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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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For me, it's just like your biology is in the right place, you know