exacerbated –by Pre-menstrual fall in Hormonal Levels in the Woman-Which causes the Migraine –in women approaching the Peri-Menopausal Age.
As you have Headache attacks with nausea but not necessarily with Vomiting-I would label these Stomach Pain attacks in the lower left Quadrant due to adhesive partial obstructions with colicky pains with nausea mostly and vomiting occasionally(as rightly pointed in your last updates, where the CT Abdomen –indicated inflamed Colon),which proves My opinion as its not Stomach Migraine.
Though your gender favors, your age negates the Stomach Migraine hypothesis –of all your symptom complexes- which seems to have started as a complication of the Section-in 2009.
Hence in all this scenario-I would label your case-at the end of this academic discussion – as a case of-Partial Intestinal Obstruction With Colitis(Cause of which needs to be investigated in your case).

MY Impression-On thoughts about your case?asked in your first query.

Dear,Thanks for the interesting updates. Dear, this Discussion is going haywire and endless, as your primary query has so many un-explained facets, which need re-assessment in the basics of- diagnosis of your case.
But I would limit this discussion, that Your Case being much complicated for a discussion, can’t be decided in few sessions and would need more follow ups and detailed clinical / physical examination data feedback.
And in the interest of your health, I would only use this forum to keep You on

ALERT-and would ask you to consult with your local doctors-who would be in better position to help you out .

My Opinion-Ideas for Control of your complaints ? asked in your first query.

-Hence due to all these reasons, I would not label and treat your daughter’s case as-Stomach Migraine.
-Hence therefore before suggesting ANY treatment, I would suggest you to re-investigate the case with your doctor,as the Treatment as asked from You would totally depend on the cause of your complaints- by taking following steps-
-Second Surgeon’s Opinion to assess your case for Stomach Migraine-
-else/ if you don’t-then do contact Me by prior appointment at My mail-id- YYYY@YYYY .

Hope I tried to answer all the facets of your complicated query with a very complicated case.
Thus I replied on -What are you thoughts? Ideas for treatment / control???

Welcome with any further query in this regard.

IF no further query,Will appreciate You, to write excellent feedback review comments, to help the needy patients like you, at HCM services.

Keep Me updated.

I would love to help you, if you come to Me for My further consultation.

Wishing your daughter early recovery.

Good Day!!

Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS

Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
Answered by
Dr.
Dr. Mukund Savaskar

General Surgeon

Practicing since :1978

Answered : 3606 Questions

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Suggest treatment for migraine and stomach pain

Brief Answer: Migrain with Stomach pain/Under Treatment Evaluation Detailed Answer: Brief Ans-Migrain with Stomach pain/Under Treatment Evaluation Hi,Dear Thanks for your query to HCM. Dear,I read your query in all the details given by you for your daughter and under stood her health concerns. Update following more information- What is the trigger factor for Migraine attacks with your daughter? What is the type of pain in stomach?Is it of Burning Type of Stomach Pain? Any specific food trigger is there to start it? Does she have acidity / anxiety? What is her job schedule and life style with it? What is her diet schedule and daily dietary intake? Any high blood pressure / obesity / diabetes is accompanied with it? Is she under job / home work or / mental anxiety and stress? Any tea,coffee,alcohol,smoking,tobacco chewing excesses? Update any investigation reports done so far? Does she suffer from Chronic on Acute Sinusitis repeatedly? Any CT /X-ray Skull and Sinuses done? pls update its reports? Does she eat the outside food frequently? Does she have frequent diarrhea/dysentery complaints? What is her obstetric / pregnancy history?How many kids she has? Does she take analgesics/NSAIDs/painkillers frequently? Does she get 8 hrs sleep?Does she have travelling or office-sedentary job? Await more information as asked above and any information related to her Migraine disease. Suggested Plan-for the time being Be on Bland non-spicy /non-fried diet Take-sweet Butter Milk with Banana Shakes-2 times per day. Reduce on tea/coffee/alcohol/tobacco immediately. Sweet Yogurt with Milk -2 times per day-especially when the aura of the Migraine starts. Avoid Citrus Food. Plenty of fluids / Low Fat-Low Carbo-Low Protein diet-weight reduction diet plan Jogging x 20 mts per day x for body fitness. Hope this would start the correction of the body interior. Welcome for any further query in this regard,to be replied in next session. Good Day!! Dr.Savaskar M.N. XXXXXXX Surgical Specialist M.S.Genl-CVTS