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If a patient does not respond to the first-line therapy (amitriptyline, cyproheptadine, and/or propranolol) the following options should be considered: (1) presence of persisting triggers (e.g., psychological stressors) and comorbid conditions (e.g., anxiety, POTS) or missed underlying disorders (e.g., hydronephrosis, chronic sinusitis, acute appendicitis, intestinal malrotation with volvulus, CNS tumors, metabolic crises) and toxic exposure (e.g., cannabis)

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doi: 10.1093/hmg/ddv183

This approach can also be helpful for detecting food sensitivities that contribute to co-occurring pain conditions such as fibromyalgia and irritable bowel syndrome