Why Do I Cry When I Vomit? - Causes and Prevention of Vomit Related Crying

Why Do I Cry When I Vomit?

Vomiting is never a pleasant experience. The painful abdominal contractions, nausea, and sour taste in your mouth are bad enough without the addition of tears streaming down your face. If you've ever found yourself crying while throwing up, you're definitely not alone. Many people report uncontrollable tears whenever they get sick and start retching. But what causes this tearful response?

The Vagus Nerve Connection

It turns out there's a neurological reason behind the crying vomit reflex. It involves your vagus nerve, which is the longest cranial nerve in your body. The vagus nerve transmits signals between your brain and many of your internal organs. When you vomit, your vagus nerve stimulates the muscles in your abdomen to contract forcefully. At the same time, it also sends signals to the lacrimal glands near your eyes, making them release tears.

Researchers believe this vagal connection between vomiting and crying evolved as a protective mechanism. The theory is that the tear response helps maintain electrolyte balance and prevent dehydration during vomiting episodes. By stimulating lacrimation (tearing up), the vagus nerve may help regulate fluid and electrolyte levels in the body so you don't become overly dehydrated from vomiting.

The Vagus Nerve's Role

The vagus nerve plays many important roles in your body beyond just linking vomiting with crying. As one of your 12 cranial nerves, it innervates your larynx, heart, lungs, and gastrointestinal tract. Key functions of the vagus nerve include:

• Stimulating muscle contractions in the small intestine
• Reducing heart rate
• Constricting bronchial tubes in the lungs
• Controlling muscles for speech and swallowing
• Transmitting sensory information from the ear, tongue, pharynx, and viscera

With such a wide array of duties, it's not surprising that the vagus nerve also coordinates signals between the digestive system and the lacrimal glands. When vomiting is triggered, the vagus nerve essentially hits two birds with one stone by stimulating both gastrointestinal and tear duct activity at the same time.

Why Crying Is Protective

On the surface, having uncontrollable tears pouring down your face as you vomit seems counterproductive. After all, vomiting often leaves you feeling miserable without the added burden of sobbing too. However, research indicates that the crying response is actually protective for the body.

One key reason is that tears help maintain electrolyte balance. Vomiting results in a significant loss of bodily fluids and electrolytes like sodium, potassium, and chloride. Crying replaces some of those lost electrolytes and fluids through your tears. Studies show that emotional tears contain higher levels of manganese, potassium, and other electrolytes than regular eye fluid (known as basal tears).

Crying may also protect the eyes themselves during forceful vomiting. The extra tears can literally flush vomit out of the eyes and prevent damage to the corneas from stomach acid exposure. Plus, the tear response stimulates increased blood flow to the eyes and conjunctiva, helping counteract any broken blood vessels or bleeding that can occur with retching.

Other Nerves Involved

While the vagus nerve plays a major role in linking vomiting with crying, it's not the only nerve implicated in the process. The trigeminal nerve, facial nerve, and glossopharyngeal nerve may also be involved. These nerves relay sensory signals from the face and throat to the brain.

Research shows that stimulating certain areas innervated by the trigeminal nerve can produce increased tear production. These areas include parts of the nasal cavity, sinus cavities, meninges, and oral cavity. Nausea and vomiting often go hand-in-hand with stimulation of these pathways.

The facial and glossopharyngeal nerves also carry signals from the tongue and tonsils that are intertwined with gag reflexes, vomiting, and tear production. In essence, many cranial nerves work together to coordinate the stereotypical vomit-cry response.

Other Causes of Crying While Vomiting

While nerves play a major role in crying during vomiting episodes, there are other potential causes as well. Some additional reasons why you may sob while throwing up include:

• Discomfort and pain - Vomiting can cause painful spasms and discomfort throughout your torso. Crying may be an involuntary response to this discomfort.
• Fear or panic - Some people experience crying spells when scared or anxious. Vomiting may trigger fear or panic, leading to tears.
• Embarrassment - Throwing up, especially in public, can be embarrassing for some. The humiliation may inadvertently cause tears in some cases.
• Violent retching - Very forceful, prolonged retching episodes can result in popped blood vessels around the eyes and nasal passages. This can make crying more likely.

In most cases though, the neurological link between the vagus nerve and lacrimal glands offers the simplest explanation for why we cry when we vomit.

Pseudobulbar Affect (PBA)

While crying during vomiting is normal, some people experience bouts of uncontrolled laughing or sobbing without any clear trigger. This condition is known as pseudobulbar affect, or PBA for short.

PBA is typically caused by an underlying neurological injury or disease. Certain brain lesions can create wiring problems in the neural pathways that regulate emotional expression. This causes uncontrollable outbursts of laughing or crying that are exaggerated or don't match how the person feels.

What Causes Pseudobulbar Affect?

PBA is linked to a wide range of neurological health issues and brain injuries. Common causes include:

• Stroke
• Traumatic brain injury
• Brain tumors
• Multiple sclerosis
• Amyotrophic lateral sclerosis (ALS)
• Parkinson's disease
• Alzheimer's disease
• Dementia

Any condition that damages the neurological pathways involving emotional expression can potentially lead to pseudobulbar affect. However, certain types of brain lesions are more likely to cause PBA than others.

Brain Lesions Associated with PBA

Research indicates that PBA is often linked to bilateral lesions in the brain. This means there is damage in corresponding locations of both the right and left hemispheres.

Some key brain region connections susceptible to lesions that can trigger PBA include:

• The corticobulbar tracts
• Frontopontocerebellar circuits
• Frontotemporal connections
• Corticoreticulospinal tracts

When these pathways are compromised due to brain lesions, it interrupts the brain's ability to regulate and control laughter, crying, and other emotional expressions. This causes the random, episodic episodes of exaggerated laughing and crying characteristic of PBA.

PBA Symptoms

The main symptom of PBA is frequent, uncontrollable episodes of laughing or crying that don't match the person's internal feelings. Other PBA symptoms and characteristics include:

• Episodes last a few seconds to several minutes
• Can occur multiple times a day
• Are often exaggerated or don't fit the person's mood
• Are involuntary and difficult to control
• May be triggered by non-emotional stimuli
• Cause significant distress or social problems

PBA episodes may occur randomly or be provoked by external stimuli like memories, smells, or conversations. The laughing and crying is typically disconnected from the person's actual emotions.

PBA Diagnosis

There are no lab tests or scans that can definitively diagnose PBA. Doctors typically diagnose pseudobulbar affect based on the person's symptoms, medical history, and neurologic exam findings.

Key diagnostic criteria for PBA include:

• Having an underlying neurological condition or brain injury
• Frequent, involuntary episodes of laughing or crying
• Episodes are exaggerated, don't match mood, or are triggered by unrelated stimuli
• Episodes cause significant distress or impairment

It's important for doctors to rule out other potential causes of excessive laughing or crying when making a PBA diagnosis. Conditions like bipolar disorder or schizophrenia can be mistaken for PBA in some cases.

PBA Treatments

While PBA has no cure, there are medication options that can help reduce episode frequency and severity. The two main drug treatments for PBA are:

• Selective serotonin reuptake inhibitors (SSRIs) - These antidepressants like fluoxetine (Prozac) and citalopram (Celexa) can dampen the laughing/crying episodes. They may take 4-6 weeks to become fully effective.
• Tricyclic antidepressants - These older antidepressants like imipramine (Tofranil) or amitriptyline (Elavil) may also be used, especially if SSRIs aren't tolerated.

For best results, the medication needs to be taken daily rather than just when episodes occur. Other drugs like Nuedexta (a combo of dextromethorphan and quinidine) may also be tried under a doctor's supervision.

Coping with PBA Episodes

In addition to medication, counseling and support groups can help people better manage PBA symptoms. People with PBA may find the following strategies helpful for coping when episodes strike:

• Using distraction techniques like counting backwards or squeezing a stress ball
• Leaving situations when possible until the episode passes
• Trying relaxation methods like deep breathing, meditation, or listening to music
• Informing friends and family about PBA so episodes are less embarrassing
• Avoiding triggers like crowded places, noise, or conversations that could provoke an episode

While PBA can significantly impact quality of life, the right mix of medication, counseling, and coping strategies can help regain emotional control.

When to See a Doctor

Occasional crying when you vomit is normal and nothing to be concerned about. However, see your doctor if:

• You cry every time you vomit, even with mild nausea
• You experience uncontrollable bouts of crying frequently without any obvious cause
• The urge to cry persists even after vomiting has stopped
• You have other neurological symptoms like numbness, headaches, or memory problems

Excessive crying can be a sign of an underlying neurological issue like pseudobulbar affect or multiple sclerosis. Your doctor can perform tests to check for any brain abnormalities and determine if medication could help.

Seeking emergency care is recommended if excessive crying is accompanied by:

• Trouble breathing
• Chest pain
• Sudden loss of vision
• Sudden severe headache
• Weakness or paralysis on one side
• Slurred speech or confusion
• Seizure

These can be signs of a stroke or other serious neurological problem requiring immediate treatment.

Preventing Vomit-Related Crying

While you can't always prevent vomiting if you get food poisoning or the stomach flu, there are steps you can take to avoid puking episodes when possible:

• Practice good hygiene like hand washing to prevent illnesses
• Avoid triggers like spicy foods, motion sickness, hangovers, etc
• Don't lie down after big meals
• Stay hydrated and don't let yourself get dehydrated
• Manage stress through relaxation techniques
• Don't eat too fast or overeat

Travelers can reduce motion sickness during flights by choosing non-window seats, using electrolyte tablets, and avoiding reading. Pregnant women can minimize morning sickness by eating small, bland meals and staying away from nausea triggers.

While vomiting continues to make most people cry, preventing it as much as possible can help you avoid those unpleasant teary episodes. Speak with your doctor if you find yourself crying with vomiting more often than normal or if episodes of tearfulness happen frequently out of the blue.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.