Which Specialist to See for Headache and Coughing Up Blood?

If you are experiencing headaches and coughing up blood, you should see a specialist in either neurology for the headaches or pulmonology for the respiratory symptoms. It may also be advisable to consult an emergency medicine physician, as coughing up blood can be a sign of a serious condition?

My 29-year-old male family member has had mild cold symptoms for about three weeks.
He has experienced alternating chills and fever, and his nasal discharge has a foul odor.
He has only taken over-the-counter medication and has not visited a hospital or clinic.
Two weeks ago, he went to the emergency department at Cheng Kung University Hospital due to eye pain and headache, where he was diagnosed with a cold.
However, he felt fine the next day.
Last night, he experienced a headache, chills, and suddenly coughed about six times, with the first two coughs producing dark brown fluid, followed by a cough that brought up thin, bright red blood-like fluid.
This was different from the usual sour-smelling vomit.
After coughing, he still had a headache, but he felt fine again in the morning.
What specialty should he see, and what tests should be done? Thank you!

Miss Hou, 20~29 year old female. Ask Date: 2003/11/10

Dr. Lin Mingxing reply Family Medicine

The Department of Family Medicine at Tainan Hospital, under the Ministry of Health and Welfare, responds to the online inquiry: Based on your description, it is likely that the bleeding is caused by the rupture of blood vessels due to damage to the mucosa of the throat or trachea from severe coughing.
If this is the case, it is generally not concerning.
Additionally, it is important to consider your medical history or any exposure history (such as contact with tuberculosis patients) and to consider a chest X-ray to rule out any other issues.

Reply Date: 2003/11/10

More Info

Based on the symptoms you've described regarding your family member, it is crucial to approach this situation with a sense of urgency, especially considering the combination of persistent headaches, coughing up blood, and a history of cold-like symptoms. Here’s a detailed breakdown of the situation and recommendations on which specialists to consult.

Symptoms Overview
1. Persistent Headache: The recurring nature of the headaches, especially if they are severe or accompanied by other symptoms, warrants further investigation.

2. Coughing Up Blood: This is a significant symptom that should never be ignored. The presence of dark brown fluid followed by bright red blood can indicate various underlying issues, ranging from minor to severe.

3. Cold Symptoms: The ongoing cold symptoms, including nasal discharge with an unpleasant odor, suggest a possible infection or sinus issue.

Recommended Specialists
Given the combination of symptoms, the following specialists should be considered:
1. Pulmonologist: Since your family member is experiencing coughing up blood, a pulmonologist (lung specialist) is essential. They can conduct tests such as a chest X-ray or CT scan to evaluate the lungs and airways for any abnormalities, infections, or conditions like bronchitis or pneumonia.

2. Otolaryngologist (ENT Specialist): Given the nasal symptoms and the history of eye pain, an ENT specialist can assess for sinus infections or other upper respiratory issues that may be contributing to the symptoms. They can perform a thorough examination of the nasal passages and throat.

3. Neurologist: If the headaches persist or worsen, a neurologist should be consulted to rule out any neurological issues. They may recommend imaging studies like an MRI or CT scan of the brain to ensure there are no serious underlying conditions.

Suggested Tests
- Chest X-ray or CT Scan: To check for any lung issues, such as infections, masses, or other abnormalities.

- Complete Blood Count (CBC): This can help identify signs of infection or other hematological issues.

- Sputum Culture: If there is a significant amount of blood in the sputum, a sample can be analyzed to identify any infectious agents.

- Nasal Swab or Culture: To check for bacterial or viral infections that could be causing the nasal symptoms.

Conclusion
It is critical that your family member seeks medical attention promptly, especially due to the symptom of coughing up blood. This could indicate a serious condition that requires immediate evaluation and treatment. Start by visiting a pulmonologist, and based on their findings, they may refer to an ENT or neurologist as necessary. Early intervention can lead to better outcomes, so do not delay in seeking care.

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