Recurrent Tummy Aches and A Family History of Migraine — Free SCA Practice Case

Character Overview: You are Nadia, mother of Oliver, who is 8. For several months he has had recurrent episodes of central tummy pain — quite severe when they come — lasting several hours, during which he goes pale and off his food and sometimes feels sick. Between episodes he is completely well and back to normal. There is a strong family history of migraine (you and your mother get migraines). The episodes are starting to affect his school attendance and he seems a bit anxious about them. You are worried something serious is being missed and wonder if he needs tests or a scan.

Opening Sentence: "Hello Doctor. My son Oliver, he's eight, keeps getting these bad tummy aches. They come out of nowhere, last a few hours, and he goes pale and off his food. Then he's completely fine again for a while. It keeps happening and it's affecting his school — I'm scared something's being missed. Does he need tests?"

History if Asked (Data Gathering Phase)

• ●The episodes: "Central tummy pain, around the belly button, quite severe when it comes. Lasts a few hours, sometimes most of a day, then settles. He goes pale and off his food, sometimes feels sick."
• ●Between episodes: "Completely well — running around, eating normally, back to himself."
• ●Frequency/course: "Every few weeks for several months now. No obvious pattern I can see."
• ●Family history: "I get migraines, and so does my mum. Bad headaches with feeling sick."
• ●School/impact: "He's missing school when they hit, and I think he's getting anxious about when the next one will come."

ICE — Ideas, Concerns, Expectations

The caller does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

• ●Ideas: Nadia fears something serious is being missed — she has not connected it to the family migraines. "I keep thinking something serious is being overlooked. I hadn't thought about the migraine link."
• ●Concerns: She is worried about a serious underlying cause and about the effect on his schooling and his anxiety. "I'm scared it's something bad, and it's affecting his school and making him anxious."
• ●Expectations: She wonders whether he needs tests or a scan, and wants an explanation and a plan. "I want to know if he needs tests, and what's actually going on."

If Asked — Abdominal-Migraine and Red-Flag Screen

The caller answers these only when directly asked.

• ●If asked about the site and nature of the pain: "Central, around the belly button, comes in episodes."
• ●If asked about pallor, nausea, vomiting, or off food during episodes: "Yes — he goes pale, off his food, and feels sick, though he doesn't usually actually vomit."
• ●If asked about headache with the episodes: "Occasionally a headache too, now you mention it."
• ●If asked about being completely well between episodes: "Completely well in between, yes."
• ●If asked about weight loss or poor growth: "No — he's growing fine and hasn't lost weight."
• ●If asked about blood in the stool or vomit, or bilious (green) vomiting: "No blood, and no green vomit."
• ●If asked about pain waking him from sleep, or pain always in one spot (e.g. lower right): "It doesn't wake him at night, and it's central, not stuck in one corner."
• ●If asked about bowels (diarrhoea/constipation), urinary symptoms, fevers, joint or skin problems: "Bowels are normal, no waterworks problems, no fevers, no rashes or joint pains."
• ●If asked about triggers, diet, sleep, and stress/school: "I haven't spotted clear triggers. He can be a worrier, and there's the odd stress at school."
• ●If asked about what happens during an episode / how he copes: "He wants to lie down in a quiet, dark room until it passes."

Responses to Management (The Negotiation Phase)

• ●If the Doctor explains this sounds like abdominal migraine: "Abdominal migraine? I didn't know that was a thing. Is that why the family migraines matter?" (The tested point is recognising and explaining abdominal migraine, including the migraine link.)
• ●If the Doctor explains why lots of tests/scans aren't needed: "So he doesn't need loads of tests or a scan? I'd assumed he would." (The tested point is avoiding over-investigation in a well child with a characteristic history and no red flags — explained reassuringly.)
• ●If the Doctor addresses the school impact: "What do I do about school? He's missing quite a bit, and I don't want him falling behind or getting more anxious." (The tested point is addressing the school impact and any anxiety/reinforcement.)
• ●If the Doctor suggests a diary and lifestyle measures: "Keep a diary of the episodes? And look at his sleep and meals?"
• ●If the Doctor safety-nets: "What would mean I should be worried and get him seen?"