About cyclic vomiting syndrome

What is cyclic vomiting syndrome?

  • Cyclic vomiting syndrome is a disorder that causes recurrent episodes of nausea, vomiting, and tiredness (lethargy) most often in children but may occur in all age groups.
  • Symptoms of cyclic vomiting syndrome are repeated attacks of intense nausea, vomiting, and lethargy that last anywhere from an hour to 10 days; other symptoms may include pale skin, abdominal pain, diarrhea, headache, and an increased sensitivity to light or to sound.
  • The most common situations that cause cyclic vomiting syndrome are emotional excitement and infections; other triggers can include periods without eating, temperature extremes, lack of sleep, overexertion, allergies, ingesting certain foods or alcohol, and menstruation.
  • Cyclic vomiting syndrome has four phases: symptom-free, prodrome, vomiting, and recovery.
  • Cyclic vomiting syndrome is diagnosed by the patient's history and symptoms.
  • Treatment is done by the patient learning to avoid the causes or triggers of the disorder; however, during the prodrome, vomiting and recovery phases, medications are often used to treat the symptoms (for example, anti-nausea medications, NSAIDs, anti-migraine medications, fluid replenishment and others).
  • Complications may include pain, reflux, fainting, depression, panic disorder, and irritable bowel syndrome.
  • Cyclic vomiting syndrome is generally considered to be a variant of migraines by researchers.
  • "Cyclic vomiting syndrome plus" is considered a diagnosis when a patients also exhibit symptoms of developmental delay or intellectual disability, muscle weakness (myopathy), and/or seizures.
  • The disorder has a wide range of reported prevalence, about 4 to 2000 per 100,000 children; but seems to occur less frequently in adults although the data is not clear.
  • Researchers suggest several factors may contribute to the disorder: brain function disorder, hormonal abnormalities, GI problems, migraine-like conditions, and changes in mitochondrial DNA.
  • Some people may inherit the changes in mitochondrial DNA that may cause the disorder.

What is cyclic vomiting syndrome?

Cyclic vomiting syndrome is a disorder that causes recurrent episodes of nausea, vomiting, and tiredness (lethargy). This condition is diagnosed most often in young children, but it can affect people of any age.

What are the symptoms of cyclic vomiting syndrome?

Cyclic vomiting syndrome is characterized by attacks of intense nausea, vomiting, and lethargy that last anywhere from an hour to 10 days. An affected person may vomit several times per hour, potentially leading to a dangerous loss of fluids (dehydration). Additional symptoms can include unusually pale skin (pallor), abdominal pain, diarrhea, headache, and an increased sensitivity to light (photophobia) or to sound (phonophobia). In most affected people, the signs and symptoms of each attack are quite similar. These attacks can be debilitating, making it difficult for an affected person to go to work or school.

What triggers cyclic vomiting syndrome?

Episodes of nausea and vomiting can be triggered by several different factors. The most common triggers are emotional excitement and infections. Other triggers can include periods without eating (fasting), temperature extremes, lack of sleep, overexertion, allergies, ingesting certain foods or alcohol, and menstruation.

What are the four phases of cyclic vomiting syndrome?

Cyclic vomiting syndrome has four phases:

Symptom-free interval phase. This phase is the period between episodes when no symptoms are present.

Prodrome phase. This phase signals that an episode of nausea and vomiting is about to begin. Often marked by nausea - with or without abdominal pain - this phase can last from just a few minutes to several hours. Sometimes, taking medicine early in the phase can stop an episode in progress. However, sometimes there is no warning; a person may simply wake up in the morning and begin vomiting.

Vomiting phase. This phase consists of nausea and vomiting; an inability to eat, drink, or take medicines without vomiting; paleness; drowsiness; and exhaustion.

Recovery phase. This phase begins when the nausea and vomiting stop. Healthy color, appetite, and energy return.

What are the symptoms for cyclic vomiting syndrome?

Mitochondrial dysfunction symptom was found in the cyclic vomiting syndrome condition

The symptoms of cyclic Vomiting syndrome often begin in the morning. Signs and symptoms include:

  • Severe Vomiting that occurs several times an hour, continues for hours to days, but lasts less than one week
  • Three or more separate episodes of Vomiting with no apparent cause in the past six months, or five or more episodes occurring at any time
  • Severe Nausea
  • Intense sweating

Other signs and symptoms during a Vomiting episode may include:

The time between Vomiting episodes is usually symptom-free.

When to see a doctor

Call your doctor if you see blood in your or your child's vomit.

Continued Vomiting may cause severe Dehydration that can be life-threatening. Call your doctor if you or your child is showing symptoms of Dehydration, such as:

  • Excess thirst
  • Less urination
  • Dry skin
  • Exhaustion and listlessness

What are the causes for cyclic vomiting syndrome?

The underlying cause of cyclic vomiting syndrome is unknown. Some possible causes include genes, digestive difficulties, nervous system problems and hormone imbalances. Specific bouts of vomiting may be triggered by:

  • Colds, allergies or sinus problems
  • Emotional stress or excitement, especially in children
  • Anxiety or panic attacks, especially in adults
  • Foods, such as caffeine, chocolate or cheese
  • Overeating, eating right before going to bed or fasting
  • Hot weather
  • Physical exhaustion
  • Exercising too much
  • Menstruation
  • Motion sickness

Identifying the triggers for vomiting episodes may help with managing cyclic vomiting syndrome.

What are the treatments for cyclic vomiting syndrome?

There's no cure for cyclic vomiting syndrome, though many children no longer have vomiting episodes by the time they reach adulthood. For those experiencing a cyclic vomiting episode, treatment focuses on controlling the signs and symptoms.

You or your child may be prescribed:

  • Anti-nausea drugs
  • Pain-relieving medications
  • Medications that suppress stomach acid
  • Antidepressants
  • Anti-seizure medications

The same types of medications used for migraines can sometimes help stop or even prevent episodes of cyclic vomiting. These medications may be recommended for people whose episodes are frequent and long lasting, or for people with a family history of migraine.

IV fluids may need to be given to prevent dehydration. Treatment is individualized based on the severity and duration of symptoms as well as the presence of complications.

What are the risk factors for cyclic vomiting syndrome?

The relationship between migraines and cyclic vomiting syndrome isn't clear. But many children with cyclic vomiting syndrome have a family history of migraines or have migraines themselves when they get older. In adults, the association between cyclic vomiting syndrome and migraine may be lower.

Chronic use of marijuana (Cannabis sativa) also has been associated with cyclic vomiting syndrome because some people use marijuana to treat their symptoms.

However, cannabis can lead to a condition called cannabis hyperemesis syndrome, which typically leads to persistent vomiting without normal intervening periods. People with this syndrome often demonstrate frequent showering or bathing behavior.

Cannabis hyperemesis syndrome can be confused with cyclic vomiting syndrome. To rule out cannabis hyperemesis syndrome, you need to stop using marijuana for at least one to two weeks to see if vomiting lessens. If it doesn't, your doctor will continue testing for cyclic vomiting syndrome.

Is there a cure/medications for cyclic vomiting syndrome?

Cyclic vomiting syndrome presents with recurrent episodes of nausea and vomiting that lasts from hours to days. Pathophysiology is not known yet.

In children with cyclic vomiting syndrome, the symptoms appear by age 3 to 7. However, the adults presenting the disease may not have episodes of vomiting in their childhood. There is no cure. However, the symptoms are treatable.


The treatments are of three types: supportive treatment, abortive, and prophylactic therapy.

  • Supportive treatment: The treatment involves mainstay in emergency departments. The medications include IV fluids and nausea medications such as ondansetron or prochlorperazine and Ketorolac is prescribed for pain. Sedatives like lorazepam or diphenhydramine help sometimes.
  • Rest, quiet and dark environments are recommended.
  • Abortive therapy: pediatric onset of the syndrome has shown to cause the onset of migraine later in life. Sumatriptan is used to treat the syndrome associated with migraines.
  • Prophylactic therapy: Prophylaxis is the treatment or action taken to prevent disease. Amitriptyline, cyproheptadine, propranolol, topiramate, and erythromycin are the drugs to prevent the disease upon diagnosis. The medications are effective to varying degrees.
  • Other treatments include correction of dehydration or electrolyte imbalance.
  • Many patients present to hospitals with unclear diagnoses or report previous surgeries such as cholecystectomy without improvement of symptoms.
  • A thorough history is necessary to narrow the differential and treatment plan.

Nausea,Vomiting,Migraine,Atonomic disturbances,Mitochondrial dysfunction
Vomiting,Nausea,Dehydration,Dry mouth,Loss of apettite,Migraine headaches,Allergies to food,Lack of sleep

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