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.