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Ictal vomiting can be a rare clinical manifestation of seizures. It is thought to originate in the anterior part of the temporal or insula lobes. It has been associated with the non-dominant hemisphere and has been considered a lateralising sign.1 A few cases have lateralised seizure onset to the dominant hemisphere.2 We describe a case of ictal vomiting where intracranial electroencephalography (EEG) has demonstrated seizure lateralisation to the dominant hemisphere and localisation of ictal vomiting to the dominant insula lobe.