Nausea & Vomiting Post Head Injury: 5 nutrition tips

Has nausea been preventing you from eating?

I’ve had a number of people come to me because they just couldn’t keep food down after their concussion. Or, the nausea alone was so bad that they had no desire to even eat! I’ve also had clients where this has lasted weeks to months.

Nausea and vomiting are some serious symptoms that can happen post TBI. And because these symptoms prevent you from eating enough, you can become at serious risk of malnutrition.

Ask yourself:

• Am I struggling to keep down 3 meals a day?
• Have I lost weight since my injury unintentionally?
• Have I been skipping meals to avoid food?

If you answered “yes” to any of these, chances are you are undernourished. And if so, how can your brain heal if it’s not getting the nutrition it needs?

We want to get on top of your nausea and vomiting as quickly as possible. Because we don’t want it to be an ongoing problem.

Other than malnutrition, there are other important side effects with ongoing vomiting:

• Vomiting increases the pressure in your head, which aggravates your symptoms
• A deficiency in electrolytes can occur, which can affect your blood pressure and heart rate
• Repeated vomiting irritates your upper digestive tract. This can lead to diseases in the esophagus.
• When this goes on for a long time, some people develop an aversion or fear of food or eating. In more serious cases, this has triggered eating disorders.

If vomiting is violent and persistent right after the injury then GO TO THE HOSPITAL right away!

Multiple episodes of vomiting, especially with worsening headache, is a sign that a person post head injury needs some immediate medical attention.

But if you’re dealing with lingering nausea with some vomiting here and there, then this article is going to look at some potential causes, what you can try to manage the nausea, and some nutrition work-arounds to make sure your brain & body are still getting the energy & nutrients they need to recover.

What causes nausea & vomiting post TBI?

Oddly enough I couldn’t find a lot of research looking at exactly what causes nausea & vomiting after a head injury.

Research has more looked at whether vomiting post injury is a sign of skull fracture. Indeed, repeated vomiting after a head injury is linked to a higher risk of skull fracture, compared to just one episode of vomiting. This is why vomiting more than once after a head injury is a red flag for more medical attention.

Otherwise, people working in the field have noticed that nausea & vomiting post head injury could be caused by a number of different things:

• Pain & migraine. These have multiple symptoms and nausea & vomiting are included.
• Problems with the vestibular system or vision. These systems are important for balance. When the systems are out of whack, they are linked to vertigo & dizziness.
• Changes in how well food moves through the digestive system. Neurological problems can sometimes slow down the movement of food. When food stays higher up in the digestive system, it can make a person nauseated or want to vomit.
• Changes to hormone levels. This is also known as neuroendocrine disorder.
• Issues with the nervous system more often in “fight or flight.” Trauma can have this effect. There’s also something called autonomic nervous system dysfunction or dysautonomia, which can contribute to nausea & vomiting.
• Anxiety. More than butterflies in the stomach, anxiety can really interfere with digestion.

So what’s a TBI survivor to do about it?

5 tips to help with nutrition in nausea & vomiting

#1 Talk to your healthcare team about some tests

Nausea & vomiting are like the symptoms of every health condition out there (so please don’t google these symptoms!) Working with your team (including your dietitian!) can help you narrow down what systems might be at play, and therefore the best treatment forward.

You can talk to your healthcare team about tests for neuroendocrine disorder (where out-of-balance hormones can cause these symptoms) as well digestive motility issues (“gastroparesis” is a neurological condition sometimes seen post TBI), or any imaging of the head.

#2 Stay hydrated with fluids & electrolytes

Vomiting can cause you to loose a lot of liquids & electrolytes. The common electrolytes you want to get are sodium, potassium, citrate, and chloride. You may also find products with magnesium & zinc. 

If you’re having trouble keeping food down, consider an electrolyte mix, homemade sport drink, and/or bone broth.

#3 Consider a “meal replacement” supplement

If you can’t eat, it’s better to get something in than nothing! Meal replacement drinks are things like Boost or Ensure. You can find these at your pharmacy and often at big grocery stores too.

Take note that no “meal replacement” product is actually a replacement for food if you can eat! These products are super helpful during those tough times. But if you have a functioning digestive system, we want to use it as much as possible! We could likely never capture all the greatness of food in one product.

So do use these products when you need them! While at the same time working on eating actual food.

#4 Prep your nervous system for eating

If you can settle your nerves then this will shift your body from fight & flight to rest & digest. This is key to good digestion!

Use the tools you have learnt throughout your recovery to manage overstimulation — apply these to your meals.

What has worked for you? Meditation? Mindfulness? Music? Breath exercises? Tea? Aromatherapy?

Include these on the regular at your dinner table 🙂

#5 Remember that food is one piece of your medicine

Even when we are sick with the flu, we often still find it within us to take any pills or supplements we might need.

So how can we do the same with food?

As your brain heals, the nausea & vomiting should subside. And in order for your brain to heal, you need to eat. This is a bit of a difficult process! Your body is resisting food, but it still really needs it. Much like a fussy toddler!

So can you say to your body:

“Hey. I hear you. This is tough and you don’t feel like eating. But if we do eat, it will help make the symptoms go away, and then we’ll be able to naturally eat again.”

Foods that might help include fresh ginger (made into tea or put into soups), candied ginger, cold vs hot foods, peppermint, or anything salty. (Though consider this is highly individual!)

The bottom line

Nausea & vomiting shouldn’t be prolonged in your recovery without getting proper medical attention. I find that sometimes these issues are passed over in regular appointments.

Being nauseated and vomiting all the time doesn’t have to be your new normal! Implore your team to work with you on this.

And if you need some help advocating for better care send me a message. It can be as simple as typing to me “I don’t want to be nauseated.” I’ll reach back out to see what we can do 🙂

Best in brain health,

Krystal Merrells

Concussion Warrior

TBI Nutrition Advocate

Registered Dietitian

References & Resources

Brown, F. D., Brown, J., & Beattie, T. F. (2000). Why do children vomit after minor head injury?. Journal of accident & emergency medicine, 17(4), 268–271. https://doi.org/10.1136/emj.17.4.268

Fife, T. D., & Kalra, D. (2015). Persistent vertigo and dizziness after mild traumatic brain injury. Annals of the New York Academy of Sciences, 1343, 97–105. https://doi.org/10.1111/nyas.12678

Nee, P. A., Hadfield, J. M., Yates, D. W., & Faragher, E. B. (1999). Significance of vomiting after head injury. Journal of neurology, neurosurgery, and psychiatry, 66(4), 470–473. https://doi.org/10.1136/jnnp.66.4.470

Post-Concussion Nausea: Why You Feel Sick & What to Do About It. Feb 2020. https://www.cognitivefxusa.com/blog/post-concussion-nausea-what-to-do

Vomiting After Head Injury: What It Means and How to Treat It. Feb 2020. https://www.flintrehab.com/vomiting-after-head-injury/