Note: This is a condensed version of a deep-dive by Mike Bradford.

Why Does Concussion Cause Nausea?

Nausea is one of the most common — and frustrating — symptoms following a concussion. It can occur immediately after the injury (acute phase) or develop and persist weeks later (persistent concussion symptoms phase).

There are multiple potential causes, often overlapping:

  • Vestibular system dysfunction – Disturbance in balance and motion perception can trigger motion-related nausea(1)
  • Oculomotor disturbances – Difficulty with eye movements or visual tracking can worsen symptoms, especially with reading or screens
  • Autonomic nervous system dysregulation – Disrupted heart rate, breathing, and blood pressure control can cause nausea(3)
  • Cervicogenic dysfunction – Whiplash or neck injuries impair balance inputs, mimicking vestibular problems
  • Migraine-related physiology – Post-traumatic migraine can feature nausea, light sensitivity, and severe headaches
  • Gut inflammation and microbiome disruption – Brain injury can trigger gut dysbiosis and intestinal inflammation, worsening digestive symptoms
  • Vagus nerve dysfunction – The vagus nerve helps regulate digestion; when impaired, nausea and gut motility issues may arise
  • Mental health (stress/anxiety) – Heightened stress responses post-injury (fight-or-flight activation) can create “butterflies” or persistent nausea
  • Medications – Some post-injury medications (painkillers, anti-inflammatories) may irritate the stomach

Acute vs Persistent Nausea

  • Acute Nausea: Appears within minutes or hours of injury. Often resolves in days.
  • Persistent Nausea: Lasts longer, worsens with activity, and signals deeper system dysfunction.

Vomiting After Concussion: Red Flags

If nausea is accompanied by persistent vomiting or any of the following, seek urgent medical evaluation:

  • Worsening headache
  • One dilated pupil
  • Slurred speech
  • Weakness or numbness
  • Seizures
  • Loss of consciousness

📍 Not sure? Find a Certified Concussion Clinic to get evaluated.

Symptom Subtypes to Consider

Nausea is a signal, not a diagnosis. Identifying the dominant dysfunction helps guide treatment:

  • Vestibular-related: Motion worsens symptoms
  • Visual-related: Reading, scrolling triggers nausea
  • Autonomic-related: Heart rate changes, fatigue accompany nausea
  • Cervical-related: Neck movement or tension linked to symptoms
  • Gut-related: Nausea worsens after meals, digestive changes present
  • Migraine-related: Cyclical headaches with nausea and light sensitivity
  • Stress-related: Emotional triggers provoke “stomach upset”

Comprehensive Treatment Approaches

Effective recovery addresses both symptom management and root causes:

  • Vestibular rehabilitation therapy (VRT) to retrain balance(5)
  • Oculomotor exercises to improve visual tracking and reduce sensory overload
  • Subthreshold aerobic exercise to stabilize autonomic function (2)
  • Cervical manual therapy to treat whiplash-related nausea
  • Nutritional strategies to reduce gut inflammation (e.g., anti-inflammatory diets, probiotics)
  • Vagal nerve stimulation techniques (breathing exercises, mindfulness)
  • Mental health support if anxiety or mood disturbances are exacerbating symptoms
  • Hydration and electrolyte balance to optimize recovery
  • Medical guidance for nausea-specific medications if necessary (with caution)

📍 Book with a Certified Concussion Clinic for a customized treatment plan.

📚 Related Reading

References
  1. Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87–93.
  2. Leddy JJ, Haider MN, Ellis MJ, et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatr. 2019;173(4):319–25.
  3. Esterov D, Greenwald BD. Autonomic dysfunction after mild traumatic brain injury. Brain Sci. 2017;7(8):100.
  4. Leddy JJ, Baker JG, Haider MN, et al. A physiological approach to prolonged recovery from concussion. J Athl Train. 2017;52(3):299–308.
  5. Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trial. Br J Sports Med. 2014;48(17):1294–8.
  6. Zhong W, Shahbaz O, Teskey G, et al. Mechanisms of nausea and vomiting: current knowledge and recent advances in intracellular emetic signaling systems. Int J Mol Sci. 2021;22(11):5797.