Vomiting is the involuntary expulsion of your stomach contents out of your body through the mouth. Throwing up is usually partnered with nausea, but not all nausea will result in vomiting. Rarely does vomiting present without nausea. By itself, it is not a disease but rather a symptom of an illness, syndrome, or other condition. Throwing up is an uncomfortable process for anyone to go through. Fortunately, most cases are self-limiting and occur infrequently. 

Vomit, throw up, hurl, puke, heave. No matter what you call it, the fact remains, it’s a terrible but usually harmless ordeal. However, if you are throwing up, one day of puking seems to last an eternity. Most people will bear through a puke session at some point in their life. There are many reasons humans, and even animals, vomit. The process of forcefully losing your last meal out the wrong end of your gastrointestinal tract can feel as though your body has betrayed you. Your body, however, has its reasons, and we will cover some of them here.

Seek medical attention if vomiting follows a head injury, you have a high fever, stiff neck, severe abdominal pain, difficulty breathing, altered mental state, lethargy, bleeding (blood in vomit), or worsening symptoms. If you have questions about the severity of your symptoms or any other concerns, knowledgeable doctors are available and happy to assist you.

Viral Gastroenteritis (Stomach Bug)

Gastroenteritis is inflammation in your stomach and intestines. If a virus is the cause of your intestinal inflammation, it is called viral gastroenteritis or, informally, a stomach bug. If you or someone you care for has viral gastroenteritis, you will likely notice watery (non-bloody) diarrhea, nausea, vomiting, stomach cramps, mild muscle aches, and low-grade fever. The most common viruses that cause vomiting are adenovirus, norovirus, and rotavirus. 

Adenovirus

Adenovirus is responsible for several infections, including the common cold and pink eye. The kind of infection you get from adenovirus will depend on the type of adenovirus you were exposed to. Gastrointestinal upset is one of the more miserable illnesses it causes. Although anyone can fall ill from adenovirus, infections are more common in children than adults. 

Norovirus 

Norovirus is a highly infectious virus that frequently causes gastroenteritis. It can take just a few norovirus particles to make a person sick. Once infected, you can shed billions of these particles.^[1]  Norovirus comes in various strains that can infect people of all ages multiple times throughout their lives. 

Rotavirus

Rotavirus can be severe enough in children to require hospitalization due to dehydration. Infants and children are most likely to get rotavirus. However, adults can contract this illness, but it tends to be milder. Children are eligible for a two or three-dose rotavirus vaccine starting at two months of age. The rotavirus vaccine is effective at preventing severe disease. 

How to Treat a Stomach Bug

Lots of rest and supportive care while letting the virus run its course is usually sufficient for treating a stomach bug. It is crucial to replenish fluid loss due to vomiting or diarrhea. When your stomach settles and your appetite returns, start with small amounts of bland food. 

If you suspect you are suffering from viral gastroenteritis but are unsure how to manage it best, schedule a visit with a doctor. Your physician can provide appropriate information that may help your recovery and support you in seeking further care, if necessary.

Migraines

Migraines are intense headaches with symptoms severe enough to be debilitating. You will likely experience more than just a headache if you have a migraine. Migraines often come with dizziness, nausea, vomiting, weakness, and photophobia (light sensitivity). They can last hours to days and occur as frequently as once per week or more in extreme cases. Migraines don’t discriminate between age, race, gender, or economic status. People of all backgrounds are affected by these unbearable headaches. 

Migraines can present in four stages. You may experience a prodrome stage where you notice early warning signs of an impending migraine, followed by the aura stage, then the headache, and lastly, a postdrome period. Not all migraine sufferers will move through each phase. 

Prodrome

During the prodrome stage, you might notice subtle warning signs indicating a migraine is on its way. You may feel tired, anxious, or irritable. Picking up on these early signals can be helpful to treat your headache preemptively. Some patients find a migraine journal worthwhile to discover if they have a prodrome phase and what it looks like for them. Identifying prodrome symptoms can allow for early treatment in hopes of thwarting an approaching headache. 

Aura

The neurological symptoms during an aura phase are usually visual, such as vision loss or seeing bright flashes of light. Some auditory or hearing disturbances may also occur during this time. The aura stage directly precedes the headache. 

Headache

A severe headache, usually on one side and often throbbing, is the hallmark of migraines. The pain associated with migraines can last hours or days and is intense enough that you are unlikely to continue normal activities during this time. It is common for nausea and vomiting to accompany migraines. Additionally, you may become unable to tolerate light, sounds, or certain smells. 

Postdrome 

During the last stage of a migraine, you may feel exhausted or depressed. You may also have residual nausea, dizziness, and photophobia. Some patients call this a migraine hangover and report that it can last up to a day after the headache. Not everyone will have a prodrome period.  

Treatment

The goal is to prevent migraines from occurring or stop them once they start. Pain-relieving medications attempt to end the headache after it begins, while preventative medications aim to avert future attacks. A wide range of drugs are available to manage these migraines and related symptoms—everything from botulinum toxin injections to blood pressure medications. Even antidepressants have shown to be a valuable tool for migraine frequency reduction. Patients can also take antinausea meds to reduce the unbearable nausea that regularly comes with migraines.

Journaling your symptoms and activities in the days leading to migraines may add valuable information to your treatment plan. You may be able to identify catalysts that initiate your headaches. Once identified, trigger avoidance can result in an overall reduction of migraines. Journaling won’t work for everyone because not all migraines have triggers. 

Although the cause of migraines is not fully understood, facial nerves appear to harbor some responsibility. Doctors believe some of these nerves become compressed by surrounding structures. Releasing specific nerves shows efficacy for migraine treatment, particularly for patients who don’t respond to more conventional therapies. In one meta-analysis that reviewed studies from 2000 to 2020, up to 93% of patients who suffered frontal migraines reported satisfactory results.^[2] A frontal migraine is a headache that causes pain in the forehead or temples. 

Anxiety

Anxiety is an often overlooked cause of vomiting and nausea but affects a large portion of the population. Anxiety is a psychological response to stress that can lead to substantial physical symptoms. If you have anxiety, you might feel restless, tense, or have a sense of impending doom. Your heart rate can increase, you may begin rapid breathing (hyperventilation), sweat, tremble, and feel weak. Your symptoms may also involve the GI tract and cause nausea, vomiting, or diarrhea.  

When you endure intense anxiety, your body thinks it either needs to flee the situation or fight the danger. When fight or flight signals are received, your body’s nonessential functions, like digestion, shut down—the altered state of the GI tract can result in nausea. If the nausea is bad enough, you may vomit. 

It is normal to have anxiety in certain situations. If you are in danger or even just nervous about a first date, you might notice a rapid heartbeat or feel a bit nauseous. It is your body’s way of ensuring an appropriate response to a pending or current risky event. However, some people can suffer from excessive anxiety. If you have an anxiety disorder, your physical and emotional responses to situations are more intense than a typical reaction. 

Because of the physical symptoms of anxiety, doctors or patients might mistake it for another condition. Fortunately, anxiety is treatable through a multipronged approach. Therapy, lifestyle changes, and medication can all work together to alleviate your symptoms. Scheduling an appointment with a general practitioner is a sufficient starting point to determine if your nausea or vomiting could be due to anxiety.  

Cyclic Vomiting Syndrome

Cyclic vomiting syndrome is a condition in which the patient will encounter episodes of vomiting with periods of normalcy, or decreased symptoms, in between attacks. The vomiting can last hours or days. Vomiting incidents can occur regularly or appear at random. Doctors diagnose cyclic vomiting syndrome more often in children, up to 2,000 per 100,000, but data shows this syndrome may affect adults with the same frequency as children.^[3] Researchers believe it is a variant of migraines, and children diagnosed with it may grow into adults with migraines. 

Episodic vomiting in the absence of a cause is the primary feature of cyclic vomiting syndrome. If you are diagnosed with this syndrome, you may have abdominal pain, diarrhea, headache, and increased sensitivity to light or sound, in addition to nausea and vomiting. During periods of normalcy, you may also begin to feel anxious in anticipation of the next occurrence. In some patients, this can lead to depression and other mental health concerns. 

Treatment focuses on controlling symptoms and preventing future attacks. Antinausea meds and even some of the same medications used to treat migraines treat cyclic vomiting syndrome. Evidence-based guidelines sponsored by the American Neurogastroenterology and Motility Society (ANMS) and the Cyclic Vomiting Syndrome Association (CVSA) recommend tricyclic antidepressants as the first line of defense for prophylactic treatment in adults with cyclic vomiting syndrome. ^[4]

Alcohol Consumption

When consumed in moderation, most people will not have an issue with alcohol. However, if you consume a large amount in a short period, you can become sick and throw up. The intake of alcohol can be intentional through alcoholic beverages or from accidental ingestion of household products that contain alcohol. Vomiting is your body’s attempt at removing excess toxins from the alcohol. In most cases, and in the absence of accidental ingestion, you can let it run its course. Call poison control if you have consumed any household product not intended for consumption.

Why does alcohol cause vomiting? 

Alcohol is a toxin. When you drink it, your body gets to work right away to metabolize the alcohol using enzymes from your liver. Your liver breaks it down into acetaldehyde and then into acetate, which then converts into water and carbon dioxide that your body can remove.^[5]  Acetaldehyde is highly toxic. When breaking down alcohol, if acetaldehyde becomes too concentrated in your liver, your body cannot cope and reacts by inducing vomiting to remove the excess toxins. If you feel your drinking negatively impacts your health, you might benefit from meeting with a doctor to discuss your drinking habits.

Alcohol Poisoning Versus Excess Alcohol Consumption

Alcohol poisoning is different from having one too many drinks and vomiting a few times. Alcohol poisoning is a medical emergency that occurs when a person drinks, intentional or unintentional, a toxic amount of alcohol over a short duration. With alcohol poisoning, your body becomes overwhelmed by the process of breaking down alcohol, and your body’s compensatory actions become insufficient to clear the toxins safely. Symptoms of alcohol poisoning are:

• Vomiting
• Confusion
• Slow heart rate
• Irregular breathing 
• Seizures
• Being unconscious or unresponsive

Alcohol poisoning can also impair your gag reflex, making you more likely to choke on your vomit. If you suspect you or someone you are with has alcohol poisoning seek medical assistance immediately. 

Motion Sickness

Motion sickness occurs when movement results in physical illness. You may find that amusement park rides don’t agree with you, or you are always reaching for the brown vomit bag on airplanes. Even something as familiar as a car ride might send you into a hurling session. Motion sickness happens because your brain receives conflicting signals from your senses. If your brain cannot process the inconsistent information, you get sick. 

The Senses Involved in Motion Sickness

You have three senses responsible for telling your brain where your body is positioned in relation to everything else around you. These senses are your eyes, the inner ear system called vestibular apparatus, and receptors throughout your body called proprioceptors. Proprioceptors are present in your skin, muscles, and joints. 

If these three systems do not agree with where your body is or how your body is moving, your brain becomes confused, causing you to become sick. When driving in a car, your inner ear senses movement, but your proprioceptors are still. Your inner ear tells your brain you are moving, but your proprioceptors tell your brain you are not. Your eyes may agree with your inner ear or your proprioceptors, depending on where you are looking. 

What are the symptoms of motion sickness? 

Symptoms of motion sickness can mimic other illnesses but are distinguishable from alternative causes of vomiting because the symptoms present when your body is in motion and relent when the movement ceases. You may feel dizzy, nauseated, or irritable if you have motion sickness. You may also notice a headache or increased saliva, and you could throw up. People might mention that your skin looks pale or sweaty. 

How do I treat motion sickness? 

There are over-the-counter medications that can treat motion sickness. You can also try to relieve the disconnect between your body and your brain. If you find yourself fighting motion sickness whenever you get in a car, try to sit up front or look out a window. Looking out a window while moving allows your inner ear system and visual cues to be on the same page. Both tell your brain you are in motion. If the activity that causes your sickness is unnecessary to everyday life, avoidance can be an easy fix. Motion sickness should relent once the movement stops. 

Talk With a Doctor to Learn More About the Causes of Vomiting and How to Treat Them

Vomiting can present for many reasons. Stomach viruses are one of the more common causes. Fortunately, viruses are usually transient and clear on their own. Although migraines, or the potentially related cyclic vomiting syndrome, can be debilitating, they are not dangerous and are treatable. It may take some trial and error to develop something that works, but many who suffer from these conditions effectively reduce their symptoms with the proper treatment. Other reasons for vomiting, like excess alcohol consumption or motion sickness, can often be avoided. 

Throwing up is a distressing experience regardless of the cause. There is not much that feels as discordant as the forceful ejection of your stomach contents. Unfortunately, almost everyone will experience it in some capacity or another during their life. Schedule an appointment with a doctor if you are throwing up and unsure how to best treat your symptoms. Usually, all that is needed is a little rest and fluid compensation. If you need more extensive care, our doctors can prescribe medications or, if necessary, point you in the direction of additional treatment.  

References

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^[1] Centers for Disease Control and Prevention. (2021, March 5). About norovirus. Centers for Disease Control and Prevention. Retrieved February 18, 2022, from https://www.cdc.gov/norovirus/about/index.html 

^[2]  Lucia Mangialardi, M., Baldelli, I., Salgarello, M., & Raposio, E. (2020). Decompression surgery for frontal migraine headache. Plastic and Reconstructive Surgery – Global Open, 8(10). https://doi.org/10.1097/gox.0000000000003084 

^[3]  U.S. National Library of Medicine. (2020, September 8). Cyclic vomiting syndrome: Medlineplus Genetics. MedlinePlus. Retrieved February 15, 2022, from https://medlineplus.gov/genetics/condition/cyclic-vomiting-syndrome/#frequency 

^[4] Venkatesan, T., Levinthal, D. J., Tarbell, S. E., Jaradeh, S. S., Hasler, W. L., Issenman, R. M., Adams, K. A., Sarosiek, I., Stave, C. D., Sharaf, R. N., Sultan, S., & Li, B. U. (2019). Guidelines on management of cyclic vomiting syndrome in adults by the American neurogastroenterology and motility society and the Cyclic Vomiting Syndrome Association. Neurogastroenterology & Motility, 31(S2). https://doi.org/10.1111/nmo.13604 

^[5] U.S. Department of Health and Human Services. (2007, July). Alcohol metabolism: An update. National Institute on Alcohol Abuse and Alcoholism. Retrieved February 19, 2022, from https://pubs.niaaa.nih.gov/publications/aa72/aa72.htm