[21F] Experiencing vomiting with coffee ground appearance, severe headache, and nausea

Patient Description

A 21-year-old female reported a single episode of vomiting during her work shift, noting the vomit had a coffee ground-like appearance. She has also been experiencing a severe, pounding headache located at the front of her head, rated 7 out of 10 in intensity, which has persisted for a couple of hours. This is the first occurrence of such a headache. The patient uses ibuprofen for relief, taking it two to three times a month at a dose of 400 mg. She has not taken more than the recommended dose recently. The patient has a history of asthma diagnosed at age 4 and is allergic to codeine. Current medications include Prozac (20 mg daily since December), Estryalla for birth control, and a One A Day multivitamin started two weeks ago, taken as directed. No other symptoms were reported, and no recent head injury or trauma has occurred. There is no indication of black or tarry stools, and the patient denies any dizziness or lightheadedness since the vomiting episode.

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Arora's Assessment

What might be happening

Based on your symptoms, here are a few possibilities:

  • Gastroenteritis: This is an inflammation of the stomach and intestines, usually caused by a viral or bacterial infection. It can result in vomiting, nausea, and sometimes headaches. However, the presence of coffee-ground vomit suggests there might be bleeding in your stomach or small intestine, which is not typical for gastroenteritis.

    • Treatment usually involves rest, hydration, and over-the-counter remedies. If the cause is bacterial, antibiotics may be prescribed.
  • Peptic Ulcer Disease: This condition is characterized by sores in the lining of the stomach or the first part of the small intestine (the duodenum). It can cause coffee-ground vomit, which is a sign of bleeding in the gastrointestinal tract. Headaches and nausea can also occur, especially if the ulcer is causing significant discomfort or stress.

    • Treatment often involves medications to decrease stomach acid, and in some cases, antibiotics to treat a bacterial infection.
  • Migraine: Migraines are severe headaches often accompanied by nausea and vomiting. However, they don't typically cause coffee-ground vomit.

    • Treatment usually involves pain relief medication, rest, and avoiding known triggers.
  • Medication side effects: Both Prozac and ibuprofen can cause gastrointestinal bleeding in some people, which could explain the coffee-ground vomit. Prozac can also cause headaches and nausea.

    • Treatment would involve reviewing these medications with your doctor.

What you can do

Given the severity of your symptoms and the potential for serious conditions, it's important to seek medical attention immediately. In the meantime, here are some things you can do:

  1. Avoid taking any more ibuprofen or other NSAIDs until you've spoken with a healthcare provider.
  2. Stay hydrated. Dehydration can make nausea and vomiting worse, and if you've been vomiting, you may have lost a lot of fluids.
  3. Rest as much as possible. This can help your body recover and may also help with your headache.

What you should look out for

Please seek immediate medical attention if you experience any of the following:

  • Continued or worsening vomiting
  • Dark, tarry stools
  • Severe abdominal pain
  • Dizziness or fainting
  • A severe or worsening headache

Remember, I'm an AI and this advice is based on the information you've provided. It's important to consult with a healthcare provider for an accurate diagnosis and treatment.

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9 mo ago


People Also Ask


What does coffee ground-like vomit indicate?

Coffee ground-like vomit typically indicates bleeding in the stomach or small intestine. The blood has been partially digested, giving it a dark, granular appearance similar to coffee grounds.


Can ibuprofen cause gastrointestinal bleeding?

Yes, ibuprofen, which is a nonsteroidal anti-inflammatory drug (NSAID), can cause gastrointestinal bleeding, especially if taken frequently or in high doses. It can irritate the stomach lining, leading to ulcers or bleeding.


What are the symptoms of a peptic ulcer?

Symptoms of a peptic ulcer include burning stomach pain, bloating, heartburn, nausea, and in some cases, vomiting blood or having black, tarry stools. The pain often occurs when the stomach is empty and may be temporarily relieved by eating certain foods or taking antacids.


How can migraines be distinguished from other types of headaches?

Migraines are typically characterized by a severe, throbbing headache, often on one side of the head, and may be accompanied by nausea, vomiting, and sensitivity to light and sound. They can be distinguished from other headaches by their intensity, duration, and associated symptoms, such as visual disturbances or aura.


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