Throat Sensation and Nausea: When to Seek Medical Help

Sensation of a foreign body in the throat with dry heaving?

Hello Doctor: About two weeks ago, I started experiencing headaches...
The sensation is a tightness in the forehead between the eyebrows, with pain on both sides of the head.
Sometimes I feel dizzy and nauseous.
After visiting the clinic and receiving pain medication, my condition improved.
On April 29, I felt headache again, with occasional nausea (after eating, I couldn't vomit anything, it felt more like dry heaving), but after dry heaving, the headache was less intense.
That day, the cycle of headache -> dry heaving -> relief occurred about three times, and I took pain medication at night before going to sleep.
On April 30, I had a persistent sensation of a foreign body in my throat (near the Adam's apple) and dry heaved about 7-8 times throughout the day.
I have no other discomfort.
Doctor, what disease do my symptoms resemble, and which specialties should I consult? Thank you for your hard work.

Johnny, 30~39 year old female. Ask Date: 2023/04/30

Dr. Jiang Junyi reply Neurology

Dear Mr.
Johnny,
You mentioned that you feel tightness in your forehead and between your eyebrows, experience pain on both sides of your head, and sometimes feel dizzy and nauseous.
After visiting the clinic and receiving pain medication, you noticed some improvement.
You also mentioned a persistent sensation of a foreign body in your throat (near the Adam's apple), with approximately 7-8 episodes of dry heaving throughout the day.

The sensation of a foreign body in your throat may suggest esophagitis following vomiting.
If your symptoms have only occurred in the past two weeks and you had no prior issues, it may be worth considering tension-type headache, which is caused by muscle tightness in the head.
Common manifestations include tight, constricting pain in the forehead and temples, similar to wearing a tight headband.
This type of headache is typically due to muscle fatigue, often starting in the afternoon and peaking in the evening or at night.
Taking a warm bath, massaging, or sleeping may provide relief.
Lack of sleep, stress, or anxiety can exacerbate the severity of the headache.
In summary, tension-type headache may be triggered by stress, anxiety, or poor posture leading to excessive muscle tightness.
Treatment involves identifying and addressing the sources of stress, engaging in muscle relaxation exercises such as yoga, and being mindful of posture.
Pharmacological treatment usually includes muscle relaxants, anxiolytics, and mild analgesics.
However, if you experience severe headaches at night, it may be necessary to consider the possibility of increased intracranial pressure.

I recommend visiting a neurologist for further evaluation and follow-up.
Wishing you good health and peace.
Sincerely,
Dr.
Jiang Junyi
桃醫神內

Reply Date: 2023/04/30

More Info

Based on your symptoms and the timeline you've provided, it appears that you are experiencing a combination of headaches, nausea, and a sensation of something being stuck in your throat. These symptoms can be indicative of several underlying conditions, and it's important to approach them with a thorough evaluation.

Possible Causes of Your Symptoms
1. Tension-Type Headaches: The tightness you feel in your forehead and temples could be related to tension-type headaches. These are often caused by stress, anxiety, or muscle strain in the neck and shoulders. The accompanying nausea can sometimes occur with headaches, especially if they are severe.

2. Gastroesophageal Reflux Disease (GERD): The sensation of a lump in your throat, along with the dry heaving, may suggest GERD. This condition occurs when stomach acid flows back into the esophagus, causing irritation and discomfort. It can lead to symptoms such as heartburn, regurgitation, and a feeling of something stuck in the throat.

3. Migraine: Migraines can also present with nausea and vomiting, and they may cause a sensation of tightness or pressure in the head. The fact that your headache improves after vomiting could suggest a migraine, as some individuals find relief after experiencing nausea and vomiting.

4. Sinusitis: If you have any nasal congestion or facial pain, sinusitis could be a contributing factor. Inflammation of the sinuses can lead to headaches and a feeling of pressure, which might also cause nausea.

5. Infections: Viral infections, such as the flu or a cold, can lead to headaches, nausea, and throat discomfort. If you have had any recent upper respiratory symptoms, this could be a possibility.

When to Seek Medical Help
Given the persistence and combination of your symptoms, it is advisable to seek medical attention. Here are some guidelines on when to see a doctor:
- Severe Symptoms: If your headache becomes severe or is accompanied by visual disturbances, confusion, or weakness, seek immediate medical attention.

- Persistent Nausea: If the nausea continues and you are unable to keep food or fluids down, this could lead to dehydration and requires medical evaluation.

- Duration of Symptoms: Since your symptoms have been ongoing for two weeks, it is important to consult a healthcare provider to rule out any serious underlying conditions.

- Difficulty Breathing or Swallowing: If you experience any difficulty breathing or swallowing, this is a medical emergency and requires immediate attention.

Recommended Specialists
1. Primary Care Physician: Start with your primary care doctor, who can perform an initial evaluation and determine if further testing or referrals are necessary.

2. Neurologist: If your headaches are severe or unusual, a neurologist can assess for conditions such as migraines or other headache disorders.

3. Gastroenterologist: If GERD or other gastrointestinal issues are suspected, a gastroenterologist can provide specialized care.

4. Ear, Nose, and Throat (ENT) Specialist: If throat discomfort persists, an ENT specialist can evaluate for any structural issues or infections in the throat.

Conclusion
Your symptoms warrant further investigation to determine their cause and appropriate treatment. It is important to communicate all of your symptoms clearly to your healthcare provider, including the frequency and severity of your headaches, the nature of your nausea, and any other associated symptoms. Early intervention can lead to better outcomes and relief from your discomfort.

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