Severe Headaches and Nausea: Neurological Symptoms

Headache accompanied by nausea and other symptoms?

I have been experiencing mild, intermittent headaches for about 3 to 4 months.
They are usually not very noticeable, but I feel the pain more acutely when I shake my head.
Recently, the situation has worsened, and for the past two to three days, I have had headaches so severe that I feel like vomiting.
I feel very uncomfortable, although I haven't actually vomited.
My appetite has significantly decreased, and I have been experiencing intermittent fevers, especially noticeable at night, making it difficult to sleep.
I also have noticeable stomach pain when fasting.
Today, I visited a neurologist and mentioned the need for an MRI, but the appointment is not available until January.
Since my daily routine is somewhat irregular, the doctor did not seem particularly concerned and only ordered blood tests to check my thyroid function.
What should I do now?

Mr. Wu, 20~29 year old female. Ask Date: 2018/12/10

Dr. Jiang Junyi reply Neurology

Hello, based on your description, cervical myofascial pain syndrome should be considered first.
Symptoms may include pain, discomfort, muscle stiffness, or a heavy sensation.
Symptoms may worsen with changes in weather and can be alleviated with stretching activities, often recurring.
During acute episodes, there may be localized muscle tension and spasms, with limited mobility.
However, since you are experiencing intermittent fever, it may also be necessary to consider the possibility of an infection, such as tuberculosis or autoimmune diseases.
The definition of fever of unknown origin is: (1) a temperature exceeding 38.3°C, (2) fever lasting more than three weeks, and (3) no diagnosis after one week of hospitalization.
It is recommended that you consult with a neurologist and an infectious disease specialist for further evaluation and treatment.
Wishing you good health and peace.

Reply Date: 2018/12/10

More Info

Severe headaches accompanied by nausea can be indicative of various neurological conditions, and your symptoms warrant careful consideration. Given that you have experienced mild headaches for several months, which have recently escalated in intensity and are now associated with nausea, decreased appetite, intermittent fever, and abdominal pain, it is essential to approach this situation with a comprehensive understanding of potential underlying issues.

Firstly, the nature of your headaches is crucial. If they are characterized by a throbbing sensation, unilateral pain, or are accompanied by visual disturbances, they may suggest a migraine. Migraines can often lead to nausea and vomiting, and they can be exacerbated by stress, hormonal changes, or dietary factors. On the other hand, if your headaches feel like a tight band around your head and are bilateral, they may be classified as tension-type headaches, which are often linked to stress and muscle tension.

The fact that your headaches have intensified and are now causing nausea is concerning. Nausea can be a result of increased intracranial pressure, which may occur due to various reasons, including but not limited to, migraines, tension-type headaches, or more serious conditions such as intracranial hypertension or even a mass effect. The intermittent fever you are experiencing could suggest an underlying infection or inflammatory process, which could also contribute to your symptoms.

Your mention of abdominal pain, particularly when fasting, could indicate gastrointestinal issues that may or may not be related to your headaches. Stress and anxiety can exacerbate gastrointestinal symptoms, leading to discomfort and changes in appetite. However, it is essential to differentiate between primary headache disorders and secondary causes that may be linked to other medical conditions.

Regarding the MRI scheduling issue, it is unfortunate that you have to wait until January for imaging. However, there are several steps you can take in the meantime to manage your symptoms and ensure your health is monitored:
1. Symptom Diary: Keep a detailed diary of your headaches, noting the frequency, duration, intensity, associated symptoms (like nausea and fever), and any potential triggers. This information can be invaluable for your healthcare provider.

2. Hydration and Nutrition: Ensure you are staying hydrated and try to maintain a balanced diet. If nausea is affecting your appetite, consider small, frequent meals that are easy to digest.

3. Stress Management: Engage in relaxation techniques such as deep breathing, meditation, or gentle yoga. These practices can help alleviate tension that may contribute to your headaches.

4. Follow-Up: Stay in touch with your healthcare provider regarding your symptoms. If your condition worsens or if you experience new symptoms such as visual changes, severe vomiting, or neurological deficits (like weakness or numbness), seek immediate medical attention.

5. Thyroid Function Tests: Since your doctor has ordered blood tests to check your thyroid function, it is essential to follow through with these tests. Thyroid dysfunction can lead to various symptoms, including fatigue, weight changes, and mood disturbances, which may contribute to your overall condition.

6. Consider a Second Opinion: If your symptoms persist or worsen while waiting for your MRI, consider seeking a second opinion from another neurologist or a headache specialist who may provide additional insights or alternative management strategies.

In summary, while your symptoms may be indicative of a primary headache disorder, the combination of nausea, appetite changes, and fever necessitates further investigation to rule out secondary causes. It is crucial to remain proactive in managing your symptoms and maintaining open communication with your healthcare provider.

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