Cyclic vomiting syndrome (CVS) is an uncommon disorder that mainly affects children. It causes episodes of severe vomiting and nausea that can last from several hours to several days. Lifestyle changes and medications can help.
Episodes of severe vomiting seen in cyclic vomiting syndrome may have no apparent cause. They may occur 4–12 times per year.
In this article, we describe the treatments of CVS and the effects on the body, as well as causes, strategies for prevention, and more.
There is no cure for CVS, but there are various ways to prevent and manage the symptoms. A treatment plan may involve:
A doctor may prescribe one or more of the following medications:
- antidepressants, such as amitriptyline (Elavil) can help prevent episodes and relieve pain
- antiemetics, medications for nausea and vomiting
- medications to control stomach acid, including omeprazole (Prilosec)
- migraine medications, including sumatriptan (Imitrex) and propranolol (Inderal), possibly on an off-label basis
It may take some time to find the right dosage, drug, or combination of drugs.
People with severe nausea and vomiting may require hospitalization, especially if they develop dehydration or other complications.
In the hospital, the person may receive intravenous — IV— medication, fluids, and nutrients.
- drinking plenty of fluids.
- eating regularly, without skipping meals
- exercising regularly
- getting enough sleep, especially during a vomiting episode
- resting and sleeping in a dark, quiet room
- managing triggers, including stress and excitement
- taking medications as prescribed
- receiving regular support from medical professionals
During and after vomiting episodes, it is important to stay hydrated. Throughout episodes, take regular sips of fluids, which should ideally contain an electrolyte mixture.
Anyone who feels well enough to resume their regular diet immediately after an episode should do so. Others may need to start with a liquid diet.
After returning to a usual diet, it is important to eat regularly, without skipping any meals.
It may also help to avoid:
- fruit juices
It can be difficult to diagnose CVS, and a doctor typically begins by ruling out other causes of vomiting.
The process begins with a full medical history. The doctor will also ask about symptoms and perform a physical examination.
They may then request one or more of the following tests:
- imaging studies of the digestive system, such as an ultrasound or endoscopy
- blood or urine tests to check for infection or metabolic conditions
- a CT scan or MRI of the head to look for lesions or tumors
- other tests to check for digestive disorders
A doctor may diagnose CVS based on the following criteria:
- The person has two or more periods of intense nausea and sudden vomiting that persist for several hours or days within a 6-month period.
- The episodes are similar each time.
- The episodes occur weeks or months apart, and the person feels healthy between the episodes.
- The symptoms do not result from another medical condition.
In addition to severe, recurrent episodes of nausea and vomiting, CVS can cause:
- dry heaving
- a fever
- increased sensitivity to light, called photophobia
- increased sensitivity to sound, called phonophobia
- loss of appetite
- pale skin
- stomach pain
- weight loss
Between episodes of nausea or vomiting, a person may experience:
People with CVS are also more likely to have:
Cyclic vomiting syndrome is more common among children than adults, although increasing numbers of adults are receiving a CVS diagnosis.
Adults and children may experience the condition differently, The National Organization for Rare Disorders point out. For example:
- In adults, episodes tend to occur less frequently, but they may persist longer — up to 8 days at a time.
- The most common trigger in children is excitement, such as about birthdays or holidays, while anxiety or panic attacks may be more significant triggers in adults.
It can be challenging to manage CVS in school children. Research indicates that children with CVS miss about 20 school days per year.
Due to the regularity of episodes, caregivers may be able to predict approximately when an attack will occur. During attacks, it is important to encourage rest and hydration.
The exact cause of CVS is unknown, but the following may be involved:
- digestive issues
- hormone imbalances
Having a regular routine for meals and quality sleep can reduce the occurrence and severity of attacks. Learning to manage other triggers, including stress and excitement, is also helpful.
Factors that trigger episodes of nausea and vomiting in people with CVS can include:
- anxiety or panic, especially in adults
- certain foods, such as cheese and chocolate
- the food additive monosodium glutamate, known as MSG
- emotional excitement, especially in children
- extremes in temperature
- going too long without eating
- illness, such as colds or the flu
- a lack of sleep
- motion sickness
- overexertion, such as exercising too much
Factors that increase the chances of developing CVS include:
CVS can lead to further health issues, such as:
- dehydration, from excessive vomiting
- tooth decay, as stomach acid can erode enamel
- damage to the esophagus, the tube that connects the mouth and the stomach
- gastroparesis, or the stomach being unable to completely empty itself in the usual way
- mood disorders, such as anxiety, depression, or panic disorder
According to some research, approximately one-third of adult patients with CVS experience disability as a result of the condition.
Some people with CVS are unable to walk or talk during episodes. A person may need to stay in bed throughout an episode or may even seem unconscious or comatose.
As a result, some people with CVS may qualify for disability benefits, depending on where they live and the severity of their condition.
CVS is also associated with other disorders that may be classed as disabilities, including:
- anxiety disorders
- autism spectrum disorder
- panic disorder
Many researchers consider CVS to be a form of migraine, and a person with the condition may also experience migraine headaches.
Most children outgrow CVS around the time of puberty, but approximately 75% of kids with the condition develop migraine headaches as they age.
Anyone with symptoms of CVS should receive medical attention.
People who already have a diagnosis should contact a doctor if they experience:
- incapacitating nausea
- severe diarrhea
- severe vomiting
- vomiting that does not respond to medication
- severe dehydration
- reduced appetite
- weight loss
It is not possible to prevent the onset of CVS, but a person can take the following steps to reduce the frequency and severity of episodes.
- Identify specific triggers and avoid exposure to them.
- Continue to take prescribed medication, even when feeling well.
- Get quality sleep regularly.
- Treat any allergies, sinus problems, or other illnesses or infections right away.
- Practice ways of managing stress and anxiety.
- Have regular meals.
- Stay in touch with the doctor and discuss methods of prevention and any changes in symptoms.
CVS is an uncommon disorder that involves recurring episodes of vomiting and nausea. It is uncommon and typically affects children aged 3–7.
The condition is likely a form of migraine. While most children grow out of CVS around the time of puberty, many go on to experience migraine headaches.
Medications and lifestyle changes can help manage the symptoms and reduce the frequency and severity of future episodes.
Anyone with CVS symptoms should receive medical attention.