What is Cyclic Vomiting Syndrome?
Cyclic Vomiting Syndrome (CVS) is an episodic syndrome that may be associated with migraine (see our post on Early Life Expressions of Migraine). Patients experience repeated and intense bouts of nausea and vomiting, often following a predictable, cyclical pattern. Additional symptoms can include abdominal pain and pallor. CVS primarily affects children aged 4-7 but can also occur in adults aged 25-32. Nearly one-third of patients report a family history of migraine.
This guide delves into the symptoms, diagnosis, causes, common triggers, and available treatments for CVS, highlighting the importance of medical evaluation and tailored care. Whether you are a patient, parent, or healthcare professional, this resource from Migraine Canada™ offers valuable insights to understand and manage CVS effectively.
Diagnosis of Cyclic Vomiting Syndrome
CVS is diagnosed based on the following criteria:
- Recurrent episodes of intense nausea and vomiting occurring at least four times per hour.
- Episodes last from over 1 hour to 10 days.
- Episodes occur more than one week apart, with the patient feeling normal between attacks.
- Only 40% of patients report headaches.
A thorough evaluation to exclude other conditions is necessary before confirming a CVS diagnosis, often involving collaboration with a gastroenterology specialist.
Worrisome Symptoms to Watch For
Be vigilant for symptoms such as:
- Convulsions
- Delayed development or regression
- Changes in awareness (e.g., drowsiness or sleepiness)
- Nausea/vomiting triggered by specific foods (high-fat, high-protein meals, fasting) or illness
If these symptoms occur, seek medical attention urgently.
Causes of Cyclic Vomiting Syndrome
The exact cause of CVS is not fully understood, but the brain and gut share several biological mechanisms, including the role of serotonin. Immune factors may also contribute. CVS attacks could be triggered by stressors affecting either the brain or the gut, with vomiting controlled by specialized centers in the brain.
Common Triggers for Vomiting Episodes
Triggers for CVS are similar to those for migraine and include:
- Infections
- Psychological stress
- Certain foods (e.g., glutamate, cheese, chocolate)
- Physical exhaustion
- Lack of sleep
- Menstruation
- Motion sickness
Available Treatments for Cyclic Vomiting Syndrome
There is limited evidence for treating CVS, but options to discuss with a healthcare provider include:
- Hydration and anti-emetics: Administered orally or as suppositories at home.
- Nasal spray migraine medications: Such as triptans (Sumatriptan and Zolmitriptan).
- Vitamins: Including coenzyme Q10, L-carnitine, and riboflavin.
- Emergency treatment: Severe attacks may require intravenous therapy in the emergency department.
- Preventive medications: For frequent and disabling attacks, options like amitriptyline, cyproheptadine, propranolol, valproic acid, pizotifen, and flunarizine may be considered. The decision to use preventive medication should be carefully weighed due to potential side effects.
Prognosis: Will CVS Last Forever?
No, around 40-60% of patients will experience a resolution of symptoms over time. However, 20% to 35% of children with CVS may develop migraine headaches later in life, compared to 15% in the general population.
References
- Gelfand A. Episodic syndromes of childhood associated with migraine. Current Opinion Neurology. 2018;31:281-285.
- Lagman-Bartolome AM, Lay C. Pediatric Migraine Variants: A review of epidemiology, diagnosis, treatment, and outcome. Current Neurology and Neuroscience. 2015;12:1-14.
Post #602
