Ictal vomiting can be a rare clinical manifestation of seizures. It has been reported in both idiopathic and symptomatic epilepsies. It is thought to originate in the anterior part of the temporal lobe or from the insula lobe. Ictal vomiting has been associated with the non-dominant hemisphere and has been considered a lateralising sign. However, a few cases have lateralised seizure onset to the dominant hemisphere. Here 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.