Soy products can cause headaches or allergies in susceptible individuals, particularly among women who are prone to hormonal headaches. Given that she recently became a vegetarian, it would make sense to test for nutritional deficiencies. This patient has a classic description of migraine headaches, but the frequency of her headaches has suddenly changed, which is concerning. She reported that she had never tried these products prior to becoming a vegetarian.ĭiagnosis: Soy-induced migraine headaches and allergies Weekly migraines typically occur in the evening following these lunches, or wake her from sleep around 3 the next morning. Nutrition: On further questioning, she insisted that she was not deficient in vitamins, minerals, or protein and that she eats tofu, edamame, or soy-based imitation meat products once per week when her office colleagues order lunch from a nearby vegan restaurant. Imaging: Brain MRI and MRA were completely normal.
Lab tests: CBC with differential, electrolyte levels, a B12 level, and thyroid tests, all of which were normal. Gait was normal and she could perform a Romberg test and heel to toe walking without any difficulty. She had no ataxia or dysmetria in bilateral upper and lower extremities. Sensation was normal in bilateral upper and lower extremities to touch, pinprick, vibration, and position sense. Reflexes were slightly brisk in bilateral upper and lower extremities, with no asymmetry. She had normal strength in the bilateral upper lower extremities. Facial sensation and movements were normal bilaterally. She did not have ptosis or facial asymmetry. Pupils were equal, round ,and reactive to light. Extra ocular movements were intact with no nystagmus, and her vision was normal. Abdominal exam was normal, with no pain, tenderness or masses. Her carotid arteries were normal with no bruits. Pulse were palpable and normal in bilateral upper and lower extremities. Her cardiac examination reveals a regular heart rate and rhythm. The chest examination was normal, with clear breath sounds. Throat examination was normal, as was thyroid examination.
Headache nausea dizziness skin#
The skin appeared normal, with no bruises or rashes. She felt the urge to vomit several times during the evaluation, but instead of vomiting large amounts, she gags. She complained of dizziness, but the dizziness does not interfere with her ability to walk. She had both a severe headache and nausea. The patient was afebrile, well-nourished, and healthy appearing. She explains that she has been getting enough calories and protein intake since the switch in diet about a year ago. She has a family history of inflammatory bowel disease, and when she began to experience intermittent abdominal discomfort a few years ago, she decided to become a vegetarian.
She has taken sumatriptan for her headaches, and, like her menstrual migraines, they improve with one or two doses. They have been occurring about once a week and lasting between 24 to 48 hours. The recurrent headaches began about 8 months ago. They always improve with one or two doses of sumatriptan. She has a normal menstrual cycle and has experienced monthly menstrual migraines for the past 5 years. She has not recently had any changes to her oral contraceptive prescription. She has been taking oral contraceptives for birth control for the past 7 years. However, she has been unable to sleep due to the pain. She went to work as usual and has been trying to sleep since returning home from her job. She has been taking over-the-counter ibuprofen and acetaminophen all day long without improvement. She also complains of tingling in both arms and hands, which had occurred with a few of her earlier bouts. She had head pain, dizziness, and nausea-similar to the previous episodes-yet she has noticed flashing lights in front of her eyes. Her symptoms began in the early morning, waking her from sleep at around 5 AM. She has come to the emergency department because she is concerned about her current episode, which is slightly different from her previous ones. A 33-year-old woman has been experiencing recurrent episodes of nausea, headaches, and dizziness for the past 8 months.
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