Cyclic Vomiting Syndrome
Recurring episodes of intense vomiting with well periods in between
Quick Facts
- Type: Functional gut-brain disorder
- Hallmark: Repeated, similar vomiting episodes
- Between episodes: Usually completely well
- Main risk: Dehydration during attacks
Overview
Cyclic vomiting syndrome (CVS) is a condition in which a person has recurring episodes of intense nausea and vomiting, separated by stretches of time when they feel normal. The episodes tend to be remarkably similar each time, often starting at the same time of day, lasting a similar length, and following the same pattern.
CVS occurs in both children and adults. It is considered a disorder of the gut-brain interaction, meaning the nerves and signaling between the digestive system and the brain do not work normally, even though the structure of the stomach and intestines is usually normal. The main danger from an episode is dehydration, which sometimes requires treatment in a clinic or hospital.
Symptoms
An episode often follows recognizable phases:
- Warning (prodrome) phase: Nausea, paleness, sweating, or anxiety, sometimes with abdominal pain, signaling an episode is coming.
- Vomiting phase: Repeated, intense vomiting and retching, often several times an hour, with exhaustion and an inability to keep down food or fluids.
- Recovery phase: Nausea and vomiting settle, energy and appetite return.
- Well phase: A symptom-free period until the next episode.
Other features can include severe nausea, abdominal pain, headache, sensitivity to light, and dizziness. During heavy vomiting, some people seek relief from hot showers or baths.
Causes
The exact cause is not fully understood. CVS is thought to involve abnormal signaling between the brain and the gut, along with how the body responds to stress. There may be a connection with migraine, as many people with CVS have migraines or a family history of them, and the conditions share some triggers and treatments.
Episodes are often set off by identifiable triggers, even though these do not cause the underlying condition. Recognizing personal triggers is an important part of management.
Risk Factors
- A personal or family history of migraine
- Emotional stress, excitement, or anxiety
- Infections such as colds or flu
- Lack of sleep or overexertion
- Certain foods, fasting, or skipping meals in some people
- Long-term heavy cannabis use, which can produce a similar pattern of cyclic vomiting
Diagnosis
There is no single test for CVS. Diagnosis is based on the pattern of repeated, similar episodes of vomiting with normal health in between, after other causes have been ruled out. Evaluation may include:
- Medical history: Documenting the timing, length, and triggers of episodes is often the most useful step.
- Blood and urine tests: To check hydration and look for other conditions.
- Imaging or endoscopy: Sometimes done to exclude blockages, ulcers, or other digestive problems.
Keeping a symptom diary can greatly help with diagnosis and management.
Treatment
Treatment aims to prevent episodes, stop them early, and manage symptoms during an attack.
- Avoiding triggers: Identifying and reducing personal triggers such as stress, missed meals, or poor sleep.
- Preventive medication: For frequent or severe episodes, daily medicines, including some used for migraine prevention, may reduce how often attacks occur.
- Treating an episode early: Anti-nausea medicines and, sometimes, medications taken at the first warning sign can shorten or abort an attack.
- Rest and a quiet, dark room: Many people feel better resting and limiting stimulation.
- Fluids: Oral rehydration when possible, or intravenous fluids in a clinic or hospital for significant dehydration.
Prevention
- Keep a diary to identify and avoid personal triggers
- Eat regular meals and avoid prolonged fasting
- Prioritize consistent, adequate sleep
- Manage stress with relaxation techniques or counseling
- Take preventive medication as prescribed if episodes are frequent
- Discuss stopping cannabis if heavy use is a possible factor
When to See a Doctor
See a doctor if you or your child have repeated episodes of severe vomiting, so the pattern can be evaluated and other causes ruled out. Seek urgent or emergency care during an episode if there are signs of significant dehydration, such as little or no urine, dizziness, confusion, or inability to keep down any fluids, or if there is vomiting of blood, severe or worsening abdominal pain, or a high fever.
Frequently Asked Questions
What triggers cyclic vomiting syndrome episodes?
Common triggers include emotional stress or excitement, infections, lack of sleep, missed meals, and in some people certain foods. Triggers do not cause the underlying condition, but identifying and avoiding yours can reduce how often episodes occur.
Is cyclic vomiting syndrome related to migraine?
Yes, there is a strong link. Many people with CVS have migraines or a family history of them, and the conditions share triggers and some treatments. Medications used to prevent migraine are sometimes used to prevent CVS episodes.
How is cyclic vomiting syndrome diagnosed?
There is no single test. Doctors diagnose it based on a pattern of repeated, similar vomiting episodes with normal health in between, after ruling out other causes. A symptom diary recording the timing and triggers of episodes is often the most helpful tool.
When does vomiting become an emergency?
Seek urgent care if vomiting leads to signs of dehydration such as little or no urination, dizziness, or confusion, if you cannot keep down any fluids, or if there is blood in the vomit, severe abdominal pain, or a high fever. Dehydration is the main danger during an attack.
Can children outgrow cyclic vomiting syndrome?
Some children have fewer episodes as they get older, and in a number of cases the episodes change into migraine headaches over time. The course varies from person to person, so ongoing follow-up helps tailor treatment.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Cyclic Vomiting Syndrome.
- Mayo Clinic. Cyclic vomiting syndrome — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Cyclic vomiting syndrome.
- Cyclic Vomiting Syndrome Association. About CVS.