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Headache/Vomiting
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Headache/Vomiting

Hi,
I'm a medical student. A good friend approached me with some recent complaints. She is a 23 yr old asian female complaining of headaches and nausea/vomiting for the past 2.5 weeks. She is experiencing headaches intermittently, sometimes tension type, sometimes unlateral throbbing and migraine like. She also has vomitting (with or without nausea), BUT the vomiting does NOT coincide with the headaches. It tends to occur a day or even 2 afterward. In the past 2.5 wks she has experienced roughly 4-5 episodes of headaches, but she used to have headaches only a few times a year. The headaches last 1-5 hours and usually occur after in afternoon or evening. Napping often helps relieve it. She has experienced 3-4 intermittent days of vomiting. On these occasions, she could vomit between 1 to 5 times that day.

Pregnancy has been ruled out. She went to a walk-in clinic last week, papilledema was not detected at the time; the doc said it could be migraines. I'm suspcious because my impression is that migraine induced vomiting/nausea should coincide with the headache, not occur afterwards. My impression is that migraine variants (e.g. cyclic vomiting syndrome) tend to be quite rare.

No visual disturbances recently, but 4 years ago she had 2 incidents of sudden transient bilateral visual loss lasting 1-5 seconds (typical of papilledema induced sudden visual loss), however, eye exam turned up completely normal (done by ophthalmologist).

No balance problems, no ataxia, no aphasia, no seizures, no memory/cognitive issues, headache not worse in morning or with movement. She has normal BMI.
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There can be variation with the nausea and headaches in migraine cases.  However, it is less likely given the time course relationship.  

With the other neurological symptoms, further imaging should be considered.  A head CT and/or brain MRI should be considered.  Once migraine is ruled out, the combination of headaches and nausea can point to a more serious neurological disease.

If the neurological workup is negative, GI tests (i.e. an upper endoscopy or abdominal ultrasound) can be considered to look for the cause of the continuing nausea.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com
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No history of travel or recent infection, no other GI system symptoms
Family history of migraines is unknown.

She is planning to see a doctor again soon, but I have several concerns.

1) Is it common for migraine-related vomiting/nausea to occur one day after the headache phase
2) With the given presentation and information, what is the likelihood of serious pathology? (e.g. brain tumor, increased ICP)
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A related discussion, vomiting+headache was started.
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