What's the Cause of My Nausea?

One of the most common and vexing  medical complaints I see in the office is nausea.  Indeed, not a day goes by that a patient does not lament the presence of this uncomfortable and vague sense of distress.   This symptom is among the most frustrating for both patients and providers.  The reason for this is that in most cases, the complaint cannot be explained.

Of course, nausea can have an specific cause which we physicians will try to identify.  In these cases, the nausea is usually a secondary effect of another medical condition.  In other words, the nausea is not typically caused by actual stomach disease.  Patients with viral infections, gallbladder issues, depression, appendicitis, migraines, inner ear disease, pregnancy or marijuana abuse can all experience nausea.  And nearly every medicine will have nausea listed among the long list of potential side effects.  When I see a patient suffering from years of nausea, how might I determine which of their 15 or so medicines might be responsible?  I'm open for suggestions! 

"Does this medicine cause nausea"?

Most of the nauseated patients I see have no clear explanatory cause.  They are just nauseated for no obvious reason.  The nausea may be constant or intermittent.  It can vanish for weeks and may suddenly reappear without any clear trigger.  In contrast to concrete issues that we gastroenterologists address, such as rectal bleeding, nausea is vague.  There is no ‘nausea blood test’ or ‘nausea scan’ to explain the symptom.   It’s similar to other challenging and common medical complaints such as fatigue, weakness, dizziness and headaches.  Of course, these symptoms are all real, just like nausea, but they can be difficult to explain.  Such patients often undergo a battery of negative diagnostic tests, which is reassuring but still frustrating. 

Even though physicians can’t explain your symptoms, doesn’t mean that you can’t be helped.  There are many available medicines, counseling techniques, functional medicine approaches and even complimentary medicines that can deliver hope and relief.  Naturally, patients want to know what is responsible for their complaints.  But when this is not possible, the mission should shift to searching out strategies to feel better.