Cough-Induced Vomiting (Emesis): Mechanism and Causes

Emesis is the medical term for vomiting. Severe coughing can trigger it via the cough-emesis reflex.

Pathophysiology

• Violent coughing → sharp ↑ intrathoracic/intra-abdominal pressure.
• Stimulates gastric mechanoreceptors and vagal afferents.
• Activates vomiting center (medulla) → coordinated emetic response.

Common Causes of Severe Cough Leading to Emesis

• Pertussis (whooping cough) — paroxysmal cough + post-tussive emesis classic
• Asthma exacerbation
• Postnasal drip (UACS)
• GERD (cough → reflux → emesis)
• Bronchitis, pneumonia
• ACE inhibitor cough
• Foreign body aspiration

Red Flags (Urgent Evaluation)

• Hematemesis or coffee-ground emesis
• Weight loss, night sweats
• Stridor, drooling, respiratory distress
• Persistent >3 weeks

Management

• Treat underlying cause (antibiotics for pertussis, bronchodilators for asthma, PPI for GERD).
• Symptomatic: hydration, antiemetics (ondansetron) if needed.
• Honey (1 tsp) for cough in >1 yr olds—evidence-supported.

Cough-induced vomiting is a symptom, not a diagnosis. Target the cough etiology.