Feeling sick (nausea)
Everybody knows the feeling: the stomach turns over, the mouth fills with saliva, the smell of food makes it worse, and it seems the vomit is only seconds away.
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Medicines commonly prescribed for Feeling sick (nausea)
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: INJECTABLE, 2 mg/mlActive substance: ondansetronManufacturer: Hikma Farmaceutica (Portugal) S.A.Prescription requiredDosage form: TABLET, 8 mgActive substance: ondansetronManufacturer: Bexal Farmaceutica S.A.Prescription requiredDosage form: TABLET, 8 mgActive substance: ondansetronManufacturer: Viatris LimitedPrescription required
Everybody knows the feeling: the stomach turns over, the mouth fills with saliva, the smell of food makes it worse, and it seems the vomit is only seconds away. Nausea is not an illness in itself but a signal, and almost anything can send it — from yesterday's salad to the heart, the brain or the body's chemistry. That is why this page is arranged not by organ but by urgency: first the things that cannot wait, then the common and almost always harmless causes, and at the end what helps while the cause is being tracked down.
When feeling sick means calling an ambulance
Nausea on its own almost never needs an ambulance. Alongside certain other signs, though, it means help is needed straight away. Call an ambulance if, together with the nausea or vomiting, there is any one of these:
- vomit containing blood, either bright red or looking like coffee grounds, or black tarry stools;
- crushing or burning pain behind the breastbone spreading to the arm, neck, jaw or back, especially with a cold sweat and breathlessness;
- a sudden headache you would call the worst of your life: it reaches its peak within seconds and the vomiting comes at the height of it;
- a high temperature with a stiff neck, when the chin cannot be brought down to the chest, and with light hurting the eyes;
- severe tummy pain that will not settle, particularly if the abdomen has gone hard and no wind or stool is passing;
- confusion, slurred speech, weakness in an arm or leg, sudden double vision;
- vomiting after a blow to the head, even if the person did not black out;
- fast, noisy breathing, breath smelling of acetone, great thirst and drowsiness in someone with diabetes;
- vomiting so frequent that not a sip of water has stayed down in twenty-four hours.
112 is the single European emergency number and works in Spain, Italy, Portugal, Poland and Ukraine; elsewhere dial your local emergency number.
When the stomach is not what is making you feel sick
This is the most important part of the page. The centre that sets off nausea sits in the brainstem, and it is not driven only by messages from the gut: it also answers to a shortage of oxygen in the heart muscle, to pressure inside the skull and to shifts in the chemistry of the blood. That is why nausea can be the one obvious complaint in illnesses that have nothing to do with digestion.
- Heart attack. Not everyone gets the classic pain behind the breastbone. In women, in older people and in people with diabetes an attack often runs without marked pain: what remains is nausea, vomiting, a heaviness at the top of the stomach that gets mistaken for indigestion, sudden weakness, a cold sweat and breathlessness. In diabetes the nerves that carry pain are damaged, and an attack can pass off almost painlessly. If the sickness came on suddenly, with weakness and sweating, and above all if it builds with exertion and eases with rest, it needs looking at as a heart problem rather than a stomach one.
- Raised pressure inside the skull. There is a telltale pattern here: the vomiting comes in the morning, straight after waking, often with no nausea beforehand and no relief afterwards, and beside it sits a headache that wakes you at night, is worse lying flat and gets stronger on coughing, straining and bending forward. That combination needs a doctor's assessment, and it is not something to leave until there is time for it.
- Diabetic ketoacidosis. Nausea, vomiting, tummy pain, great thirst, passing large amounts of urine and breath smelling of acetone in someone with diabetes: a situation counted in hours. It can also be the first sign of diabetes that has not yet been diagnosed, most often in children and young adults.
- Acute glaucoma. Sharp pain in one eye, redness, blurred vision and coloured haloes around lights, all with vomiting. That vomiting is often taken for food poisoning, and without quick treatment the eye loses sight.
The commonest causes
Most of the time the cause turns out to be a simple one, and the symptoms sitting next to it give it away.
- Gut infections and food poisoning. Nausea and vomiting, often with diarrhoea and cramps, starting abruptly and settling within a day or two.
- Any infection with a high temperature. Flu, tonsillitis, a middle ear infection, a urine infection: a fever makes a great many people feel sick, and children more than most.
- Acid coming back up from the stomach. Nausea with heartburn, a sour taste and bloating, arriving after meals and worse lying down and at night.
- Migraine. Here nausea is not a side detail but part of the attack, along with light and noise becoming unbearable.
- Inner ear disorders. Labyrinthitis and positional vertigo produce a spinning sensation that brings sickness and vomiting with it; the nausea follows the vertigo rather than arriving alone.
- Anxiety and panic. The lump in the throat, the sick feeling and the urge to go to the toilet before something you dread are an ordinary bodily reaction.
- Alcohol, both while drinking and as a hangover the next day.
- The first days after an operation and an anaesthetic. A common and predictable reaction worth mentioning to your team: it can be prevented in advance.
- Severe pain of any kind, from an injury to toothache.
- Kidney stone colic. Loin pain in waves travelling down towards the groin, with nausea and vomiting; the person cannot keep still and no position helps.
Medicines and treatments as a cause
This is the most overlooked cause and the easiest to find: just look at what you started taking in the few days before the nausea began. Almost any drug can do it, but the usual culprits are antibiotics, anti-inflammatory painkillers, opioid painkillers, iron preparations, some diabetes medicines, hormonal contraception, and antidepressants during the first weeks. Chemotherapy and radiotherapy are a chapter of their own: sickness there is not something to put up with, there are well-worked-out ways of preventing it, and it should be raised with your cancer team rather than solved alone.
What to do about it. Do not quietly stop a prescribed medicine: with some drugs, stopping suddenly does more harm than the nausea. Tell your doctor instead, because often it is enough to take it with food or at bedtime, to switch to a different form, or to swap it for another drug in the same group. And check the dose: nausea can be the first warning that there is too much of a medicine in the body, which is how an excess of digoxin or of lithium tends to announce itself.
Feeling sick in pregnancy
Sickness in the early months is the commonest thing pregnancy does; calling it morning sickness is only habit, because it turns up at any hour. It is usually at its strongest towards the end of the first three months and eases noticeably after that. What helps is small frequent meals, a dry biscuit or piece of toast before even getting out of bed, water in sips between meals, and getting away from whatever smell is unbearable at the moment.
There is a line, though, beyond which this stops being normal. If vomiting happens many times a day, water will not stay down, weight is falling, urine is dark and scanty and standing up brings dizziness, this is severe pregnancy sickness, and it is treated by doctors, sometimes with a drip in hospital. Nothing here needs to be endured: there are anti-sickness medicines that can be used in pregnancy and a doctor will choose one. Ask separately if the sickness starts for the first time after the first three months, or comes with headache, swelling and disturbed vision.
Travel sickness
Travel sickness happens because the inner ear tells the brain there is movement while the eyes report that the inside of the vehicle is still; the brain gets contradictory information and answers with nausea. Everything that helps follows from that: look at the road or at a distant horizon rather than at a phone or a book; sit where there is least movement, at the front of a car, over the wing in a plane, mid-deck on a boat; open a window or aim the air vent at your face; set off neither heavy-stomached nor completely empty; break the journey. Children are affected more than adults, and it usually fades of its own accord by the teenage years.
For a long journey there are travel sickness medicines sold without prescription: first-generation antihistamines and hyoscine patches. They are taken before setting off, not once the queasiness has started. All of them cause drowsiness, and nobody drives after them. Ginger helps some people and does no harm. New dizziness with nausea that appears for the first time and has nothing to do with travelling, on the other hand, is not travel sickness and should be taken to a doctor.
When vomiting leads to dehydration
What is dangerous is usually not the vomiting itself but the loss of fluid, and it sets in especially quickly in small children and in older people. It shows as a dry mouth, thirst, urine that has become dark and much less frequent, dizziness on standing, weakness and growing drowsiness. In a child: nappies staying dry for several hours in a row, crying without tears, sunken eyes, and a listlessness that is not like them.
Drink little and often rather than in gulps: a few sips or a teaspoonful every few minutes, because otherwise it comes straight back up. An oral rehydration solution from the pharmacy works best, as it replaces both the water and the salts; fizzy drinks and fruit juices are not suitable and make diarrhoea worse. Food can start again as soon as it appeals, beginning with plain things, and there is no need to sit out a day of fasting. If the vomiting has not settled after a day, if no fluid at all stays down, if signs of dehydration appear, or if there is blood or green bile-stained material in the vomit, you need to be seen by a doctor the same day rather than wait any longer.
What helps while the cause is unknown
While the cause is being worked out, the feeling itself can be eased by simple things. Fresh air and a cool room; take off or loosen anything tight at the waist. Eat small amounts often, choosing bland food that is not piping hot: toast, rice, banana, boiled potato. Move strong smells out of range — frying, perfume, smoke — and hand the cooking to somebody else if you can. Sip cold drinks. Do not lie down straight after eating, and if you must lie down, prop the head of the bed up. Distraction helps: music, conversation, a film, along with slow steady breathing. Many people find ginger or mint in any form settles things.
Anti-sickness medicines do exist, and they are several different groups with different uses: what rescues you on a boat is useless in a stomach bug, and the drug given after chemotherapy has no place in a migraine. A doctor chooses them knowing the cause, so hunting for a tablet on your own usually just costs time. It is worth booking an appointment if you have felt sick for several days with no obvious reason, if the nausea keeps coming back, if you are losing weight without trying, if swallowing has become difficult, or if your bowel habit has changed.
Online consultation
Nausea is one of those complaints where half the work is done by the conversation. In an online consultation the doctor will go through when exactly you feel sick and what it lines up with: before food or after it, in the morning or towards evening, on the road or at home, whether it tracks your menstrual cycle or the start of a new medicine. They will look at the whole list of what you take, supplements included, help you separate nausea from vertigo and from heartburn, say which tests make sense in your case and which are surplus, and choose a treatment if one is needed. Most valuable of all, they will name the signs that, for you specifically, mean not waiting for an appointment but calling an ambulance. If the sickness comes with chest pain, the worst headache of your life or blood in the vomit, an online appointment is not what is needed — an ambulance is.
This material is for information only and does not replace medical advice.
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