What is the appropriate next step in managing a 7-year-old male with a history of migraines and new onset vomiting?

In cases involving a 7-year-old with a known history of migraines who now presents with new onset vomiting, the most appropriate next step is to consider a trial of prophylactic medication for migraine headaches. This decision is based on the understanding that vomiting may be a manifestation of increased migraine severity or frequency, rather than indicative of a new, different pathology such as a tumor or other intracranial pressure issues.

In young patients with a known history of migraines, it is important to manage and mitigate the progression and frequency of the migraine episodes, especially when they start exhibiting new symptoms like vomiting, which could indicate that the migraines are getting worse. Prophylactic medication serves to reduce the frequency of migraine attacks, thus also potentially reducing associated symptoms like vomiting.

The use of imaging, like a CT scan, is generally reserved for cases where there is suspicion of an acute neurological problem or when the clinical picture suggests a need to rule out other serious conditions. Since the child already has a diagnosis of migraines and the symptom of vomiting can be explained within that context, routine imaging would not be warranted at this stage.

Scheduling a follow-up or referring the child to a neurologist would be appropriate in cases of unusual presentation or if the current management plan is ineffective