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Tired nauseous headache. Tired, Nauseous, and Headache: Understanding the 16 Conditions That Cause These Symptoms

What are the common causes of fatigue, headache, and nausea. How can you identify the underlying conditions that lead to these symptoms. When should you seek medical attention for persistent tiredness, headaches, and nausea.

The Complex Interplay of Fatigue, Headache, and Nausea

Experiencing fatigue, headaches, and nausea simultaneously can be a distressing combination of symptoms. These three complaints often intertwine, creating a challenging situation for those affected. Understanding the potential causes and their relationships is crucial for proper diagnosis and treatment.

Are these symptoms always indicative of a serious condition? Not necessarily. While some underlying causes may require immediate medical attention, others might be managed through lifestyle changes or over-the-counter remedies. However, persistent or severe symptoms should never be ignored.

Migraines: A Common Culprit Behind the Trio of Symptoms

Migraines are a neurological condition characterized by intense headaches, often accompanied by nausea and fatigue. How do migraines manifest these symptoms?

  • Prodrome stage: Fatigue and low energy may occur 1-2 days before the headache
  • Attack phase: Severe head pain, often with nausea and vomiting
  • Postdrome: Feelings of fatigue and apathy after the headache subsides

Can migraines be managed effectively? With proper diagnosis and treatment, many people find relief through a combination of medications, lifestyle changes, and trigger avoidance. Consulting a neurologist specializing in headache disorders can provide tailored solutions for migraine sufferers.

Dehydration: An Overlooked Cause of Headaches and Fatigue

Dehydration is a surprisingly common cause of both headaches and fatigue. Why does lack of proper hydration lead to these symptoms?

  • Reduced blood volume can lead to decreased oxygen flow to the brain
  • Electrolyte imbalances may affect nerve and muscle function
  • The body expends more energy trying to maintain proper function with limited resources

How can you prevent dehydration-related symptoms? Aim for at least 8-10 glasses of water daily, increasing intake during physical activity or hot weather. Monitoring urine color (pale yellow indicates good hydration) can help ensure you’re drinking enough.

Medication Side Effects: When Treatment Becomes the Problem

Many medications can cause headaches, fatigue, and nausea as side effects. Which types of medications are most likely to produce these symptoms?

  • Diuretics and certain blood pressure medications (may cause dehydration)
  • Sleep aids or medications that interfere with sleep patterns
  • Some antidepressants and anti-anxiety medications
  • Certain pain relievers, when used frequently

Should you stop taking medication if you experience these side effects? Never discontinue prescribed medications without consulting your healthcare provider. They can often adjust dosages or suggest alternatives to minimize side effects while maintaining treatment efficacy.

The Caffeine Conundrum: Friend or Foe?

Caffeine’s relationship with headaches and fatigue is complex. How can this popular stimulant both alleviate and exacerbate these symptoms?

  • Short-term benefits: Increased alertness and potential headache relief
  • Long-term issues: Sleep interference leading to fatigue and rebound headaches
  • Withdrawal: Stopping caffeine intake can cause temporary headaches and fatigue

Is there an ideal caffeine consumption strategy? Moderation is key. Limiting caffeine intake to earlier in the day and avoiding excessive consumption can help balance its benefits while minimizing negative effects on sleep and overall well-being.

Chronic Fatigue Syndrome and Fibromyalgia: When Fatigue Takes Center Stage

Chronic Fatigue Syndrome (CFS) and Fibromyalgia are complex conditions where fatigue is a primary symptom, often accompanied by headaches and other issues. How do these conditions differ?

Chronic Fatigue Syndrome:

  • Severe, disabling fatigue lasting at least 4 months
  • Not improved by rest
  • Often accompanied by headaches, muscle pain, and cognitive difficulties

Fibromyalgia:

  • Widespread pain and general fatigue
  • Tender points or trigger points throughout the body
  • Frequent headaches and sleep disturbances

Can these conditions be effectively managed? While there’s no cure for CFS or Fibromyalgia, many patients find relief through a combination of medications, lifestyle adjustments, and alternative therapies. Working closely with a healthcare provider specializing in these conditions is crucial for developing an effective treatment plan.

Sleep Disorders: The Hidden Culprits Behind Daytime Symptoms

Various sleep disorders can lead to headaches, fatigue, and even nausea during waking hours. Which sleep-related issues commonly cause these symptoms?

  • Insomnia: Difficulty falling asleep or staying asleep
  • Sleep apnea: Interrupted breathing during sleep
  • Restless leg syndrome: Uncomfortable sensations and urges to move the legs
  • Bruxism: Teeth grinding during sleep

How does poor sleep quality affect overall health? Lack of quality sleep can lead to increased cortisol levels, impacting mood, cognitive function, and physical well-being. Addressing underlying sleep disorders often results in significant improvement in daytime symptoms.

Concussions and Head Injuries: When to Seek Immediate Care

Concussions and other head injuries can cause persistent headaches, fatigue, and nausea. What are the key symptoms that indicate a possible concussion?

  • Headache and fatigue
  • Memory problems or confusion
  • Nausea or repeated vomiting
  • Blurred vision
  • Sensitivity to light and sound

Is immediate medical attention always necessary for head injuries? Any suspected concussion or significant head impact should be evaluated by a healthcare professional. Some symptoms may not appear immediately, and proper assessment is crucial to prevent potential complications.

Hangovers: The Price of Overindulgence

Excessive alcohol consumption often leads to hangovers, characterized by headaches, fatigue, and nausea. Why does alcohol cause these symptoms?

  • Dehydration: Alcohol has a diuretic effect
  • Vasodilation: Widening of blood vessels can trigger headaches
  • Sleep disruption: Alcohol interferes with sleep quality
  • Gastrointestinal irritation: Can lead to nausea and stomach discomfort

Can hangovers be prevented? While the only surefire way to avoid a hangover is to abstain from alcohol, strategies like staying hydrated, eating before drinking, and limiting alcohol intake can help minimize symptoms.

Hormonal Imbalances: The Body’s Delicate Balance

Hormonal fluctuations and imbalances can lead to a variety of symptoms, including headaches, fatigue, and nausea. Which hormonal changes commonly cause these issues?

  • Menstrual cycle fluctuations
  • Thyroid disorders (both hyperthyroidism and hypothyroidism)
  • Adrenal gland dysfunction
  • Menopause and perimenopause

How can hormonal imbalances be addressed? Proper diagnosis through blood tests and clinical evaluation is crucial. Treatment may involve hormone replacement therapy, lifestyle changes, or medications to manage specific hormonal disorders.

Anemia: When Iron Levels Fall Short

Anemia, particularly iron-deficiency anemia, can cause persistent fatigue, headaches, and occasionally nausea. What are the primary causes of anemia?

  • Insufficient dietary iron intake
  • Blood loss (e.g., heavy menstrual periods, gastrointestinal bleeding)
  • Impaired iron absorption
  • Chronic diseases affecting red blood cell production

Can anemia be easily treated? In many cases, yes. Iron supplementation and dietary changes can often resolve iron-deficiency anemia. However, it’s essential to identify and address the underlying cause to prevent recurrence.

Infections: From Common Colds to Serious Illnesses

Various infections, ranging from mild to severe, can cause headaches, fatigue, and nausea. Which types of infections commonly present with these symptoms?

  • Viral infections (e.g., influenza, COVID-19)
  • Bacterial infections (e.g., strep throat, urinary tract infections)
  • Parasitic infections
  • Fungal infections

How can you distinguish between a minor infection and a more serious illness? While many infections resolve on their own, persistent or severe symptoms, high fever, or signs of systemic involvement warrant medical evaluation. When in doubt, consult a healthcare provider for proper diagnosis and treatment.

Stress and Anxiety: The Mind-Body Connection

Chronic stress and anxiety can manifest physically, often leading to headaches, fatigue, and gastrointestinal symptoms like nausea. How does psychological stress impact physical health?

  • Increased muscle tension, particularly in the head and neck
  • Disrupted sleep patterns
  • Elevated cortisol levels
  • Altered neurotransmitter balance

What strategies can help manage stress-related symptoms? A multi-faceted approach often works best, including:

  1. Stress reduction techniques (e.g., meditation, deep breathing exercises)
  2. Regular physical activity
  3. Cognitive-behavioral therapy
  4. Time management and prioritization skills
  5. Adequate sleep and self-care practices

Autoimmune Disorders: When the Body Attacks Itself

Various autoimmune disorders can cause a constellation of symptoms, including headaches, fatigue, and nausea. Which autoimmune conditions are most likely to present with these symptoms?

  • Lupus
  • Multiple sclerosis
  • Rheumatoid arthritis
  • Celiac disease
  • Hashimoto’s thyroiditis

Why are autoimmune disorders often challenging to diagnose? These conditions can mimic many other illnesses and may present with vague or fluctuating symptoms. Comprehensive blood tests, imaging studies, and sometimes biopsies are often necessary for accurate diagnosis.

Nutritional Deficiencies: Beyond Iron

While iron-deficiency anemia is a well-known cause of fatigue, other nutritional deficiencies can also lead to headaches, tiredness, and nausea. Which nutrients are crucial for preventing these symptoms?

  • Vitamin B12
  • Vitamin D
  • Magnesium
  • Folate
  • Zinc

How can nutritional deficiencies be identified and addressed? Blood tests can reveal many common deficiencies. A balanced diet rich in fruits, vegetables, lean proteins, and whole grains is essential. In some cases, supplementation under medical supervision may be necessary to correct severe deficiencies.

When to Seek Medical Attention

While occasional headaches, fatigue, and nausea are common, certain situations require prompt medical evaluation. When should you consult a healthcare provider?

  • Symptoms persist for more than a week despite home remedies
  • Headaches are severe, sudden, or accompanied by neurological symptoms
  • Fatigue significantly impacts daily activities
  • Nausea is severe or accompanied by persistent vomiting
  • You experience unexplained weight loss
  • Symptoms are accompanied by fever, rash, or other concerning signs

What can you expect during a medical evaluation? Your healthcare provider will likely:

  1. Take a detailed medical history
  2. Perform a physical examination
  3. Order blood tests or imaging studies as needed
  4. Discuss your lifestyle, stress levels, and any recent changes
  5. Consider referrals to specialists if necessary

Lifestyle Modifications for Symptom Management

While medical treatment may be necessary for underlying conditions, certain lifestyle changes can help manage and prevent headaches, fatigue, and nausea. What strategies can you implement in your daily life?

  • Maintain a consistent sleep schedule
  • Stay hydrated throughout the day
  • Engage in regular physical activity
  • Practice stress-reduction techniques
  • Eat a balanced, nutritious diet
  • Limit caffeine and alcohol consumption
  • Identify and avoid personal triggers (e.g., certain foods, environmental factors)

How can you track the effectiveness of lifestyle changes? Keeping a symptom journal can help you identify patterns and correlations between your habits and symptom occurrence. This information can be valuable for both self-management and discussions with healthcare providers.

Integrative Approaches to Symptom Relief

In addition to conventional medical treatments, many people find relief through integrative or complementary approaches. Which alternative therapies show promise for managing headaches, fatigue, and nausea?

  • Acupuncture
  • Massage therapy
  • Yoga and tai chi
  • Herbal supplements (e.g., ginger for nausea, feverfew for headaches)
  • Mindfulness meditation
  • Biofeedback

Is it safe to combine alternative therapies with conventional treatments? While many complementary approaches can be safely used alongside traditional medicine, it’s crucial to inform your healthcare provider about any alternative treatments you’re considering. This ensures comprehensive care and helps avoid potential interactions or complications.

Understanding the complex interplay between fatigue, headaches, and nausea is crucial for effective management and treatment. By recognizing potential underlying causes, seeking appropriate medical care when necessary, and implementing lifestyle modifications, many individuals can find relief from these challenging symptoms. Remember that persistent or severe symptoms always warrant professional medical evaluation to ensure proper diagnosis and treatment.

16 Conditions That May Cause Both

If you’re suffering from fatigue and constant headaches, it may be time to see a doctor.

Headache could be a sign of a migraine disorder, sleep disorder, dehydration, or several other chronic illnesses. Fatigue is a common symptom of many conditions including depression, sleep disorders, and fibromyalgia. Fatigue and lack of energy is also a frequent complaint of people who suffer from migraine headaches.

It’s possible that headaches and fatigue could be interconnected. Let’s take a closer look at the relationship between these two symptoms.

Fatigue and headache are shared symptoms of many conditions. Not all of these conditions are considered serious. However, some may require lifestyle changes or ongoing treatment.

As you consider the reasons why you may be experiencing headache and fatigue, make sure to think about your lifestyle, including your sleeping patterns, diet, and any medications you’re currently taking.

Here are 16 conditions and other factors that could cause both headache and fatigue:

Migraine is a neurological condition that causes frequent intense headaches. Migraine symptoms may start one to two days before the headache itself. This is referred to as the “prodrome” stage. During this stage, many people also experience fatigue, depression, and low energy.

When the headache hits, it’s referred to as the “attack” phase. Other symptoms include:

  • nausea
  • vomiting
  • dizziness
  • head pain
  • sensitivity to light and sound

Once the headache subsides, you might feel fatigued and apathetic. You should see a doctor if headaches start to affect your daily life.

Many people get a headache when they don’t drink enough water. Other common symptoms of dehydration include fatigue and sleepiness.

Dehydration headaches often go away within a few hours after drinking water. To prevent headache and fatigue caused by dehydration, aim for at least 8 to 10 glasses of water a day — more if you’re working out or it’s a particularly hot day.

Headache and fatigue are a common side effect of many different types of medications. Some medications such as diuretics and certain blood pressure medications may lead to headache and fatigue because they can make you dehydrated.

Other medications can interfere with your sleep patterns. Lack of sleep is also associated with headaches.

Caffeine is a central nervous system stimulant. Though it can make you feel alert and reduce fatigue right after you drink it, caffeine can also interfere with your sleep if you consume too much. Poor sleep can lead to fatigue and headache.

If you tend to drink caffeinated beverages on a daily basis, your body becomes dependent on the caffeine. If you decide to eliminate caffeine from your diet, you’ll likely experience withdrawal symptoms, which include both headache and fatigue.

The main symptom of chronic fatigue syndrome (CFS) is severe and disabling fatigue that goes on for at least 4 months and is not improved by rest. Other symptoms include frequent headaches, muscle pain, joint pain, sleep problems, and trouble concentrating.

Fibromyalgia is a chronic disorder that’s associated with widespread pain and general fatigue. The pain usually occurs in tender points, also called trigger points, in many areas of the body.

People with fibromyalgia may also have frequent headaches.

Researchers and doctors don’t know what causes fibromyalgia, but more is learned about the condition every day. If you’re experiencing, pain, headaches, and fatigue that won’t go away, see a doctor for an accurate diagnosis.

Any disorder that affects your sleep, including insomnia, restless leg syndrome, bruxism (grinding your teeth at night), and sleep apnea, can cause headache and fatigue. Sleep disorders are also associated with migraine headaches.

Lack of sleep causes levels of the stress hormone cortisol to rise in the body, which can negatively impact mood. Other symptoms of high cortisol include weight gain, irritability, acne, headache, and fatigue.

A concussion is a temporary brain injury and is usually the result of an injury or impact to the head.

Seek immediate medical attention if you’ve had a head injury and think you could have a concussion. Aside from headache and fatigue, other symptoms of a concussion include:

  • unconsciousness
  • memory problems
  • continual vomiting
  • behavior changes
  • confusion
  • blurred vision

A hangover is a consequence of drinking too much alcohol. Since alcohol has a dehydrating effect on the body, it can cause headaches. Drinking alcohol also causes your blood vessels to widen (vasodilation), which is associated with headaches as well.

Alcohol may also interrupt your sleep, which can leave you feeling drowsy and fatigued the next day.

If you frequently experience headache and fatigue after drinking alcohol, consider these 7 ways to prevent a hangover.

Headache and fatigue are common symptoms of the flu and common cold, which are both caused by viruses. Most of the time, headache and fatigue will be accompanied by other symptoms, such as fever, runny nose, sore throat, and a cough.

Anemia occurs when the number of healthy red blood cells in your body is too low. When this happens, your body’s tissues can’t get enough oxygen. If you have anemia, you’ll likely feel fatigued and weak. You may also feel dizzy and short of breath and have pale skin and brittle nails. Headaches are another common symptom of anemia, particularly anemia caused by iron deficiency.

Hormonal changes both before and during menstruation can lead to both headache and fatigue. Some women experience migraines during menstruation.

Most women have experienced some form of premenstrual syndrome (PMS) right before their period. Common symptoms of PMS include:

  • emotional outbursts
  • sore breasts
  • fatigue
  • headache
  • food cravings
  • changes in sleep patterns

Staring at a computer, tablet, or cell phone screen all day may be necessary for school or work, but it’s incredibly stressful for your eyes. As your eyes become fatigued, you might start to have a headache.

Another symptom of digital eye strain is general fatigue or tiredness. You may also have difficulty concentrating or problems sleeping, which could cause you to become even more fatigued.

To combat eye strain, try to look away from your screen every 20 minutes to something that’s at least 20 feet away, for at least 20 seconds.

Headache and fatigue are just two of the many symptoms of pregnancy. Fatigue is a result of high levels of the hormone progesterone. Likewise, headaches can be caused by hormonal changes and changes in blood volume during pregnancy.

Systemic lupus erythematosus (SLE) or lupus for short, is a chronic autoimmune disease. An autoimmune disease occurs when your immune system mistakenly attacks your own body.

Symptoms of lupus are varied. Common symptoms include:

  • severe fatigue
  • headaches
  • a “butterfly” rash on the cheeks and nose
  • joint pain and swelling
  • hair loss
  • fingers turning white or blue and tingling when cold (Raynaud’s phenomenon)

See a doctor if you’re experience headache and fatigue along with any of the above symptoms. A doctor will have to run several tests to make a diagnosis.

Depression can make you feel emotionally and physically drained. It can also affect your sleep, leading to both headache and fatigue. Other symptoms include severe sadness, social withdrawal, body aches, appetite changes, and feeling worthless.

A doctor or mental health professional can help you find the best treatment for depression so you can start feeling like yourself again.

Anyone who experiences unexplained headaches and fatigue should see a doctor. While some of the causes of these symptoms, like caffeine withdrawals and the common cold, will go away on their own, others require long-term management.

If medications are to blame for your headache and fatigue, you doctor may want to switch you to a different medication or lower your dose.

You’ll also want to visit a doctor right away if your headache is sudden and severe or accompanies a fever, stiff neck, confusion, vomiting, behavior changes, vision changes, numbness, or difficulty speaking.

Dizziness, nausea, headache, fatigue: What you need to know

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Nguyen Thi My – Department of Medical Examination & Internal Medicine – Vinmec Danang International Hospital.

Sudden dizziness and nausea are very common in public life. Everyone meets them at least once in their life. However, in some people, the ongoing condition is actually a medical condition. The information below will give more knowledge about this disease, its causes, as well as its treatment and prevention.

1. What is dizziness, nausea, headache, fatigue?

One morning, the patient woke up, opened his eyes, was about to get up to get out of bed, but suddenly felt a strong dizziness. The patient feels that everything around him is spinning, houses are collapsing, tables and chairs are moving or somersaulting. This will naturally come to them, causing them to inevitably panic and fear. At this time, the more they worry, the more intense they will feel dizzy and dizzy. In some cases, there are also nausea, vomiting, headache, fatigue.
This condition is very common in the population, especially in middle-aged people, more women than men. The prominent feature is that dizziness is often related to posture, increases when the patient sits up, turns the head and decreases, completely relieved if they lie still, close their eyes. That’s why this condition is called “benign paroxysmal postural vertigo” in medicine. Episodes of vertigo often appear in series that last for a few days to a few weeks, then go away on their own and will return after several months to several years.
However, in some cases, the symptoms of headache, dizziness, nausea, vomiting do not change or decrease with the position and rest, it is necessary to think of a more dangerous neurological disease: cerebral infarction, In this case, the patient should go to a medical facility for examination, monitoring and emergency treatment.

2. Is this disease dangerous?

As the name suggests, benign postural vertigo does not cause serious complications.
In the case of vertigo, the patient is very scared, extremely worried, feeling that the house is spinning like upside down, tilted. However, they will find themselves that when turning their head, looking around will make symptoms worse, promote nausea, vomiting, so they tend to close their eyes and lie still. After that, the dizziness will subside on its own for a minute or two before disappearing completely.
In other words, the disease is completely benign if the patient rests on the bed, be careful not to fall, get injured if trying to walk.
Besides, when examining, doing tests, brain imaging will not record any abnormal signs. The patient is completely free of paralysis or has any focal neurological signs; Ear examination was also normal, with no changes in hearing.

3. What causes this disease?

To date, there have been many theories about the cause of benign paroxysmal vertigo, but most of them have not been clearly proven. Of these, the hypothesis of the presence of small stones in the cochlea seems more convincing.

Chóng mặt tiền đình

The vestibule is considered a sense, sensing posture in space, thereby helping to maintain stability, body balance, posture as well as coordination of eye, head and trunk movements. The vestibular system includes a receptor, the semicircular canal located in the cochlea, nerves that conduct and analyze signals in the brain.
The cochlea attaches with three rings of semicircular canals, arranged in three different spatial planes. The circulation of fluid in the semicircular canals helps the body to orientate the posture. Therefore, when the body changes in a certain direction, the stone particles moving in the semicircular canal in that plane will stimulate the vestibular system, send signals to the brain, and initiate the sensation of dizziness. . As a result, the body has a reflex to lie still, keeping the head position where it feels most secure. The pebbles do not move anymore, the feeling of dizziness will subside.
Besides, it is necessary to make a differential diagnosis with other diseases that also have symptoms of dizziness when central and peripheral vestibular organs are damaged such as inflammation, sclerosis, degeneration to ischemia, bleeding or trauma. The difference, however, is that the vertigo in these conditions has nothing to do with posture.
See more: Is it dangerous to have frequent headaches, nausea, and dizziness?

4. What is the treatment and prevention?

Benign paroxysmal vertigo is exactly what the name suggests if the patient knows how to avoid triggers, adhere to vestibular stabilizers, and perform maneuvers to reposition the semicircular canal.

4.1. Avoid changing positions too suddenly and too quickly

At all times, always remember not to change positions suddenly and quickly. Specifically, when changing from a lying position to sitting up, standing up or turning the head, bowing and tilting the head must also be done slowly and slowly. It is best to close the eyes to limit the visual reception of spatial change signals, reducing vestibular stimulation. After establishing the pose at the new position, slowly open your eyes.
If you notice that dizziness often occurs when you wake up, then in your sleep, you should use many pillows to prop your head up, should lie on your back, avoid leaning to one side.
In addition, do not sit in a swivel chair or chair with a headrest that leans back too much, limit excessive leaning and bending movements such as picking up things, tying shoelaces.

4.2. Using drugs

Groups of drugs can assist in the correction of dizziness during acute attacks as well as the relief of symptoms of nausea and vomiting.
Antihistamines should only be used when the patient has severe dizziness that does not improve much after stabilizing the posture. Some sedative drugs can be added if the person is overstimulated, anxious, scared.
However, drugs acting on the central nervous system will have side effects such as drowsiness, lethargy, and dizziness that are difficult to completely go away. Therefore, it should only be used when absolutely necessary and adhere to the dosage as directed by the doctor.

4.3. Exercises for vestibular system

Currently, the treatment of benign paroxysmal vertigo tends not to use drugs but to apply exercises to reposition the stones in the semicircular canal, helping the vestibular system to recover and adapt to the displacement in the air. body space.
Exercises can be done at the clinic with the support of physiotherapists or the patient can practice at home. If done correctly and patiently, unpleasant symptoms will improve significantly.

Chóng mặt kịch phát lành tính có thể điều trị không cần dùng thuốc

4.4. Other treatments

When dizziness occurs, it is necessary to stay calm, close your eyes, limit your head rotation and find a suitable position to rest. If you feel nauseous, you should control it by taking deep breaths and focusing on your breathing. Just follow this, the dizziness will quickly subside in a few minutes.
Do not walk long distances, do heavy work, climb, operate vehicles or machinery when dizzy. Because these things cause more severe dizziness, lasting longer, and can even cause accidents for yourself and others. Keep the space in the room, the aisle clear, avoid messy and indiscriminate items. Add handles in bathtubs and toilets. Drink enough water every day, eat a balanced, varied diet rich in vitamins and minerals. Avoid drinking coffee, alcohol, carbonated soft drinks. Do not use stimulants, smoke or be exposed to secondhand smoke. Get enough sleep, rest in moderation, think optimistically. Have appropriate and moderate exercise habits. In summary, benign paroxysmal positional vertigo is a common disease in the community. Information about the disease, how to respond and prevent it is essential to overcome these unpleasant symptoms and enjoy life confidently.
Master. American doctor has more than 6 years of experience as an internal medicine doctor at Hue Central Hospital, Hue University of Medicine and Pharmacy Hospital; Tam Tri Da Nang Hospital; Danang Hospital.