When to See Your Doctor for Nausea and Vomiting

Nausea and vomiting have many possible causes, some benign and some serious. No matter what the cause, nausea and vomiting feel awful and can be debilitating—and a sudden episode can be very scary. The first step to getting better is narrowing down why you got sick in the first place.

Food poisoning, food allergies, stomach viruses, pregnancy, overindulgence in alcohol, and migraines are some common, typically harmless causes of nausea and vomiting that can be treated with hydration, rest, and medications.

More serious causes of vomiting may include:

Many cancer patients receiving chemotherapy also suffer from nausea and vomiting.

Children commonly experience vomiting due to viruses, motion sickness, overeating, and high fevers, but they may also vomit for more serious reasons.

It's important to know whether to get medical attention or focus on nursing yourself back to health at home—or a combination of these.

Prolonged vomiting can cause dehydration, which can become a medical issue on its own, so it's important to try to pin down why you're sick. Signs of dehydration in children include dry lips and mouth, sunken eyes, rapid breathing or pulse.

1

Ask Yourself These Questions First

Glass of dissolving medicine with vomiting man in background
Tom Merton / Getty Images

How your vomiting started, and any additional symptoms you have, can provide clues to its causes. Here are some questions to ask yourself: 

Were You Feeling Fine and Then Suddenly Started Vomiting?

If you had no signs of being sick before you started vomiting, this could be a sign of a potentially serious problem, such as appendicitis or intestinal obstruction. 

Are You Experiencing Severe Abdominal Pain?

Vomiting that occurs with abdominal pain (not just nausea) may be a sign of appendicitis. Contact your health care provider.

Do You Have a Severe Headache?

Vomiting that occurs with a severe headache can be a sign of some very serious illnesses such as meningitis.

If you are experiencing a severe headache and vomiting, seek medical attention right away.

If you have had diarrhea and vomiting and then develop a bad headache, it could be due to dehydration. If you believe this may be the cause of your headache, contact your healthcare provider to determine if you need treatment.

Did You Have Nausea or Diarrhea Prior to Vomiting?

These are reassuring signs that your vomiting is most likely due to a stomach bug. It could be a virus such as gastroenteritis or bacteria such as E. coli or salmonella. While most cases get better on their own, children and those with weak immune systems can develop complications. 

Do You Have a Fever?

A fever is another common symptom of a stomach virus. When it occurs with diarrhea and vomiting and you have no other symptoms, you can probably take steps to treat yourself at home unless you believe you are dehydrated.

However, if you have a high fever and vomiting without diarrhea, this could be an indication of a more serious illness. Determine if you have any other symptoms and check with your healthcare provider.

Have You Had a Head Injury in the Past 24 Hours?

If you or your child has had a head injury in the past 24 hours and has started vomiting, seek medical attention. This could be a sign of a concussion or increased pressure on the brain.

Are You Traveling/Moving?

Many people experience nausea and vomiting when they get motion sick. Motion sickness is very common when traveling in cars, airplanes, and boats.

Do You Have Painful Urination?

Fever, vomiting, and pain when urinating are all symptoms of a urinary tract infection. If you believe you might have a urinary tract infection, you will need to see your health care provider to be tested and treated with antibiotics.

Do You Also Have Signs of the Flu?

If you or your child is congested and are also vomiting, these can be symptoms of influenza (the flu). Vomiting is not common with the flu for adults but occurs more frequently in children. If you believe you or your child may have the flu, contact your health care provider. If your symptoms have started within the past 48 hours, you may be a candidate for antiviral medications that might help you feel better a little faster.

Do You Have Recurrent Attacks of Severe Nausea and Vomiting?

In cyclic vomiting syndrome, you have severe attacks of nausea and vomiting separated by normal periods, lasting for hours or days. These episodes recur but can be separated by weeks or months. People with this disorder often have a history of migraine, motion sickness, or long-term marijuana use.

Does Vomiting Seem Associated With Certain Foods?

Vomiting may occur after eating foods to which you are allergic or intolerant. In most food allergies, a reaction to the food happens soon after ingestion. However, in food protein-induced enterocolitis syndrome (FPIES), the reaction may be delayed for hours and so it is harder to identify the trigger.

2

Look Before You Flush

Gross as it may be, the consistency of your vomit can tell you some information about its cause. Take a look and see if it is: 

Food You Recently Ate

Most vomiting starts out looking like whatever it was you ate last. If you just vomit a few times and it consists of food, it could be a stomach virus, food poisoning or something completely different, such as pregnancy.

Orange

Food that is being digested will give vomit an orange color, so it is typical to see this color if you are vomiting within hours of eating.

Clear

If you have been vomiting repeatedly, your vomit will often become clear as all of the food has been ejected and only digestive juices remain to be vomited.

Green or Yellow

Vomit that is shades of green or dark yellow is typically due to bile, a digestive fluid released from the gall bladder into the first section of the small intestine. For children, this can signal a blockage or torsion of the stomach or small intestine that requires immediate medical attention. It can also occur when a person has vomited so much that there is no food or liquid left in their stomach. In this case, it may be an indication of dehydration. In adults, vomit that is green from bile may also be due to a bowel blockage.

Red

If you are vomiting bright red, it could be blood. Other causes of red vomit can be recently eating or drinking something red or a recent nosebleed.

If you know you have not recently had anything red to eat or drink, and have not had a nosebleed, then the presence of bright red vomit indicates a medical emergency.

Coffee Grounds

Black vomit that looks like coffee grounds may also be blood. If it is not fresh blood, it will often turn very dark and look black when you vomit. Although there may not be active internal bleeding, vomit that looks like coffee grounds is still considered a medical emergency.

Brown

Brown vomit that smells like feces could be a sign of a bowel blockage, which can be due to an obstruction or severe constipation with fecal impaction. If this occurs, see your doctor immediately.

3

When to See a Doctor for Vomiting

Usually, vomiting is caused by a stomach virus and will resolve on its own in 24 hours. As long as you don't get dehydrated, there is no reason to see a doctor for vomiting if you have a stomach virus.

However, as noted above, some illnesses that cause vomiting require urgent or immediate medical attention. 

To recap, signs that you may need to see your health care provider for vomiting include:

  • Dehydration (if you repeatedly vomit even small amounts of liquids, you need to see a doctor; other signs of dehydration include no urination for 12 hours especially in young children, dry mouth or eyes, and fatigue)
  • Very severe headache associated with vomiting and/or stiff neck
  • Severe abdominal pain
  • Confusion
  • Fever
  • History of head injury in the past 24 hours
  • Red vomit, coffee-ground vomit, or brown and foul-smelling vomit
  • In infants, green vomit or persistent vomiting
4

Home Remedies for Vomiting

If you have a stomach bug or any other more benign cause of vomiting, treatment will most often include rest and small sips of liquid, progressing to a BRAT diet.

Rest

This includes resting your body and your stomach. Do not try to eat or drink anything for 15 to 20 minutes after you vomit.

Lay down and do not attempt to participate in any physical activities while you are sick.

Clear Liquids

If you do not vomit for a period of 15 to 20 minutes, you can try to introduce clear liquids. Take a small sip of water or an electrolyte drink (such as Gatorade or Pedialyte) every 5 or 10 minutes.

As you are able to tolerate the clear liquids, you can slowly increase the amount that you drink each time. Continue clear liquids for at least 6 hours before proceeding to Step 3. If you start vomiting again, go back to step one.

Bland Diet

If you are able to keep clear liquids down for six hours or more, you can progress to a bland diet. The traditional BRAT diet stands for bananas, rice, applesauce, and toast. Other versions are BRATT (adding decaffeinated tea) and BRATTY (adding yogurt). All of these foods are good to eat if you have had a stomach virus. They are bland and easy to digest.

You can eat other foods as long as they are also bland and easy to digest. Some other good options include mashed potatoes, dry crackers, and pretzels. Many experts don't recommend staying on the BRAT diet for long, however, as it lacks proper calories and nutrients.

If vomiting returns after you have started the BRAT diet, go back to step one.

Foods to Avoid

While actively vomiting, it is best to avoid eating and stick with sips of clear liquids. This will help prevent dehydration and it reduces the risk of choking when vomiting. Once the risk of vomiting has subsided, continue to avoid spicy, fatty, and salty foods, as well as those that have a strong odor, until you are tolerating food well.

Complementary Therapies

Ginger has been used to reduce nausea and vomiting. Ginger ale might be tolerated as a clear liquid during or after a bout of vomiting. Peppermint may also be useful, in a tea or sucking on hard candies. Aromatherapy with peppermint oil has been tried, but according to a recent study, it may not be more effective than a placebo.

5

Medications for Vomiting

There are a few medications available to treat nausea and vomiting. Over-the-counter medications for vomiting are typically ineffective, but may help with nausea or an "upset stomach."

Some common OTC medications include:

  • Pepto Bismol, Kaopectate (bismuth subsalicylate). Works by protecting the stomach lining. Do not use this medication if you are allergic to it. Do not combine with aspirin. Also, it should never be given to someone under the age of 12 or to someone under the age of 18 who has the chickenpox or the flu, due to the risk of developing Reye's Syndrome.
  • Dramamine. Although it is an antihistamine (anti-allergy medication), Dramamine is commonly used to treat nausea and vomiting that is caused by motion sickness.

A few prescription medications are available to help with severe nausea and vomiting. These include:

  • Zofran (ondansetron). Originally developed and used to treat severe nausea and vomiting due to chemotherapy, Zofran is used to treat uncontrolled vomiting in adults and children.
  • Phenergan (promethazine). Phenergan is also an antihistamine, but is frequently used to treat nausea and vomiting. It may also be used as a pain reliever or to make a person fall asleep prior to surgery.

Both of these medications are available by prescription only. Most health care providers will not prescribe them over the phone. It is important to be seen by your health care provider before taking one of these medications. Only they can determine if the medication is appropriate for you and your illness.

A medical professional will be able to rule out more serious causes of your vomiting.

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Article Sources

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