Headaches and Nausea: When to Seek Specialist Care - Otolaryngology

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Headache and vomiting?


Hello Doctor: Yesterday I experienced dizziness, headache, vomiting, a feeling of warmth in my body but also felt cold with cold sweats.
I visited a family medicine clinic, and the doctor said it didn't seem like a cold or gastroenteritis, and the condition was unclear.
They only prescribed pain relievers and antiemetics, suggesting I take the medication and see how it goes, as this happens to me once a year.
If this situation occurs again, which specialty should I consult?
Additionally, I mentioned to the clinic doctor that I often suddenly choke on saliva.
I am a chronic asthma patient and use an inhaler daily for control.
I also have a history of arrhythmia and underwent radiofrequency ablation last year.
The doctor advised me to see a neurosurgeon regarding the choking issue.
Which specialty should I actually consult?

Hua, 30~39 year old female. Ask Date: 2017/10/25

Dr. Zheng Jueyi reply Otolaryngology


Hello, if you frequently experience choking and dizziness, it is recommended to first visit the Ear, Nose, and Throat (ENT) department and the Neurosurgery department at the hospital for evaluation.
Wishing you safety and good health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the ENT Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2017/10/25

More Info


When experiencing symptoms such as dizziness, headaches, nausea, and sweating, it can be quite distressing, especially when these symptoms recur annually. Based on the information provided, it seems that your primary care physician has ruled out common conditions like the flu or gastroenteritis. Instead, they have prescribed pain relief and anti-nausea medication, suggesting that they want to monitor your symptoms before making a definitive diagnosis.

Given your history of chronic asthma and arrhythmia, it is crucial to approach your symptoms with caution. The combination of headaches, nausea, and dizziness can be indicative of various underlying issues, including but not limited to migraines, tension headaches, or even more serious conditions like vestibular disorders or neurological issues. Since you mentioned that this has been a recurring issue, it would be wise to seek further evaluation if the symptoms persist or worsen.


When to Seek Specialist Care
1. Neurologist: If your symptoms continue to recur, especially with the addition of neurological symptoms (like visual disturbances, severe headaches, or changes in consciousness), it would be prudent to consult a neurologist. They can perform a thorough evaluation, which may include imaging studies like an MRI or CT scan, to rule out any serious conditions such as a migraine variant, intracranial pressure issues, or other neurological disorders.

2. Pulmonologist: Given your chronic asthma, if you experience increased shortness of breath, wheezing, or any respiratory distress alongside your other symptoms, a pulmonologist may be necessary. They can assess whether your asthma is contributing to your symptoms or if there is another underlying respiratory issue.

3. ENT Specialist: If you are experiencing dizziness that feels like vertigo, or if you have issues with balance, an Ear, Nose, and Throat (ENT) specialist may be able to help. They can evaluate for conditions such as Meniere's disease or vestibular neuritis, which can cause similar symptoms.

4. Gastroenterologist: If your nausea persists and is accompanied by gastrointestinal symptoms, a gastroenterologist may be appropriate. They can evaluate for conditions like gastroparesis or other digestive disorders that could be contributing to your symptoms.


Additional Considerations
- Medication Review: Since you are on medication for asthma and have a history of arrhythmia, it is essential to review all medications with your healthcare provider. Some medications can have side effects that may contribute to dizziness or nausea.

- Lifestyle Factors: Consider lifestyle factors that may exacerbate your symptoms, such as stress, dehydration, or dietary habits. Keeping a symptom diary can help identify triggers.

- Emergency Symptoms: If you experience severe headaches that feel different from your usual headaches, sudden onset of nausea, confusion, weakness, or any other alarming symptoms, seek emergency care immediately.


Conclusion
In summary, while your primary care physician has started with a conservative approach, it is essential to monitor your symptoms closely. If they recur or worsen, do not hesitate to seek specialist care. A neurologist would be a good starting point, given the combination of your symptoms and your medical history. Always prioritize your health and ensure that you have a comprehensive evaluation to rule out any serious conditions.

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