Nausea Causes 101: Oversimplified By A Gut Doctor.

Fast facts:

  • Nausea is an unpleasant sensation of being about to vomit (with or without vomiting).
  • It occurs due to abnormal Motility of your stomach as a response to various diseases (nausea is not a disease of its own).
  • Nausea when you are in a car or boat is usually due to motion sickness.
  • Chronic or recurrent nausea after meals is usually due to acid reflux or GERD.
  • Psychic stress and severe pain are also very common causes of nausea.
  • See a doctor if you have severe unexplained nausea, vomiting, fever, or chest pain.

Common Causes of Nausea in adults: 

1- Motion sickness.

Motion sickness occurs when you are in a car, boat, or any other means of transport. The symptoms include:

  • Dizziness. 
  • Sudden nausea. Vomiting can also occur.
  • Making more saliva than usual.
  • Sweating, warmth. And belching.

This is one of the most common causes of nausea.

How to manage your motion sickness?

Some tips to help you avoid motion sickness:

  • When you are in the car or the boat, sit in the front.
  • Also, fix your eyes in the direction you are moving on.
  • Avoid looking at things close to you or inside the vehicle.
  • Avoid reading, looking at your phone.

There are a number of medicines that can help prevent and treat motion sickness. Generally, these drugs work better if you take them before getting into your car or boat.

Over-The-Counter medicines for Motion sickness:

  • Dimenhydrinate (Dramamine ®, Trip Tone ®).
  • Meclizine (Antivert ®, Bonine ®)
  • Diphenhydramine (Benadryl ®).

Prescription medicines include: 

  • Scolopamine Patches (Scopace ®, Transderm Scop ®): this is a skin patch that can stary for up to 3 days.
  • Promethazine (Promethegan ®).

Ask your doctor or your nurse about the best option for your motion sickness. If your pregnant and have motion sickness, always contact your doctor as not all of the above medications are safe during pregnancy.

Learn more about Motion Sickness and nausea

2- Acid Reflux and GERD:

Acid reflux is the regurgitation of the acid content of your stomach into the esophagus. Acid reflux occurs due to the “loosening” of the sphincter between your lower part of the esophagus and stomach.

When symptoms become bothersome to you, doctors call the condition “Gastro-Esophageal Reflux Disease or GERD. 

Symptoms of GERD and ACID Reflux:

  • Heartburn: burning feeling in your chest.
  • Regurgitation: of acid or food into your throat or your mouth.
  • Nausea, or vomiting.
  • Unexplained cough, bad mouth odor.
  • Trouble swallowing.
  • Having a raspy voice and a sore throat.

Learn more about GERD AND Nausea

3- Gastroenteritis / Food poisoning.

Infection with gut bugs such as norovirus or rotavirus causes inflammation of your stomach and intestines (gastroenteritis). Also, eating food contaminated with viruses, bacteria, chemicals or bacterial toxins (food poisoning) can lead to gastroenteritis. 

How to suspect gastroenteritis/food poisoning?

  • Acute onset nausea, diarrhea, colics, and epigastric pain.
  • The condition can be associated with fever.
  • Diarrhea is usually severe and can be yellowish watery or greenish.
  • Vomiting can occur with nausea.
  • Malaise or generalized fatigue and body aches can occur.
  • In severe cases, dehydration can occur leading to confusion, dizziness, and decreased urine.

Gastroenteritis is usually a self-limiting condition within a few days. Consult your doctor if your symptoms last for more than 3 days or have severe symptoms and you suspect food poisoning.

Learn more about gastroenteritis and food poisoning.

4- Severe pain.

Acute and chronic pain conditions can be the cause of your nausea . If you have diseases that cause chronic pain or you have a sudden severe painful condition, this can lead to nausea or vomiting.

Examples of acute and chronic painful conditions that can lead to nausea (or vomiting):

  • Kidney (loin) pain: due to stones or gravels inside your kidney or ureter.
  • Pancreatitis : severe pain at the upper central part of your abdomen due to inflammation of the pancreas (mainly due to obstruction of its duct).
  • Cholecystitis : acute cholecystitis pain is usually very severe, associated with intense nausea and maybe vomiting.
  • Heart attack (chest pain): the pain from a heart attack occurs in the chest or the upper part of the abdomen. And it can be associated with nausea or vomiting.
  • Severe trauma: any severe trauma to your bones or your internal organ can lead to nausea or vomiting.
  • Post-operative pain: postoperative nausea or vomiting are very common. Pain is the most common cause of postoperative nausea
  • Chronic cancer pain.
  • Migraine headaches (see later)

CAUTION: Nausea and severe chest or stomach pain can be a sign of a dangerous health condition such as HEART ATTACK. Please consult your doctor immediately if you have no explanation of your severe pain

5- Psychic stress, anxiety, and Reactions to certain smells.

Psychic stress and anxiety can cause nausea by triggering “fight or flight response’. The response includes a rush of hormones and neurotransmitter that prepares your body to cope with stressful situations. 

But, this “rush” of hormones can affect your digestive system causing:

  • Nausea or vomiting.
  • Colics, diarrhea, or painful spasms in the bowel.

Learn more about stress, anxiety, and nausea.

Also, certain smells can trigger nausea or even vomiting. The reaction to smells is greatest among females, especially pregnant females.

-Pregnancy (morning nausea).

Nausea is one of the most common complaints during pregnancy. Up to 70% of pregnant women feel nauseous at some point during pregnancy . It is thought to be due to the increase in pregnancy hormones such as estrogen and progesterone.

Nausea (and vomiting) of pregnancy are more common in the morning (morning sickness). Fortunately, researchers found that there is a decreased risk of miscarriage in women who have nausea with pregnancy .

Nausea (& vomiting)  of pregnancy is more common with :

  • Younger women.
  • First-time pregnancy.
  • Obese women.
  • Non-smokers!
  • Women with a previous history of motion sickness.
  • Women with a history of nausea due to oral contraceptive pills .

6- Medications.

One of the most common causes of nausea is the medications you intake. Many groups of medications can potentially cause nausea. 

Before thinking of the worst. Just review any medications you intake recently (and also your chronic medications). 

Even non-prescription drugs (over-the-counter) can be the cause of your nausea. They include :

  • Analgesics and anti-gout medications.
  • Drugs used to treat heart diseases and hypertension.
  • Cancer chemotherapy medications.
  • Oral contraceptive pills
  • Some antibiotics.
  • Medications used to treat neurological disorders such as anti-parkinsonian drugs and anticonvulsants.
  • Anti-asthma Medications
  • Radiation therapy.
  • IBD medications.
  • Over-dose of vitamin supplements .

The complete list of drugs causing nausea (or vomiting) : 

Medications causing nauseaExamples
1- Analgesics: medications used to treat headache and painAspirin.Other NSAIDs such as Ibuprofen, ketoprofen.Anti-gout medications.
2- Drugs for heart diseases:Digoxin (especially over-dose).Beta-blockers (such as bisoprolol).Calcium channel blockers (as Amlodipine).Other antihypertensives and anti-arrhythmia medications.Diuretics
3- over-use of vitamin supplements (hypervitaminosis).Vitamin D overdose.Vitamin A overdose.
4- Cancer chemotherapy.Severe nausea and vomiting especially with:Cisplatinum.Dacarbazine.Nitrogen mustard.Others cause moderate to mild nausea:Methotrexate.Cytarabine.Etoposide.Fluorouracil.Tamoxifen.
5- Hormonal preparations/therapiesOral contraceptives.Anti-diabetic drugs.
6- Antibiotics / AntiviralsErythromycin.Tetracycline.SulfonamidesAnti-TB drugs.Acyclovir.
7- IBD (Crohn’s & Ulcerative Colitis) medicationsSulfasalazine.Azathioprine.
8- CNS drugs:Antiparkinsonian drugs.Anticonvulsants (& epilepsy) drugs.
9- Anti-asthma drugs:Theophylline

7- Too much alcohol drinking.

Too much alcohol drinking causes bad effects on your gut, including nausea and throwing up. This is due to :

  • Alcohol is irritant to your stomach.
  • It can cause dehydration and electrolyte imbalance.
  • Central effects on your brain (hangover).

8- Migraine.

Migraine is a very common condition characterized by severe headache, associate with light and sound sensitivity, and maybe nausea and vomiting .

Nausea is one of the most distressing symptoms of migraines together with the headache. Between 20% and 50% of people with recurrent migraines have nausea or vomiting with some or all of their migraine episodes .

Nausea with migraine can be controlled by over-the-counter or prescription medications. also, diet and diet control and some alternative medicine techniques can help. 

Learn more about the management of migraine nausea here.

9- Ear problems.

Inflammation inside your ear can cause nausea, most commonly: ,

  • Inflammation inside the inner ear (Vestibular neuritis and Labyrinthitis)
  • Inflammation inside the middle ear (Otitis media)

Vestibular neuritis symptoms include:

  • Vertigo: a sense of whirling and loss of balance. Usually acute onset.
  • Nausea and/or vomiting.
  • If the condition is severe, it may affect your gait .
  • NO affection of hearing in pure vestibular neuritis.

Labyrinthitis is the same as vestibular neuritis Plus the involvement hearing affection (hearing loss or abnormal hearing sensations such as tinnitus).

Also, Middle ear inflammation can cause nausea and/or vertigo. Consult your doctor about your nausea related to vertigo especially if:

  • You experience acute onset, persistent vertigo.
  • Vertigo and nausea are associated with severe headaches.
  • Vertigo and nausea are associated with unilateral numbness, weakness, or speech abnormality.
  • The onset of your nausea and vertigo started above the age of 60 years.

– Gut obstruction (gastric outlet or small intestinal obstruction).

Obstruction of your stomach due to abnormalities of the sphincter connecting it to the duodenum and small intestine is called “Gastric Outlet Obstruction).

Also, obstruction of your intestines for any reason will result in severe nausea, distension, vomiting, and/or constipation.

If you develop acute, persistent nausea, vomiting, severe abdominal distension or bloating, and constipation please consult your doctor immediately.

10- Gastroparesis (especially if you have diabetes mellitus).

Gastroparesis means delayed emptying of your stomach in the absence of Mechanical gastric obstruction . Gastroparesis results in chronic or recurrent nausea and other symptoms such as: 

  • Early satiety even with small amounts of food eaten.
  • Nausea may progress to vomiting.
  • Bloating: a sense of fullness.
  • Belching: expelling gas loudly from your stomach through the mouth.

The most common causes of Gastroparesis are:

  • Diabetes mellitus: due to damage to the nerves controlling the motility of your stomach.
  • Some medications such as :
    • Calcium channel blockers (used in hypertension and heart medications).
    • Narcotics.
    • Tricyclic Antidepressants.
    • Progesterone (present in Birth control pills).
    • Lithium & others.
  • Stomach or intestinal surgery.
  • In some patients, the cause is unknown.

Gastroparesis diagnosis can be difficult, and your doctor may need some tests to assess and diagnose the condition. Consult your doctor if you have diabetes mellitus or using any of the above medications.

11- Cholecystitis.

Cholecystitis is the inflammation of your gallbladder. This inflammation may be due to stones (calcular cholecystitis) or other causes (Non-calcular cholecystitis). 

Cholecystitis can be acute with severe upper abdominal pain (to the right), severe nausea, vomiting, and maybe fever. Also, it can become chronic with recurrent acute attacks of Rt upper abdominal pain, nausea, or vomiting.

The pain from cholecystitis can be referred to as the back between shoulder blades or to the right shoulder.

Risk factors for developing cholecystitis and gall stones include:

  • Being female.
  • Obesity.
  • Being age 40 or older.
  • High-fat diet or low fiber food.
  • Rapid weight loss.
  • Being pregnant or taking oral contraceptive pills
  • Diabetes mellitus, and blood diseases such as sickle cell anemia or leukemia.

12- irritable Bowel Syndrome.

Irritable bowel syndrome is a functional intestinal disorder characterized by recurrent abdominal pain related to defecation and/or change in stool frequency and stool form.

Nausea is not a cardinal feature of irritable bowel syndrome, but it is frequently noticed with IBS. A study revealed that people with IBS had a 2.7-fold chance to develop nausea compared to people without IBS . Also, it is known for people with IBS to have other functional GI disorders such as functional dyspepsia and GERD. This increases the chances of developing nausea and IBS.

If you have IBS and Nausea, talk with your doctor about the possible cause and its relation to IBS. 

13- Other causes of nausea inside your abdomen.

A variety of diseases of your gut can cause nausea. We discussed GERD, Gastroparesis, intestinal obstruction, and gastric outlet obstruction with some detail above.

Other Gut diseases causing nausea include:

  • Other functional gut diseases such as Non-ulcer dyspepsia, chronic intestinal Pseudo-obstruction, Chronic constipation can cause nausea.
  • Pancreatic cancer.
  • Inflammatory intra-peritoneal diseases.
  • Pancreatitis (acute and chronic).
  • Hepatitis, especially acute hepatitis such as Hepatitis A virus.
  • Crohn’s disease.
  • Decreased blood supply to the intestine or colon (Mesenteric ischemia).
  • A condition called Retro-peritoneal fibrosis (Or any retro-peritoneal masses).
  • Intra-abdominal cancers or Metastases.

14- Causes inside your brain.

Nausea and vomiting centers lie inside your brain, many brain diseases can lead to nausea, and vomiting through the affection of these centers. Migraine is thought to be cause nausea through the affection of the vomiting centers in the brain.

Brain diseases that are associated with nausea include:

  • Migraine .
  • Any diseases causing an increase in the pressure inside your skull (intracranial pressure):
    • Brain tumors.
    • Brain hemorrhage or infarction (stroke).
    • Brain infections such as abscess meningitis.
    • Hydrocephalus and congenital malformations of the brain.
  • Seizures disorders such as epilepsy.
  • Brain irradiations (during treatment of brain malignancy or metastases).
  • Psychiatric disorders such as depression, psychogenic vomiting, anorexia nervosa, bulimia nervosa).

15-Others:

Other causes may include:

When to see a doctor for your nausea?

Call your doctor or nurse about your nausea if

  • Your nausea lasts for more than a day or two with no obvious cause.
  • You have very severe nausea or you have associated vomiting.
  • You have intense chest or abdominal pain.
  • Have reddish or blackish stool (blood in stool).
  • You have a fever of more than 38℃  (101℉).
  • You have a severe headache or stiff neck.
  • Your nausea is not responding to usual treatments.