Headache, Nausea and Vomiting – What is the Cause?

A headache, nausea and vomiting are three symptoms that are difficult to contend with individually but the experience is significantly worse if two or all three occur simultaneously. While some of the causes of head pain, nausea and vomiting may be obvious, at other times it may be difficult to isolate the cause or system contributing to these symptoms. Where these symptoms are persistent or due to a serious underlying disorder, other signs and symptoms will also be evident, which will assist with a diagnosis.

Definition of Terms

Nausea is the sensation that you need to vomit (‘spew, puke’) and while it is an unpleasant feeling, it does not always result in vomiting.

Vomiting occurs when the abdominal muscles and gastric muscles forcefully expel the contents of the stomach up the esophagus (food pipe).

A headache is typically a pain experienced in the upper part of the head, with or without accompanying pain in the face, and there are several different types of headaches.

Causes of a Headache with Nausea and Vomiting

The causes of these symptoms may vary and it is important to take note of other accompanying signs and symptoms as well as consider the events that precede the onset of these symptoms.

Some of the causes include :

• Migraine. Typically there are warning signs preceding the onset of a migraine like an aura (not always present) and there is usually a history of migraines. Nausea may precede the migraine or occur simultaneously and in severe cases vomiting may occur. Physical stimuli, like light and/or noise, may aggravate the pain and nausea. It is important to note that nausea and vomiting may occur with any type of severe headache although it is common with migraines.

• Motion sickness. The symptoms begin with movement and may continue even at rest. A person with a history of motion sickness can be triggered by even the slightest, unusual movement. Nausea is always present and may be accompanied by a headache and vomiting.

• Hormones. This tends to occur more frequently in women, due to hormonal changes either as a result of fluctuations within the menstrual cycle, pregnancy, menopause or use of hormone contraceptives or hormone replacement therapy (HRT). Women who have a history of  migraines or premenstrual tension (PMT) are more likely to experience headaches with nausea and/or vomiting due to hormonal causes. In pregnant women with excessive morning sickness, special attention has to be taken to identify and treat hyperemesis gravidum, which can lead to serious complications for both the mother and unborn child.

• Drug side effect. Headache, nausea and vomiting are three of the most common side effects reported from use of pharmaceutical drugs. This may also be accompanied by other common side effects like dryness of the mouth. Post-operative complaints of these symptoms may be related to anesthesia. Excessive use of analgesics to treat a headache may trigger nausea with or without vomiting.

• Withdrawal symptoms. May be related to abuse of alcohol, narcotics and pharmaceutical drugs (like barbituates and analgesics). Caffeine and nicotine withdrawal may also cause these symptoms.

• Infections affecting the central nervous system, like the brain, its linings (meninges) or the spinal cord, are likely to cause  head pain with nausea and vomiting. Some examples of these localized infections include meningitis and encephalitis. A fever is usually present and there are signs of mental confusion, difficulty concentrating and sleep disturbances.

• Generalized and other infections may also present with a headache, nausea and vomiting. These are common complaints in generalized infections like the seasonal influenza infection (‘flu’) as well as the influenza- A H1N1 (‘swine flu‘). These symptoms may also be present in localized infections, like viral gastroenteritis (‘gastric flu’) and upper respiratory tract infections, especially those affecting the sinuses or throat. Food poisoning is another possible cause and vomiting and diarrhea is usually profuse in this instance. Septicemia or ‘blood poisoning’ as a result of an untreated or widespread infection may also be responsible.

• Head trauma may cause a headache, nausea and vomiting and this may be related to a concussion or occur even if a concussion is not present. The injury may not always be obvious ad there may be no clear signs of a head injury (closed head injury) but usually the history will reveal some sort of injury to the head area.

• Increased intracranial pressure may also give rise to a headache, nausea and vomiting and if there is a sudden onset of the symptoms, it should be the first consideration. Any pressure on the brain and associated organs, either due to a tumor, bleeding within the cranial cavity (hemorrhage) . fluid accumulation or swelling may result in these symptoms and there may also be other symptoms depending on which area of the brain is impacted by the pressure. This can vary from sleep changes, to mental confusion, memory disruptions, hallucinations, disturbance of the sense or motor functions of the brain.

• Blood glucose imbalances, either hypoglycemia (‘low blood sugar’) or hyperglycemia (‘high blood sugar’). Acute pancreatitis, which is the inflammation of the pancreas particularly after excessive alcohol intake, may give rise to headache, nausea and vomiting in addition to the severe abdominal pain, changes in heart rate, blood pressure and sweating that is present.

• Thyroid disorders, particularly hypothyroidism, may give rise to these symptoms.

• Dehydration may cause headaches, nausea and vomiting, along with changes in the color of the urine, fever-like symptoms, muscle cramps and impaired mental abilities, depending on the extent of the dehydration.

• Lifestyle factors may also play a part in the onset of these symptoms. This occurs in cases where there is excesses like in excessive dieting, exercise, use of stimulants (caffeine, nicotine, taurine) and overindulgence in certain foods and drinks, particularly alcohol. Stress may also result in these symptoms due to the action of the stress hormones – adrenalin and cortisol.

• Inner ear inflammation, like labyrinthitis, may cause dizziness or vertigo, impaired balance and tinnitus. Other auditory disruptions may also be present like unilateral hearing loss. Headaches and nausea with/without vomiting may be accompanying symptoms and pain may be identified as occurring deep inside the temporal (temple) region.

• Spinal injury like in T4 syndrome typically presents with a headache, nausea and vomiting, particularly in the acute stage. Other persistent symptoms of T4 syndrome include tingling and numbness of the arm and/or back, or neck and arm pain and pain upon movement of the spine. Other spinal injuries, infections or diseases may also contribute or cause a headache, nausea and/or vomiting.

• Psychogenic causes of a headache, with nausea and vomiting may occur in stressful situations, especially in cases of anxiety or depression. The symptoms may be perceived or psychosomatic in nature.

• Psychological disorders, particularly in eating disorders like anorexia nervosa or bulimia. In both these conditions vomiting may be induced as part of the pattern of behavior.  Certain psychotropic drugs used to treat psychiatric disorders may also result in headaches, with nausea and vomiting.

• Poisoning or toxicity due to the ingestion, inhalation or absorption (via the skin) of poisonous substances and toxic chemicals. Headache, nausea and vomiting may also occur as a result of exposure to high levels of radiation (‘radiation sickness), overuse of nutritional supplements and intake of metals (like lead).

Rare or Less Common Causes

A headache, accompanied by nausea and vomiting  may at times be considered to be vague symptoms and if there are no other signs and symptoms present or no clear history to assist with a diagnosis, then it is difficult to identify the cause.

Many gastrointestinal conditions like food intolerances, gastroparesis, bowel obstruction, gastroesophageal reflux disease (GERD) and appendicitis may cause headaches with nausea and/or vomiting. Usually abdominal pain, changes of bowel movement or other symptoms of gastrointestinal disruption, like excessive belching or bloating, are present.

Disorders affecting other systems that could cause a headache and nausea with vomiting may include :

• Liver – example hepatitis.
• Kidney – example renal failure, kidney stones.
• Respiratory – example tuberculosis, TB.
• Cardiovascular – example a heart attack, stroke, aortic dissection.
• Autoimmune – example Hashimoto’s thyroiditis, SLE.
• Deficiencies – example iron-deficiency anemia.

It is important to consult with a medical practitioner to identify the exact cause of your symptoms, especially if it is persisting and affecting your daily functioning.