Severe Headaches and Nausea: Possible Causes and Solutions

Headache with vomiting?

Hello, a friend of mine has been experiencing headaches that lead to vomiting for about four to five years, occurring approximately three to four times a year.
However, this year the situation has worsened, with episodes happening twice a month.
Previous tests, including EEG and blood tests, have all returned normal results.
In late August of this year, she was diagnosed with a retinal detachment and underwent surgery.
Her vision is currently in the process of recovery.
Initially, we thought the headaches and vomiting were caused by high intraocular pressure, and we expected that after the surgery, her condition would normalize.
Unfortunately, she has recently started experiencing these symptoms again.
Typically, the headache begins as a dull pain, and over-the-counter pain relievers are ineffective.
The pain then intensifies, often accompanied by a sensation of needing to use the restroom.
After using the bathroom, she experiences nausea and mild tremors in her hands, along with weakness in her limbs.
Following vomiting, the headache worsens, and she feels dizzy, often describing a sensation of shaking in her head.
Usually, she finds relief after undergoing gua sha treatment and taking a nap.
Additionally, during this recent episode, she immediately had her vision and intraocular pressure checked, both of which were normal.
Given that these symptoms have persisted for many years, I would like to inquire about the possible underlying causes.
Thank you!

Amy, 20~29 year old female. Ask Date: 2009/12/11

Dr. Cai Jueren reply Family Medicine

Hello, I apologize for the delay in responding due to my recent trip abroad.
Regarding the symptoms you mentioned, they may still be related to a brain issue, possibly central vertigo combined with typical migraines.
I recommend that you first visit an ENT clinic for an examination.
If everything is normal, you can then follow up with a neurologist.
Thank you for your correspondence, and I wish you good health.
Dr.
Tsai Jue-Ren, Hualien Hospital.

Reply Date: 2009/12/11

More Info

Severe headaches accompanied by nausea can be indicative of various underlying conditions, and understanding the potential causes is crucial for effective management. Your friend's history of headaches, particularly the recent increase in frequency and severity, warrants a thorough evaluation to rule out serious conditions.

Firstly, the fact that your friend has experienced headaches for several years, with an escalation to 3-4 times a month, suggests a chronic headache disorder. The initial symptoms of dull pain that escalate to severe headaches, followed by nausea and vomiting, can be characteristic of migraines. Migraines often present with a prodrome phase, where individuals may experience mood changes, fatigue, or gastrointestinal disturbances before the headache begins. The nausea and vomiting that follow can be quite debilitating and are common in migraine sufferers.

Given your friend's recent surgery for retinal detachment, it is essential to consider whether the headaches could be related to changes in intracranial pressure or other complications from the surgery. Although her eye pressure and vision are currently normal, the surgical procedure can sometimes lead to post-operative headaches due to inflammation or changes in the ocular structure.
Additionally, the symptoms of lightheadedness, hand tremors, and weakness could suggest a more systemic issue, such as a neurological condition or even a reaction to medication. If your friend is taking any new medications post-surgery, it would be wise to review these with her healthcare provider, as some medications can have side effects that include headaches and nausea.

Another potential cause to consider is tension-type headaches, which can occur due to stress, poor posture, or muscle tension, especially if your friend has been under stress or has changed her daily routine following her surgery. These headaches can also lead to nausea, particularly if they are severe.

It is also important to rule out secondary causes of headaches, such as increased intracranial pressure, which can occur due to various reasons, including infections, tumors, or other neurological conditions. Given that your friend has had normal brain wave and blood tests in the past, it may be beneficial for her to undergo further imaging studies, such as an MRI or CT scan, to ensure there are no structural abnormalities contributing to her symptoms.

In terms of management, it is crucial for your friend to maintain a headache diary, noting the frequency, duration, and intensity of her headaches, as well as any associated symptoms. This information can be invaluable for her healthcare provider in determining the best course of action.
For immediate relief, over-the-counter pain relievers such as acetaminophen or NSAIDs (like ibuprofen) can be effective, but if these are not providing relief, it may be necessary to explore prescription options, including triptans or preventive medications. Non-pharmacological approaches, such as relaxation techniques, biofeedback, and cognitive behavioral therapy, can also be beneficial in managing headache disorders.

In conclusion, while the symptoms your friend is experiencing could be related to migraines or tension-type headaches, it is essential to consider her recent surgical history and any potential complications. A thorough evaluation by a healthcare provider, possibly including a neurologist, would be the best course of action to determine the underlying cause of her headaches and to develop an effective treatment plan. Encouraging her to seek medical advice promptly is crucial, especially given the changes in her symptoms.

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