The pontine brain, the dorsal medulla, and the periventricular area are the preferred sites for optic neuromyelitis optica (NMO). These sites are also the “vomiting centers”. Once an inflammatory reaction occurs in these areas, there is a high risk of intractable nausea, vomiting, eructation, and coughing. Internal examinations such as gastroscopy, abdominal ultrasound or CT will not reveal any abnormalities. At this point, cranial MRI should be investigated to clarify whether it is related to NMO. In fact, many patients with NMO in clinical practice have had the above symptoms when tracing their past medical history. Eructation, vomiting can be the first symptom of NMO or even the only symptom in case of recurrence.