Abdominal Migraine and Homoeopathy

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Keywords:

Migraine, Pain, Pediatrics, Neurotransmitters, Functional dyspepsia, Irritable bowel syndrome, Abdominal migraines, Childhood functional abdominal pain

Abstract:

Recurrent pains in abdomen are very frequent concern are for patients, especially children as well as for parents. Children often complaint of periumbilical pains especially after meals (Psora). These post prandial abdominal pains may be due to abdominal migraine (Psora). They involve intense midline or diffuse belly ache with or without a headache. Test results are often negative for other conditions. The causes of abdominal migraines are still unknown, but it may be due to a sensitive nervous system, imbalances in brain chemicals, and changes in gut bacteria or so on. The term recurrent abdominal pain has been rejected for the more meaningful terms falling into the category- “abdominal pain-related functional GI disorders” for children. It has four entities-

  1. Functional dyspepsia (characterized by epigastric pain)
  2. Irritable bowel syndrome (characterized by altered form and frequency of stools and better with defecation)
  3. Abdominal migraines
  4. Childhood functional abdominal pain

Definition:

Abdominal migraine is a common cause of chronic and recurrent abdominal pain in children, characterized by paroxysms of moderate to severe abdominal pain that is midline, periumbilical, or diffuse in location and accompanied by other symptoms including headache, anorexia, nausea, vomiting, or pallor. (Psora) The condition predominantly affects children between 3 and 10 years of age and is more common in females.

Signs and symptoms:

Abdominal migraines are most common in children. Sometimes children may not tell the suffering, but act a bit off, grasp at their stomach or go off their food. Main symptoms of abdominal migraine may be-

  • Extreme abdomen pain, especially periumbilical (Psora)
  • Headache (Psora)
  • Nausea (Psora)
  • Reduced food intake (Psora)
  • Sensitivity to light or noise (Psora)
  • Sick, pale appearance (Psora)
  • Vomiting (Psora)

The main symptom is periumbilical colic (Psora). Headache is not a common symptom in this type of migraine. The child may complain about going to school or their favorite play date, showing as if something is fictitious there (Psora). These migraine attacks typically are short lived, lasting only 1 hour to 3 days. In between attacks, child may feel fine (Psora). The symptoms free time can be weeks or months without any pain or gastrointestinal symptoms.

Causes:

Causes of abdominal migraine are still to be traced out. The following hypothesis may explain the etiology of abdominal migraine-

Sensitized Nervous System:

Individuals with functional gut disorders, like abdominal migraines or irritable bowel syndrome, have quicker responses to painful stimulus due to a low threshold for pain. (Psora)

Altered Gut Function:

The gut wall may get stretched causing abnormal contractions. Carnett sign may be positive. (Psora)

Activated Immune System:

Gut-brain axis is affected by immune system. Allergies and other disruptions in the immune system may contribute to abdominal migraines. ((Psora/ Syphilis)

Abnormal neurotransmitter regulation:

Imbalance of neurotransmitters may trigger a migraine or abdominal migraine. (Psora)

Genetics:

Like typical migraines, abdominal migraines may be genetically passed down. (Psora/ Syphilis)

Sympathetic / parasympathetic imbalance:

Like in migraine, sympathetic and/or parasympathetic imbalance may cause induction of abdominal migraine. (Psora)

Altered gut microbiome:

The symbiotic bacterial flora of gut maintains normal functioning of gut system. While altered, it may lead to manifestation of abdominal migraine. (Psora/Syphilis/Sycosis)

Changes to the hypothalamic-pituitary axis:

Any functional or pathological change in HPA may trigger it. (Psora)

Small intestinal bacterial overgrowth (SIBO):

SIBO may be a cause for abdominal migraine. (Psora/Syphilis/Sycosis)

Acute infections with chronic consequences:

Infections may lead to alteration in gut flora or may release certain toxins causing abdominal migraine to flare up. (Psora)

Abnormal cell functions, particularly the mitochondria:

This may be a frequent cause of abdominal migraine. (Psora)

Pathophysiology:

There are numerous possible contributors to the pathogenesis of functional gastrointestinal disorders (FGIDs), but the cause of abdominal migraine remains unclear. The complex brain-gut interaction seems to be disrupted in patients with FGIDs. The following hypotheses have been developed regarding the pathophysiology of functional abdominal pain disorders.

Visceral Hypersensitivity:

The most accepted hypothesis is that it is a result of visceral hypersensitivity of primary sensory and central spinal neurons. It is thought that genetic, psychosocial, and environmental factors may all predispose an individual to visceral hyperalgesia. The brain-gut axis abnormally secretes excitatory neurotransmitters due to sensitization of these neurons. Serotonin, especially, affects gastrointestinal sensation, which may contribute to abdominal pain attacks. Serotonin also affects motility and secretion of the gastrointestinal system.

Gut-Brain Enteric Nervous System Alterations:

The pathogenesis of abdominal migraine may be associated with altered gut motility. There may be significantly lower gastric emptying times and antral motility in patients of abdominal migraine. Any painful stimuli, nausea of central origin, and several endocrine changes can all result in observed changes in gastric emptying and antral motility. Altered secretion of neuropeptides may cause abdominal migraine.

Psychological Factors:

Psychological factors may play a role in the pathophysiology of abdominal migraine. These may include abuse and stressful events. Increased stress induces central nervous system arousal, causing neurotransmitters and neuropeptides to be released, which then contribute to dysregulation of the gastrointestinal system. Stress may predispose an individual to alterations in the hypothalamic-pituitary-adrenal axis, causing abdominal migraine.

Predisposing factors:

These (Causa occasionalis) may include-

  • 3- 10 years of age and females
  • Bright or flickering lights (Causa occasionalis)
  • Dietary- citrus food, caffeine, cheese, chocolate, carbonated drinks, colorings and flavorings agents (Causa occasionalis)
  • Fatigue (Causa occasionalis)
  • Motion sickness (Psora)
  • Poor/ insufficient sleep (Causa occasionalis)
  • Prolonged fasting (Causa occasionalis)
  • School or family stressors (Causa occasionalis)

Diagnosis:

The diagnosis of abdominal migraine is clinical. The laboratory investigations are often normal. The following steps are necessary to diagnose the condition-

History:

  • Onset, frequency, duration and site of pain
  • Radiation, chronic (dull, colicky)
  • Severity (not helpful)
  • Exaggerating factors
  • Relation to food, feeding and bowels
  • Relieving factors
  • Treatment received and effects
  • Associated pains (legs, head, etc.). (Concomitants)

Case history of the child:

  • Change in activities or group activities
  • Daily activities—eating, sleeping, playing, mixing and their effects on pain
  • Functioning at school
  • Relation with siblings/friends/parents/fussy/conscientious, easily hurt
  • School attendance, academic performance
  • School teacher change.

Case history of the family:

  • After life threatening illness
  • Fear of parents regarding pain
  • Inter-parent relationship
  • Low level family conflict
  • Over attention/single child
  • Parents personality/illness
  • Recurrent abdominal pain history.
  • Similar complaint in family
  • Symptomatic pain or modeling

Physical Examination:

  • A thorough physical examination is a must even for reassurance:
  • General physical examination:
  • Weight/height, anemia, lymphadenopathy, BP, urticaria, joint swelling, fever
  • Abdominal examination:
    • Tenderness, organomegaly, mass
  • Rectal examination:
    • For fecal impaction.

Laboratory Investigations:

  • Complete blood count with peripheral blood film (PBF),
  • ESR, CRP
  • Urine R/M/E and C/S
  • Stool R/M/E
  • Plain X-ray abdomen
  • Liver function test
  • Serum creatinine
  • Mantaux test
  • Hydrogen breath test (lactose intolerance)
  • 13C breath test (H. pylori)
  • Enzyme-linked immunosorbent assay test for H. pylori
  • Stool R/M/E (for worm)
  • Gastrointestinal endoscopy, colonoscopy
  • Ultrasound scan of abdomen ( to exclude cholelithiasis)
  • Barium swallow of esophagus (for GER)
  • Barium meal X-ray of stomach and duodenum and follow through (for searching site of lesion, flocculation of barium instead of feathery mucosa in malabsorption, ileocecal region in intestinal TB and Crohn’s disease, etc.).

Differential diagnosis:

  • Psychosomatic
  • Urinary tract infections
  • Constipation
  • Gastro-oesophageal reflux
  • Coeliac disease
  • Inflammatory bowel disease
  • Cow’s milk intolerance
  • Abnormal renal anatomy, e.g. pelviureteric junction obstruction
  • Abdominal migraine
  • Peptic ulcer
  • Sexual or other abuse

Main disorders related to abdominal pain in children:

Functional dyspepsia-

All of the following present at least once weekly for at least 2 months:

  • Persistent or recurrent abdominal pain or discomfort centered in the upper abdomen.
  • Pain not relieved by defecation or associated with a change in stool frequency or form.
  • No evidence of an inflammatory, anatomic, metabolic, or neoplastic process to explain the symptoms.

Irritable bowel syndrome-

All of the following present at least once weekly for at least 2 months:

  • Abdominal discomfort or pain associated with two or more of the following:
    • Improvement with defecation
    • Onset associated with a change in stool frequency
    • Onset associated with a change in stool form.
  • No evidence of an inflammatory, anatomic, metabolic, or neoplastic process to explain the symptoms.

Functional abdominal pain-

All of the following present at least once weekly for at least 2 months:

  • Episodic or continuous abdominal pain.
  • Does not meet criteria for another FGID.
  • No evidence of an inflammatory, anatomic, metabolic, or neoplastic process to explain the symptoms.

Aerophagia-

  • Pain for more than 12 weeks with two or more of the following:
  • Air swallowing
  • Abdominal distension
  • Increased flatus

Abdominal migraine-

All of the following must have occurred at least twice in the preceding 12 months:

  • Paroxysmal episodes of intense, acute periumbilical pain lasting at least 1 h.
  • Intervening periods without pain lasting weeks to months.
  • Pain which interferes with normal activities.
  • Pain associated with at least two of the following:
    • Anorexia
    • Nausea
    • Vomiting
    • Unilateral headache
    • Photophobia
    • Pallor
  • No evidence of an inflammatory, anatomic, metabolic, or neoplastic process to explain the symptoms.

Treatment:

Standard Medical Care and Reassurance is the basis of effective medical management. Explain to the parents about its benign nature, commonness. Thorough history and physical examination helps win the child and parent’s confidence.

Psychological Interventions:

Aims to modify belief, thought and behavioral response to symptoms. It includes:

  • Relaxation therapy
  • Biofeedback
  • Behavioral therapy
    • Coping skill therapy
    • Cognitive therapy
    • Hypnosis
    • Family therapy

Diet and regimen:

  • Avoid citrus food, chocolate, caffeine containing drinks, cheese.
  • Laxatives in constipation and incomplete rectal evacuation.

Homoeopathic treatment:

Top remedies for abdominal migraine:

Repertory of abdominal migraine:

MIND – ANGUISH – colic; with Coff.

MIND – DELIRIUM – alternating with – Abdomen; colic in plb.

MIND – FEAR – menses – during – menstrual colic, during ant-t.

MIND – FEAR – touched; of being – colic; in Nux-v.

MIND – IRRITABILITY – pain, during – colic; from coloc.

MIND – SHRIEKING – children, in – colic with Cham. Nux-v.

VERTIGO – ALTERNATING WITH – colic coloc. mag-c. spig. verat.

STOMACH – VOMITING – colic; during op.

STOMACH – VOMITING – food; from – colic; during op.

STOMACH – VOMITING; TYPE OF – bile – colic; with Chin. coloc. Iod. Nux-v. op.

STOMACH – VOMITING; TYPE OF – green – blackish – colic; with hell.

ABDOMEN – RETRACTION – Umbilicus – colic; during chel. nat-c.

ABDOMEN – RUMBLING – colic; after ars.

RECTUM – DIARRHEA – colic; after cortiso.

RECTUM – URGING – colic, during alum-sil. anac. coloc. elaps ind. indg. kali-n. nat-c. nat-p. NUX-V. op. sec.

STOOL – MUCOUS – colic and chilliness; with cop.

FEMALE GENITALIA/SEX – LEUKORRHEA – colic; after am-m. calc-p. con. lyc. mag-c. mag-m. sil. Sulph.

CHEST – PALPITATION of heart – colic; with plb.

CHEST – SPASMS of – colic; with Cupr. Sep. verat.

EXTREMITIES – COLDNESS – Thighs – colic, during Calc.

EXTREMITIES – CRAMPS – Feet – Soles – colic, preceding plb.

EXTREMITIES – CRAMPS – Legs – Calves – colic; with coloc. plb. sec.

EXTREMITIES – CRAMPS – Lower limbs – colic; with coloc.

EXTREMITIES – NUMBNESS – Upper limbs – colic; with aran.

EXTREMITIES – PAIN – Joints – alternating with – colic plb.

EXTREMITIES – PARALYSIS – Lower limbs – colic; with Plb.

EXTREMITIES – PERSPIRATION – Lower limbs – menstrual colic, during ant-t.

EXTREMITIES – TREMBLING – colic; after plb.

DREAMS – WIND COLIC fago.

CHILL – EVENING – colic; with led.

FEVER – ACCOMPANIED BY – migraine tub-d.

PERSPIRATION – COLIC, during mez. nux-v. plan. plb. sulph.

SKIN – PURPURA – colic; with bov. coloc. cupr. merc-c. thuj.

GENERALS – CONVULSIONS – colic, during bell. CIC. Cupr. plb. sec.

GENERALS – FAINTNESS – colic, during intestinal asaf. Castm. Coll. Coloc. hydr. Manc. Nux-m. stram.

GENERALS – FOOD and DRINKS – beer – desire – colic, after ph-ac.

GENERALS – PAIN – neuralgic – accompanied by – colic alumn. ant-t. ars. Atro. Bell. cham. Cocc. coloc. cupr-ar. cupr. Dios. euph. hydr-ac. hyos. kali-c. mag-p. Nux-v. op.  plb-act. Plb. santin. tab. verat. zinc.

GENERALS – STRETCHING OUT – colic, during haem. plb.

STOOL – Concomitants during stool – colic Merc-c.

STOOL – Concomitants after stool – abdomen – colic mag-p.

STOOL – Concomitants after stool – anus, and rectum – colic in mag-m.

URINE – After urination – abdomen – colic eup-per.

CHEST – Aggravation – colic, during plb.

STOMACH – PAIN – extending to – Umbilicus brom. Cina dulc. jatr-c. kola lach. lyc. nit-ac. puls.

STOMACH – PAIN – extending to – Umbilicus – cutting painnat-c. phos.

STOMACH – PAIN – Umbilicus; region of – extending to – Throat – gnawing pain acon.

ABDOMEN – PAIN – drawing in umbilicus agg. bar-c. chel. plb.

ABDOMEN – PAIN – Hypochondria – extending to – Umbilicus aloe carl. kali-chl. rhus-t.

ABDOMEN – PAIN – Hypochondria – extending to – Umbilicus – cutting pain borx.

ABDOMEN – PAIN – Hypochondria – extending to – Umbilicus – pressing pain ph-ac.

ABDOMEN – PAIN – Hypogastrium – menses – before – agg. – extending to – Umbilicus lach. lyc. phos. sep.

ABDOMEN – PAIN – Hypogastrium – extending to – Umbilicus cadm-met. lach. lyc. phos. sep.

ABDOMEN – PAIN – Hypogastrium – extending to – Umbilicus – stitching pain carb-v.

ABDOMEN – PAIN – Sides – extending to – Umbilicus – lying on right side agg. – stitching pain plat.

ABDOMEN – PAIN – Sides – extending to – Umbilicus – pressing pain aloe

ABDOMEN – PAIN – Umbilicus Aesc. agar. All-c. Aloe Apis Arn. ars-i. Ars. arund. asaf. bapt. bar-c. bar-i. bar-ox-suc. bol-la. bov. bry. cadm-met. cain. Calc-p. calc. canth. carbn-s. caul. Cham. CHEL. Chin. chion. cimic. Cina coc-c. Coloc. con. crot-t. Dios. dulc. echi. ferr-i. fl-ac. fum. gels. ign. indg. iod. Ip. kali-bi. kali-c. kali-n. kalm. kreos. lac-d. lac-h. laur. lec. Lept. lyc. mag-c. mang. merc-c. merc. merl. mosch. mur-ac. nat-c. nat-m. nat-s. nit-ac. nux-m. Ox-ac. paraf. petr-ra. ph-ac. phos. phyt. Plat. plb. Ptel. ran-b. rhus-v. ruta senec. sep. sil. squil. stann. stram. Stront-c. sul-ac. sumb. symph. ter. tub. ust. valer. verat. verb.

ABDOMEN – PAIN – Umbilicus – left side of – stitching pain jac-c.

ABDOMEN – PAIN – Umbilicus – morning – drawing pain con. mang. nat-c.

ABDOMEN – PAIN – Umbilicus – morning – stitching pain agar.

ABDOMEN – PAIN – Umbilicus – forenoon – cutting pain Rhus-t. sil.

ABDOMEN – PAIN – Umbilicus – afternoon – 14 h – tearing pain laur.

ABDOMEN – PAIN – Umbilicus – afternoon – cutting pain cimic.

ABDOMEN – PAIN – Umbilicus – afternoon – stitching pain alum.

ABDOMEN – PAIN – Umbilicus – evening – cutting pain nux-m.

ABDOMEN – PAIN – Umbilicus – night – cutting pain nux-m.

ABDOMEN – PAIN – Umbilicus – bending – body – agg. – drawing pain nit-ac. tax.

ABDOMEN – PAIN – Umbilicus – bending – body – backward agg. – drawing pain oci-sa.

ABDOMEN – PAIN – Umbilicus – bending – forward – amel. – cutting pain bov. calad. Rhus-t.

ABDOMEN – PAIN – Umbilicus – boring pain sep. tarax.

ABDOMEN – PAIN – Umbilicus – breathing deep agg. – cutting pain mang.

ABDOMEN – PAIN – Umbilicus – child refers to the navel as the most painful part dulc.

ABDOMEN – PAIN – Umbilicus – cutting pain ant-t. bol-la. bov. cact. calad. castm. Chinin-s. cimic. coc-c. colch. Coloc. crot-t. dios. dulc. indg. Ip. laur. Nux-m. Nux-v. plb. puls-n. rhus-t. rhus-v. sil. ter. verat-v. VERAT.

ABDOMEN – PAIN – Umbilicus – drawing pain acon. aloe anac. ars. bar-c. bell. calc-p. calen. carbn-s. Chel. clem. con. eupi. gamb. gent-c. grat. ign. kali-c. mang. mez. mosch. nat-c. nit-ac. nux-m. nux-v. oci-sa. phos. plat. Plb. ran-b. rat. rhus-t. ruta sep. sulph. tab. zinc.

ABDOMEN – PAIN – Umbilicus – eating; after – drawing pain con.

ABDOMEN – PAIN – Umbilicus – inspiration agg.; deep – stitching pain Hyos. sil. verb.

ABDOMEN – PAIN – Umbilicus – menses – during – agg. – drawing pain nux-m.

ABDOMEN – PAIN – Umbilicus – motion agg. – drawing pain nit-ac.

ABDOMEN – PAIN – Umbilicus – motion agg. – stitching pain cycl. mag-s.

ABDOMEN – PAIN – Umbilicus – rising agg.; after – drawing pain con.

ABDOMEN – PAIN – Umbilicus – sitting agg. – drawing pain kali-c.

ABDOMEN – PAIN – Umbilicus – sneezing agg. – stitching pain aloe

ABDOMEN – PAIN – Umbilicus – standing agg. – stitching pain alum.

ABDOMEN – PAIN – Umbilicus – stitching pain acon. AGAR. aloe alum. ammc. Anac. ant-t. asaf. Bell. cic. cocc. colch. coloc. Cycl. Dig. dulc. grat. gymno. ham. hyos. IP. kreos. laur. mag-s. merc-i-f. nux-v. pall. pic-ac. Plat. PLB. raph. rhus-t. ruta sep. sil. sulph. verb.

ABDOMEN – PAIN – Umbilicus – stool – after – amel. – drawing pain oci-sa.

ABDOMEN – PAIN – Umbilicus – stool – before – drawing pain nat-c.

ABDOMEN – PAIN – Umbilicus – stooping agg. – stitching pain verb.

ABDOMEN – PAIN – Umbilicus – synchronous with pulse – stitching pain rhus-t.

ABDOMEN – PAIN – Umbilicus – tearing pain amph. chin. crot-t. cycl. laur. nux-v. plb. stram.

ABDOMEN – PAIN – Umbilicus – waking; on – stitching pain agar.

ABDOMEN – PAIN – Umbilicus – walking – agg. – drawing pain anac.

ABDOMEN – PAIN – Umbilicus – walking – agg. – stitching pain sulph.

ABDOMEN – PAIN – Umbilicus – walking – amel. – drawing pain kali-c.

ABDOMEN – PAIN – Umbilicus – walking – rapidly – agg. – stitching pain chin.

ABDOMEN – PAIN – Umbilicus – Above – pressing pain kali-c. mang.

ABDOMEN – PAIN – Umbilicus – Above – pressure – amel. – boring pain Cina

ABDOMEN – PAIN – Umbilicus – Above – stitching pain aur. bell. chel. dig. grat. kali-c. nat-m. rhus-t.

ABDOMEN – PAIN – Umbilicus – Below – morning – pressing pain calc.

ABDOMEN – PAIN – Umbilicus – Below – constricting pain stroph-s.

ABDOMEN – PAIN – Umbilicus – Below – cutting pain mez.

ABDOMEN – PAIN – Umbilicus – Below – pressing pain symph.

ABDOMEN – PAIN – Umbilicus – Below – stitching pain bar-c. calc. chel. chin. coloc. hyos. kali-bi. mag-c. olnd. plb. ruta

ABDOMEN – PAIN – Umbilicus – Below – stool – after – agg. – cutting pain nat-c.

ABDOMEN – PAIN – Umbilicus – Below – extending to – Pudendum – stitching pain ruta

ABDOMEN – PAIN – Umbilicus – Region of umbilicus acon. Aesc. agar. All-c. Aloe Am-m. ant-c. ant-t. apis arg-n. arn. ars. asaf. atra-r. bapt. bar-c. Bell. berb. bism. bov. Bry. cadm-met. Calc-p. calc. canth. Carb-an. carb-v. carbn-s. caul. caust. cench. Cham. Chel. Chin. chinin-ar. cina clem. coc-c. Colch. coll. COLOC. crot-h. Crot-t. cupr. dig. DIOS. dulc. erig. eucal. fl-ac. Gamb. gels. gran. graph. gymno. hell. hep. heroin. hir. hydr. indg. Iod. Ip. Iris jatr-c. jug-c. kali-bi. kali-i. kali-n. kali-sula. kreos. lac-ac. Laur. Lept. lyc. mag-c. malar. mang. merc-c. merc-i-f. merc. mez. mosch. mur-ac. nat-ar. Nat-c. Nat-m. NAT-S. nit-ac. nux-m. Nux-v. onos. op. ox-ac. ozone pert-vc. petr. Ph-ac. phel. phos. phys. Phyt. Plat. PLB. Ptel. ran-b. Raph. rat. rhod. Rhus-t. rhus-v. ruta sabin. sang. sarr. sars. senec. seneg. sep. sphing. spig. spong. stann. staph. stront-c. stroph-s. sul-i. Sulph. sumb. tab. tarent. teucr. Thuj. toxo-g. tritic-vg. tub. ust. valer. vanil. verat-v. Verat. zinc-p. Zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – right – pressing pain kali-bi.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – right – stitching pain kali-c. zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – daytime – cutting pain stann.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – morning – 7 h – cutting pain scroph-n.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – morning – cutting pain bros-gau. hell. mang. petr. sars. sulph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – morning – pressing pain mang.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – morning – tearing pain dig.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – morning – twisting pain hell.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – forenoon – 10 h – cutting pain verat-v.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – forenoon – cutting pain nat-c. sars.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – forenoon – menses; during – cutting pain mag-c.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – noon – cutting pain mag-m.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – afternoon – 16 h – cutting pain lyc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – afternoon – 16 h – pressing pain Sulph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – afternoon – cutting pain lyc. naja ptel. spig. ABDOMEN – PAIN – Umbilicus – Region of umbilicus – afternoon – pressing pain alum.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – afternoon – standing agg. –  pressing pain alum.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – evening – bed agg.; in – pressing  pain chin. valer.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – evening – bed agg.; in – stitching pain staph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – evening – cutting pain bar-c. bry. nat-m. staph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – evening – pressing pain nat-m.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – night – midnight – cutting pain sulph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – night – cutting pain sil.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – night – pressing pain carb-v. sep. sulph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – night – twisting pain ruta

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – bed; when going to – cutting pain nat-m.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – biting pain petr.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – boring pain aloe apis calen. cina lac-c. nat-m. plb. seneg. sep. tarax.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – breakfast – before – agg. – tearing pain NAT-S.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – bursting pain dulc. thuj. verb.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – clawing pain acon. Bell. Hep. kreos. petr. stann.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – cold – drinks – after – agg. – cutting pain calc-p.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – cough – during – agg. – pressing pain ambr.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – cutting pain aesc. agar. aloe am-c. am-m. ammc. ant-t. arn. asaf. bar-c. bell. bov. brom. cact. calad. calc-p. camph. canth. caps. castm. cham. chin. chinin-s. cimic. cocc. COLOC. con. crot-t. Cupr. DIOS. Dulc. graph. grat. hell. hyos. hyper. ign. iod. IP. kali-bi. Kali-c. Kali-i. kali-m. Kali-n. kali-p. kreos. laur. led. lyc. Mag-c. mag-m. Mang. Merc-c. merl. mez. mur-ac. naja nat-c. Nat-m. nux-m. NUX-V. ol-an. Op. paeon. petr. phos. plan. plat. plb. psor. ptel. puls. raph. Rheum rhus-t. rhus-v. Sars. senec. sep. Sil. sol-ni. spig. Stann. staph. Sul-ac. sulph. tab. ust. valer. verat-v. verat. verb. zinc-p. zinc. zing.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – delivery; during – cutting pain IP. NUX-V.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – diarrhea – after – agg. – cutting pain cupr. nat-m.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – diarrhea – before – stitching pain gamb.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – digging pain carc. dig. mag-c. Scir. stann.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – dinner – after – agg. – cutting pain cham.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – dinner – after – agg. – tearing pain crot-t.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – dinner – before – cutting pain mang.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – drawing pain rhus-t.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – eating – after – agg. – cutting pain Coloc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – eating – after – agg. – pressing pain anac. chin. Coloc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – eating – after – agg. – stitching pain bov. bry. sulph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – eating – agg. – stitching pain dig.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – eructations – amel. – pressing pain ambr.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – expiration – agg. – tearing pain coloc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – expiration – during – agg. – cutting pain rhus-t.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – flatus; passing – amel. – cutting pain Mag-c. sars.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – flatus; passing – amel. – twisting pain mez.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – gnawing pain ars. berb. cimic. coloc. dulc. gamb. grat. kali-bi. nat-m. olnd. ruta

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – ice cream agg. – cutting pain calc-p.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – inspiration – agg. – cutting pain arn. coloc. Mang.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – inspiration – agg. – pressing pain anac. coloc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – inspiration – agg. – stitching pain cina spig.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – laughing aloud agg. – tearing pain coloc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – leukorrhea – before – twisting pain

nat-c.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – leukorrhea – with – cutting pain am-m. sil.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – lying – bent; lying – amel. – cutting pain hell.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – menses – before – agg. – clawing pain kreos.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – menses – during – agg. – cutting pain mag-c.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – motion agg. – cutting pain caps.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – motion agg. – stitching pain irid-met. zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – periodical – pressing pain Chel. ph-ac.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – pinching pain acon. alum. am-m. anac. ant-t. bar-c. bell. bry. calc. camph. carb-an. Carb-v. caust. cham. Chel. chin. dulc. graph. guaj. Hell. ign. Ip. kali-bi. Kreos. laur. mag-c. mag-m. meny. merc-c. mez. mur-ac. nat-c. nux-m. nux-v. par. ph-ac. plat. plb. ran-b. rhod. rhus-t. sabad. sabin. spig. Stann. stront-c. verat. verb. zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – pressing pain acon. alum. am-c. ambr. ANAC. arn. asaf. bell. bry. calc. camph. carb-v. chel. Chin. chinin-s. cina cocc. colch. Coloc. crot-h. crot-t. cupr. dig. Dios. dulc. grat. hell. hyos. ign. kola Lach. lact. lyc. mang. meny. merc. mosch. Nat-m. nit-ac. olnd. petr. Ph-ac. Ran-s. raph. rheum samb. seneg. sep. sil. Spig. stann. staph. sul-ac. Sulph. tab. teucr. valer. vanil. Verb. zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – pressure – agg. – cutting pain chel. ip.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – pressure – agg. – pressing pain anac. cina zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – pressure – agg. – tearing pain plb.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – pressure – amel. – cutting pain nat-m. Stann.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – respiration – pressing pain anac.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – retraction of abdomen agg. – pressing pain zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – rising – after – agg. – cutting pain sulph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – sitting – agg. – cutting pain nat-c. rhus-t.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – standing agg. – pressing pain alum.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stepping – every step; at – cutting pain arn.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stitching pain acon. aesc. am-m. ambr. anac. androc. ant-t. arn. asaf. bamb-a. bell. bov. bry. canth. chin. cina cocc. colch. Coloc. Cupr. cycl. dig. dulc. eupi. gamb. gels. grat. hyos. kali-c. kreos. lyc. mag-c. merc-c. mosch. mur-ac. nat-m. Nux-v. olnd. ph-ac. plat. plb. rhus-t. ruta sep. sil. spig. spong. staph. sul-ac. sulph. tritic-vg. vanil. verb. zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stitching pain – pulsating pain staph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stool – after – agg. – cutting pain Aloe cact. COLOC.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stool – after – agg. – pressing pain anac.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stool – after – agg. – stitching pain

bamb-a.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stool – amel. – cutting pain benz-ac.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stool – before – cutting pain Gamb. graph. grat. nat-c. NUX-V.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stool – during – agg. – gnawing pain kali-bi.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stool – during – agg. – pressing pain anac.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stooping – agg. – cutting pain caps. sulph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – stooping – agg. – pressing pain Verb.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – tearing pain agar. arn. ars. carbn-s. Cham. chin. coloc. con. crot-t. cupr. dig. dios. grat. ip. jatr-c. mag-c. mang. merc-c. Nat-s. Plb. psor. stram. tep. ter. verb. zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – touch agg. – cutting pain ip.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – touch agg. – stitching pain zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – turning body to the left agg. – stitching pain bamb-a.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – twisting pain all-s. aloe ang. berb. bry. calc. caps. cimic. Cina COLOC. con. crot-t. dulc. hell. ign. kali-c. mez. naja nat-c. nat-m. nux-m. ox-ac. plat. Plb. ran-b. ruta sil. verb.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – ulcerative pain mag-c.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – waking; on – cutting pain sulph.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – walking – agg. – cutting pain arn. caps. dios. sul-ac.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – walking – agg. – pressing pain anac. zinc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – walking – agg. – stitching pain spig.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – walking – air agg.; in open – pressing pain bry.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – walking – rapidly – agg. – pressing pain chin.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – weather – cold – agg. – cutting pain Dulc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – yawning – agg. – cutting pain sars.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – Above umbilicus, comes and goes slowly carc.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – extending to – Anus – pressing pain ox-ac.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – extending to – Bladder – tearing pain carbn-s.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – extending to – Chest, left – pressing pain chel.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – extending to – Epigastrium – pressing pain crot-t.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – extending to – Lumbar region – cutting pain bell.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – extending to – Mons pubis – drawing pain rhus-t.

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – extending to – Rectum – cutting pain aloe

ABDOMEN – PAIN – Umbilicus – Region of umbilicus – extending to – Uterus – stitching pain IP.

ABDOMEN – PAIN – Umbilicus – Sides – right – stitching pain bamb-a. dulc. grat. heroin. kali-c. lyc. nat-m. tritic-vg.

ABDOMEN – PAIN – Umbilicus – Sides – left – stitching pain am-m. anac. cina con. crot-t. dulc. kali-i. sul-ac.

ABDOMEN – PAIN – Umbilicus – Sides – stitching pain crot-t. dulc. grat. kali-c. kali-i. lyc. psil. psor. raph. spig.

ABDOMEN – PAIN – Umbilicus – extending to – Abdomen – stitching pain sul-ac.

ABDOMEN – PAIN – Umbilicus – extending to – Anus – drawing pain nat-m.

ABDOMEN – PAIN – Umbilicus – extending to – Back – cutting pain sil.

ABDOMEN – PAIN – Umbilicus – extending to – Back – drawing pain oci-sa.

ABDOMEN – PAIN – Umbilicus – extending to – Back – stitching pain ptel.

ABDOMEN – PAIN – Umbilicus – extending to – Bladder – stitching pain cic.

ABDOMEN – PAIN – Umbilicus – extending to – Heart – stitching pain rhus-t.

ABDOMEN – PAIN – Umbilicus – extending to – Legs – drawing pain nux-m.

ABDOMEN – PAIN – Umbilicus – extending to – Mammae – stitching pain Pall.

ABDOMEN – PAIN – Umbilicus – extending to – Mammae – Region of – stitching pain kreos.

ABDOMEN – PAIN – Umbilicus – extending to – Pelvis – stitching pain pall.

ABDOMEN – PAIN – Umbilicus – extending to – Pubis – drawing pain rhus-t.

ABDOMEN – PAIN – Umbilicus – extending to – Pudendum – cough agg.; during – stitching pain sep.

ABDOMEN – PAIN – Umbilicus – extending to – Stomach – cutting pain crot-t.

ABDOMEN – PAIN – Umbilicus – extending to – Thighs – drawing pain nat-m.

ABDOMEN – PAIN – Umbilicus – extending to – Uterus – stitching pain IP.

ABDOMEN – PAIN – Umbilicus – extending to – Vagina – drawing pain calc-p.

ABDOMEN – PAIN – extending to – Umbilicus crot-c.

ABDOMEN – PAIN – extending to – Umbilicus – pressing pain crot-c.

RECTUM – PAIN – pressure – umbilicus agg.; on CROT-T.

RECTUM – PAIN – extending to – Umbilicus cadm-met. ign. Lach.

RECTUM – PAIN – extending to – Umbilicus – drawing pain Lach.

BLADDER – PAIN – night – alternating with – Umbilicus; pain in ter.

BLADDER – URINATION – urging to urinate – frequent – cutting pain from umbilical to ovarian region coloc.

GENERALS – SHUDDERING, nervous – pain – during – umbilicus; in chin. ip.

Prognosis:

  • Twenty-five percent of people with functional abdominal pain continue to have pain or headache in adulthood
  • Recurrent abdominal pain may be antecedent of IBS in adults
  • Incidence of psychiatric disorders particularly anxiety disorders in adults
  • The acceptance of the biopsychosocial model by the patients and their families is an important factor in the response to therapy.

Bibliography:

  • Acute Abdominal Pain > WHAT ARE THE PATIENT’S RISK FACTORS FOR GASTROINTESTINAL DISORDERS? Book: Principles and Practice of Hospital Medicine, 2e… pain syndrome Right upper quadrant (mainly) tenderness and positive Carnett sign Neurologic/Psychiatric Herpes zoster Unilateral, painful vesicular rash in dermatomal distribution, positive DFA of lesion or PCR of fluid Abdominal migraine Adolescents, cyclic occurrence…
  • Acute Abdominal Pain: Basic Principles & Current Challenges > General Considerations Book: CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e… Chronic abdominal wall pain syndrome RUQ (mainly) tenderness and positive Carnett sign Neuropsychiatric Herpes zoster Unilateral, painful vesicular rash in dermatomal distribution, positive DFA of lesion or PCR of fluid Abdominal migraine Adolescents, cyclic occurrence…
  • Disorders of the Autonomic Nervous System, Respiration, and Swallowing > Cyclic vomiting syndrome Book: Adams and Victor’s Principles of Neurology, 11e … This syndrome of obscure cause is associated with abdominal migraine in children (see Chap. 9 ), and is a prominent component of Riley-Day dysautonomia. It is also well known as a factitious self-induced disorder, for example, in bulimia. Cyclic vomiting syndrome…
  • Encyclopedia Homoeopathica
  • Gastrointestinal Emergencies > Clinical Description Book: CURRENT Diagnosis & Treatment: Emergency Medicine, 8e …, and “abdominal migraine,” which has similar diagnostic criteria as CVS may be a concurrent diagnosis. Diarrhea and mild fever may be present in one-third of cases, presenting like gastroenteritis. Triggers for vomiting episodes may be present, such as infections (sinusitis most common), foods (chocolate…
  • Headache > ED Treatment of Migraine Book: Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e …ED Treatment of Migraine TABLE 165-7 Treatment Options for Migraine Headache Drug Dosing Contraindications Precautions and Pregnancy Category Notes Ketorolac 10–30 milligrams IV or IM History of peptic ulcer disease (especially in elderly…
  • Neurologic & Muscular Disorders > A. Symptoms and Signs Book: Current Diagnosis & Treatment: Pediatrics, 25e … headaches with autonomic dysfunction (watery eye, congestion, facial sweating, miosis, ptosis). According to the ICHD-III, migraines include childhood periodic syndromes such as cyclic vomiting, abdominal migraine, and benign paroxysmal vertigo of childhood. History of these periodic syndromes may…
  • Overview of Headache > DIAGNOSTIC CRITERIA AND CLASSIFICATION Book: Principles of Rehabilitation Medicine… without aura 1.5.2 Probable migraine with aura 1.6 Episodic syndromes that may be associated with migraine 1.6.1 Recurrent gastrointestinal disturbance 1.6.1.1 Cyclical vomiting syndrome 1.6.1.2 Abdominal migraine 1.6.2 Benign paroxysmal vertigo 1.6.3 Benign…
  • Radar 10
  • The 22q11.2 Deletion Syndrome > Clinical Characteristics Book: Clinical Genomics: Practical Applications in Adult Patient Care …, juvenile rheumatoid arthritis, vitiligo), neurologic problems (unprovoked seizures, polymicrogyria, cerebellar abnormalities, cervical cord compression, neural tube defects, abdominal migraines), ophthalmologic findings (sclerocornea, coloboma, micro/anophthalmia, posterior embryotoxin, tortuous retinal…
  • Radar Opus 2.1.11

About the Author©:

 Dr. Rajneesh Kumar Sharma M.D. (Homoeopathy)

Dr. Divyanshi Lohni BHMS

Dr. Aarti Singh BHMS

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