What's wrong with a headache that makes me vomit

When the headache is more severe, it often irritates the digestive tract and causes some digestive tract symptoms, which can easily lead to vomiting. There are many reasons for this situation, such as intracranial venous sinus thrombosis, endocrine or metabolic disorders. In addition, if the medication is used improperly, it may also cause increased intracranial pressure, which can easily lead to headaches and vomiting.

What's wrong with headaches and vomiting?

1. Causes of disease

The causes may include endocrine and metabolic disorders, intracranial venous sinus thrombosis, drugs and toxins, as well as primary benign intracranial hypertension, that is, the cause is unknown.

2. Pathogenesis

The pathogenesis of this disease is still unclear, and it is caused by intracranial hypertension that develops over weeks or months. As to whether the direct cause of increased intracranial pressure is due to swelling of the brain parenchyma itself or changes in cerebrospinal fluid, there is still no consensus. Most people believe that it is caused by cerebrospinal fluid absorption disorder, but there is not much evidence.

Karahalios et al. (1996) found that all patients with benign intracranial hypertension had increased cerebral venous pressure. In this case, cerebrospinal fluid absorption was obstructed, which could cause increased intracranial pressure. However, it was not clear whether increased cerebral venous pressure was the cause or result of increased intracranial pressure. During continuous cerebrospinal fluid monitoring of patients with benign intracranial hypertension, it was found that the cerebrospinal fluid pressure increased continuously and irregularly. After the pressure increased to a plateau for 20 to 30 minutes, it would suddenly drop to normal levels, as if the increased CSF was draining away (Johnston and Paterson, 1974). A considerable number of patients were reported to have irregular menstruation or amenorrhea, some of whom were pregnant women, some had endocrine dysfunction, and some had taken tetracycline, indomethacin, oral contraceptives or other hormones. There were also reports of vitamin A poisoning. It is inferred that the above conditions are all related to benign intracranial hypertension, but there is no substantial evidence.

Differential Diagnosis

The main ones include occult dural venous sinus thrombosis, diffuse gliomatosis, carcinomatous meningitis, granulomatous meningitis and micro-cerebral artery malformation. The main characteristics of the above lesions are that they can cause headaches, optic disc edema, and severe increased intracranial pressure, but no space-occupying lesions can be seen in imaging examinations and no other localizing signs are found in neurological examinations.

Dural venous sinus thrombosis (including great cerebral vein thrombosis) is sometimes almost indistinguishable from benign intracranial hypertension clinically. However, dural venous sinus thrombosis occurs rapidly, the headache is mostly located at the top, and epilepsy may occur. Attention to the shape of the superior sagittal sinus on MRI or contrast-enhanced CT can aid in the differential diagnosis.