A 10-year-old boy presents to pediatric gastroenterology with concerns of periods of nausea, abdominal pain, and vomiting that have occurred multiple times over the past 3 months. These episodes, which are not triggered by food or activity, last about 12 hours and are improved with sleep. Afterwards, he feels completely fine. The patient reports feeling dizzy before the onset of nausea and abdominal pain, which he describes as a dull, nonradiating pain in the umbilical area. Vomiting is the last symptom to appear. He has missed multiple school days and sports activities because of these episodes.

Physical exam reveals nothing remarkable. His vital signs are normal and there is no appearance of dysmorphic characteristics. Neurologic exam is normal. The patient has no other comorbidities but does have a positive family history for migraine on his father's side. Other systemic assessments are normal. Laboratory testing is performed: complete blood count with differential, comprehensive metabolic panel, serum lactate, serum pyruvate, serum ammonia, and urine organic acids. All results are within normal range.