Recurring Headaches, Chills, and Vomiting: Possible Neurological Issues?

Recurring headaches, chills, and vomiting over the course of a month?

Hello Dr.
Jiang,
My mother began experiencing chills and forehead pain at the beginning of January this year, with her temperature rising from 36.5°C to around 37.1°C.
This was followed by vomiting within 1 to 2 days, and after fasting for 2 to 3 days, her condition improved.
Strangely, about 7 to 14 days after recovering, similar symptoms reoccurred.
Today marks the third instance of this situation, although the duration and severity of the symptoms seem to be gradually decreasing each time.
Each visit to the clinic has resulted in prescriptions for antacids, pain relievers, and antiemetics.

My mother has rarely been ill over the past few decades, and even during a COVID-19 infection, she had the mildest symptoms among our family of four.
For the past month, the other three family members have strictly followed preventive measures and have not experienced vomiting or similar symptoms, leading me to suspect that my mother may not be suffering from a gastrointestinal virus infection.

Could issues related to the brain or ophthalmological problems (the latter being inferred from the forehead pain symptom) present similar symptoms? If we were to go to a major hospital for more thorough examinations, which specialties would you recommend?
Thank you for your assistance, Dr.
Jiang.
Wishing you peace, health, and happiness in the new year, and may you shine brightly!

Mr. Huang, 30~39 year old female. Ask Date: 2024/02/03

Dr. Jiang Junyi reply Neurology

Hello Mr.
Huang,
You mentioned that your mother experienced chills and forehead pain at the beginning of January this year (her temperature rose from 36.5°C to around 37.1°C), followed by vomiting that began within 1 to 2 days, and that her condition improved after fasting for 2 to 3 days.
Strangely, after recovery, similar symptoms reappeared approximately 7 to 14 days later, and today marks the third occurrence of this situation.

May I ask your mother's age? If this is a case of viral gastroenteritis, symptoms typically resolve within about a week, leading to the development of immunity.
However, if there are recurrent fevers, I recommend consulting an infectious disease specialist.
The strict definition of "fever of unknown origin" is: multiple episodes of fever or persistent fever above 38.3°C lasting for three weeks or longer, with hospitalization and standard examinations showing persistent fever for one week without identifying a cause.
It has been found that 30-40% of these cases are due to infections, approximately 20-30% are caused by malignancies or cancers, and around 20% are related to collagen diseases or connective tissue disorders.
If there is a combination of headache and vomiting, I suggest discussing this with a neurologist, especially if the headaches occur at night.
Increased intracranial pressure may present with unsteady gait, impaired coordination or balance, visual disturbances, nausea, and vomiting.
Thank you for your inquiry.
I welcome further discussion and wish you good health, peace, and joy.
Dr.
Jiang Junyi
Department of Internal Medicine
Taoyuan Hospital

Reply Date: 2024/02/03

More Info

Dear Patient,
Thank you for sharing your mother's symptoms, which indeed raise several important considerations regarding her health. The recurring episodes of chills, forehead pain, and vomiting, especially in the context of her previously good health, warrant a thorough evaluation to rule out any underlying neurological or other systemic issues.

Understanding the Symptoms
1. Recurring Headaches: The forehead pain your mother experiences could be indicative of several conditions. Primary headaches, such as tension-type headaches or migraines, can cause localized pain and may be associated with nausea and vomiting. However, given the recurrent nature of her symptoms, it is essential to consider secondary causes of headaches, which could be related to more serious conditions such as intracranial hypertension, infections, or even tumors.

2. Chills and Vomiting: The presence of chills and vomiting alongside headaches raises the possibility of an infectious process. While gastrointestinal infections are common, the fact that your mother has experienced these symptoms multiple times over a short period suggests that it may not be a simple viral gastroenteritis. Instead, it could be a manifestation of a central nervous system infection, such as meningitis, or other systemic infections that may present with neurological symptoms.

3. Duration and Severity: You mentioned that the duration and severity of the symptoms seem to be decreasing with each episode. This could indicate a self-limiting process, but it is crucial to monitor this closely. A pattern of recurring symptoms, even if they are less severe, should not be overlooked.

Potential Neurological Issues
Given the symptoms described, it is prudent to consider the following neurological conditions:
- Meningitis: This is an infection of the protective membranes covering the brain and spinal cord, which can present with headaches, fever, chills, and vomiting.

- Intracranial Hypertension: Increased pressure within the skull can lead to headaches and vomiting, and it may be associated with other neurological signs.

- Cerebral Aneurysm or Tumor: While less common, these can also present with headaches and other systemic symptoms.

Recommended Actions
1. Consultation with Specialists: Given the complexity of your mother's symptoms, I recommend consulting with a neurologist for a comprehensive evaluation. They may suggest imaging studies, such as a CT scan or MRI of the brain, to rule out any structural abnormalities.

2. Further Testing: Depending on the neurologist's assessment, they may recommend additional tests, such as a lumbar puncture (spinal tap) to analyze cerebrospinal fluid if there is a suspicion of meningitis or other central nervous system infections.

3. Other Specialists: If the neurologist rules out neurological causes, it may be beneficial to consult with an infectious disease specialist, especially if there are concerns about systemic infections.

4. Monitoring Symptoms: Keep a detailed log of your mother's symptoms, including their onset, duration, severity, and any associated factors (like dietary changes or stress). This information can be invaluable for her healthcare providers.

Conclusion
In summary, while your mother's symptoms could be related to a variety of causes, the recurrent nature and combination of chills, headaches, and vomiting necessitate a thorough evaluation to rule out serious conditions. Engaging with a neurologist and possibly other specialists will be crucial in determining the underlying cause and appropriate treatment.
Thank you for your thoughtful inquiry, and I wish your mother a swift resolution to her health concerns.

Best regards,
Doctor Q&A Teams

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