Chronic Nausea and Vomiting

What counts as chronic

Short bursts of nausea and vomiting, from a stomach bug or food poisoning, settle within a few days. See nausea and vomiting for those. Doctors use "chronic" when symptoms last 4 weeks or longer. Chronic symptoms fall into three patterns, which point to different causes:

Causes

Medicines and substances

This is the first thing to check. Common culprits include opioids, metformin, GLP-1 medicines for diabetes or weight loss (semaglutide, tirzepatide), antibiotics, iron, digoxin, chemotherapy, some antidepressants and alcohol.

Cannabis

Cannabinoid hyperemesis syndrome causes repeated bouts of severe vomiting and belly pain in people who use cannabis frequently, usually daily for a year or more. A strong clue is relief from hot showers or baths. It resolves only when cannabis use stops.

Stomach and gut problems

• Gastroparesis: the stomach empties too slowly. Early fullness, bloating and vomiting of food eaten hours earlier. Common in long-standing diabetes and after some surgeries.
• Peptic ulcer and gastritis, including from H. pylori or NSAIDs.
• Partial bowel or stomach outlet blockage: from scarring, adhesions or tumors.
• Gallbladder, pancreas and liver disease.
• Celiac disease and eosinophilic gastrointestinal disorders.

Functional (gut-brain) disorders

When tests are normal, the cause is often a disorder of gut-brain interaction. Rome IV criteria include:

• Chronic nausea vomiting syndrome: bothersome nausea at least 1 day a week or vomiting at least once a week, for 3 months, with normal tests.
• Cyclic vomiting syndrome: stereotyped episodes, often linked to migraine or a family history of migraine.
• Functional dyspepsia: fullness and upper belly discomfort with nausea.
• Rumination syndrome: effortless regurgitation after meals, often misdiagnosed as vomiting.

Other causes outside the gut

• Pregnancy, including hyperemesis gravidarum
• Hormonal problems: Addison's disease, thyroid disease, high calcium, diabetic ketoacidosis
• Kidney failure
• Brain causes: migraine, vestibular disorders, and, rarely, raised pressure inside the skull from a tumor or fluid build-up
• Anxiety, depression and eating disorders

How doctors find the cause

Your doctor will ask about the timing, relation to meals, what you vomit, weight change, medicines, alcohol and cannabis use, pregnancy, headaches and dizziness. Tests usually include:

1. Blood tests: blood count, electrolytes, kidney and liver function, glucose, calcium, thyroid, and sometimes a morning cortisol.
2. Pregnancy test in anyone who could be pregnant.
3. Upper endoscopy: a camera test to look for ulcers, inflammation, blockage or cancer.
4. Imaging: abdominal ultrasound or CT if blockage or gallbladder disease is suspected.
5. Gastric emptying study: measures how quickly a radio-labeled meal leaves the stomach. It must be done off medicines that slow the stomach, such as opioids and GLP-1 drugs.
6. Brain MRI: if there are headaches, neurological symptoms or vomiting worse in the morning.

Treatment

Treat the cause

Stopping a culprit medicine, stopping cannabis, treating an ulcer or controlling blood sugar can resolve symptoms completely.

Diet changes

• Eat 5 or 6 small meals a day instead of 3 large ones.
• Choose low-fat, low-fiber foods, which leave the stomach faster. Liquids and pureed foods are easier with gastroparesis.
• Sip fluids between meals and do not lie down for 2 hours after eating.

Medicines

A doctor may prescribe anti-nausea medicines such as ondansetron or prochlorperazine, or prokinetics that speed stomach emptying, such as metoclopramide (limited to short-term use because of a risk of movement disorders) or erythromycin. For functional nausea and cyclic vomiting, low-dose tricyclic antidepressants and other "neuromodulators" can calm gut-brain signaling. Cyclic vomiting is often treated with migraine-preventing medicines.

Other therapies

• Cognitive behavioral therapy and gut-directed hypnotherapy for functional disorders.
• Diaphragmatic breathing for rumination syndrome, which is highly effective.
• Gastric electrical stimulation for selected people with severe, drug-resistant gastroparesis.

Complications

• Dehydration and low potassium, sodium or magnesium
• Weight loss and malnutrition
• Tears in the esophagus lining from forceful vomiting (Mallory-Weiss tears)
• Dental enamel erosion
• Reduced quality of life, missed work and anxiety about eating

Frequently asked questions

What causes nausea every day for weeks?

Common causes are medicines (opioids, GLP-1 drugs, metformin), pregnancy, gastritis or ulcers, gastroparesis, frequent cannabis use, anxiety and functional nausea. Less often, it signals hormonal, kidney, liver or brain problems. Daily nausea for 4 weeks or more deserves a medical assessment.

What is chronic nausea vomiting syndrome?

It is a Rome IV functional gut disorder: bothersome nausea at least once a week or vomiting at least once a week for 3 months, with normal endoscopy and blood tests. It reflects disturbed signaling between the gut and brain and is treated with neuromodulators and behavioral therapies.

Can anxiety cause chronic nausea?

Yes. Anxiety and depression commonly cause ongoing nausea, often worse in the morning or before stressful events. Because other causes can coexist, a doctor should still check for physical causes before attributing symptoms to anxiety alone.

How is cyclic vomiting different from chronic nausea?

Cyclic vomiting syndrome causes repeated, similar episodes of intense vomiting lasting hours to days, with weeks of feeling well in between. Chronic nausea vomiting syndrome causes more continuous symptoms. The treatments overlap but cyclic vomiting is often managed like migraine.

When should I see a doctor for persistent nausea?

See a doctor if nausea or vomiting lasts more than 2 weeks, or sooner if you lose weight, cannot keep fluids down, vomit blood, have severe belly pain or headaches, or are pregnant and unable to eat.