Understanding Chronic Nausea

Most people know what nausea feels like because they’ve experienced it during a bout with a virus or even from a roller coaster or a bumpy plane ride, and pregnant women usually know it well. Nausea is an unsettled feeling in the stomach and may be accompanied by the sensation that one might vomit. It can range from being strong, where vomiting seems as though it could happen at any moment, to a low level of lingering stomach upset.

Nausea is not generally thought of as a condition in and of itself, but is rather a symptom of something else that’s happening within the body. Sometimes nausea is also accompanied by a lack of appetite, regurgitation, vomiting, and abdominal pain or discomfort.

Acute nausea might be caused by a condition that comes on suddenly, which is called acute. Acute nausea may be caused by a virus that affects the stomach and causes nausea and vomiting (this is gastroenteritis, which is often called “stomach flu,” though it is not related to influenza). Food poisoning is another cause of nausea (sometimes also accompanied by vomiting and diarrhea) that will occur suddenly and usually resolves on its own when the bacteria clears the body. 

Other common causes of acute nausea that usually resolve on their own include:

• Car sickness (motion sickness)
• Extreme pain
• Hangover
• Medication side effects
• Migraine
• Overeating
• Stress
• Trauma (such as a concussion)

Chronic is when the nausea may be present all the time or it may come and go. In some cases the nausea may come on after a triggering factor, such as eating, only to improve and then come on again after the next meal. When the nausea is chronic, and there’s no clear cause such as pregnancy, it’s time to talk to a doctor about why it might be happening. There won't be one particular test that can help determine the cause of nausea so testing will depend on what might be the suspected caused.

Nausea is a symptom of a condition, and some of the more common reasons can include:

Pregnancy: Chronic nausea is common in pregnant women, especially in the first trimester, and is commonly called “morning sickness” even though it can last all day. For many women, nausea comes on in the middle of the first trimester and is gone by the second, but some women have nausea their entire pregnancy or it comes back towards the end. When nausea is severe and is accompanied by vomiting to the point where keeping any food or water down is challenging, this could be a condition called hyperemesis gravidarum. 

Gallstones: Gallstones are common, especially in women, who are twice as likely to have stones as men. Gallbladder stones might cause no symptoms but may also cause pain in the back, shoulder, or upper abdomen, and nausea and vomiting. Symptoms might be worse after eating, especially when eating a meal containing high levels of fat. Gallstones might be diagnosed with one of several different imaging tests and are most often treated with gallbladder removal.

Gastroesophageal reflux disease (GERD): GERD is a common condition that occurs when stomach contents come back up into the esophagus. This can cause symptoms of heartburn, regurgitation, and nausea. Symptoms might be worse after eating or at night after lying down, and the nausea may linger, especially if stomach acid backs up into the throat. In many cases GERD is treatable with over-the-counter or prescription medication (including antacids, histamine-2 receptor antagonists, H2RAs; and proton pump inhibitors, PPIs). Lifestyle changes such as losing weight and sleeping with the head elevated, as well as avoiding potential triggers for symptoms (such as smoking, alcoholic beverages, coffee, chocolate, fatty foods, and fried foods) may also help.

Migraine: Migraine headaches might cause nausea either before the headache comes on or during the headache. Diagnosing headaches can be complex because there are several different types of migraines that have different symptoms. Treatment may involve both lifestyle changes and medications.

Peptic ulcer: A peptic ulcer is when there are sores in the stomach, small intestine, or esophagus. In most cases, peptic ulcers are caused by a bacteria called Helicobacter pylori (H pylori). Another cause of peptic ulcers is the use of non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, but this is not as common. Peptic ulcers often cause pain or discomfort, but may also cause nausea, vomiting, loss of appetite, weight loss, and feeling full after small meals. For ulcers caused by H pylori, antibiotics will be prescribed, along with other medications to help alleviate symptoms.

Central nervous system disorders: Conditions that affect the nervous system such as intracranial hemorrhage or infections may be associated with nausea. These conditions are serious and are usually accompanied by symptoms of confusion, dizziness, or changes in memory. If these symptoms occur and a hemorrhage or an infection like meningitis are suspected, they are a reason to seek medical attention right away.

Hepatitis: Hepatitis is an inflammation of the liver and can occur as a result of an infection with a virus or from autoimmune hepatitis or alcoholic hepatitis. Hepatitis can be acute or chronic and may cause nausea along with jaundice, fever, headache, and joint pain. Treatment will depend on the cause of hepatitis but will range from lifestyle changes to antiviral medications to steroids.

Hiatal hernia: A hernia is when there’s a weak point in the abdominal wall and the stomach pushes through it and up into the chest. Hernias may cause symptoms of reflux as well as pain or discomfort and in some cases, there may also be nausea. Small hernias might not be noticeable, cause any symptoms, or even require treatment, but larger ones may require surgery.

Inflammatory bowel disease (IBD): IBD includes Crohn’s disease, ulcerative colitis, and indeterminate colitis, which are diseases of the digestive tract. These diseases cause inflammation in various parts of the digestive system and can be associated with chronic nausea. In some cases, nausea might be an adverse effect of medications or be the result of a complication (such as a bowel obstruction). Treatment will depend on the cause of nausea and might also include effective treatment of the inflammation caused by the IBD. 

Intestinal obstruction: An obstruction is when the small or large intestine gets blocked. A blockage could be caused by one of several reasons, including scar tissue or a kink or twist in the intestine. Usually, the most prominent symptom of an intestinal obstruction is pain, but nausea and vomiting can also happen in some cases. Obstructions are more common in people who have IBD (Crohn’s disease in particular) but they can happen to anyone. Obstructions can be a medical emergency, so it’s important to get care right away when one is suspected. In most cases, obstructions can be treated in the hospital without surgery.

Pancreatitis: The pancreas is an organ that releases enzymes for digestion into the stomach and hormones into the bloodstream. Pancreatitis is when the pancreas becomes inflamed, which can lead to symptoms of pain that gets worse after eating, fever, nausea, and vomiting. Pancreatitis is rare and people who have the condition are often quite sick because it is a serious condition. Treatment will depend on what is causing pancreatitis.

Idiopathic means that no physical reason can be found for nausea. This doesn’t mean that there isn’t a cause, however, or that one won’t become clear in the future. In some cases, this might also be called functional nausea. Because there doesn’t appear to be an underlying cause for nausea, treatment is usually focused on reducing the discomfort of nausea, treating any other conditions that might be occurring at the same time such as migraines, balance problems, or digestive diseases, and preventing vomiting. 

Treating chronic nausea will depend largely on the underlying cause, therefore getting an accurate diagnosis is important. However, once the cause is understood, there are several things that can be done to help get nausea under control so it is less bothersome. Treating nausea at home can include:

• Antihistamines or anti-emetics (on the advice of a physician)
• Concentrating on deep, even breathing
• Eating foods that are less likely to cause nausea (crackers, bread, rice)
• Foods containing ginger or sucking on ginger candy
• Motion sickness medication (such as Dramamine) on the advice of a physician
• Moving to a cool room
• Sipping cold water, ginger ale, or tea
• Taking smaller, more frequent meals

Nausea isn’t typically an emergency but call a doctor right away in the case of:

• Black or tarry stools
• Blood in the stool or vomit
• Confusion
• Dizziness
• High fever
• Severe abdominal pain
• Signs of dehydration 
• Vomiting that won’t stop

Nausea is a nonspecific symptom. It might be challenging to pin down exactly what’s causing it. In many cases, related symptoms (such as pain, fever, or vomiting) can give a physician more insight into what might be causing your nausea. Having nausea that comes or goes or is chronic is a reason to schedule an appointment with a physician in order to get to the bottom of it.

Common conditions that are associated with nausea might be treated in various ways but home remedies might also help in the short-term to cope with nausea. When nausea is accompanied by red flag symptoms such as severe pain or vomiting or blood in the vomit or stool, it’s reason to contact a physician right away.