Cyclic vomiting syndrome

Overview

Cyclic vomiting syndrome (CVS) is a rare condition that causes repeated episodes of severe nausea, vomiting, and physical exhaustion. These episodes can last from a few hours to several days and then disappear completely, leaving the person feeling well between episodes. It's like a cycle – the vomiting comes and goes.

No, cyclic vomiting syndrome is not common. It affects about 3 in every 100,000 children and is even rarer in adults. However, it may be underdiagnosed because its symptoms are similar to other conditions like stomach flu or migraines.

CVS can affect people of all ages, but it most often starts in childhood, typically between ages 3 and 7. It also occurs in some adults, sometimes as a continuation from childhood or starting later in life. Women may be slightly more affected than men.

Symptoms

Common symptoms

• Sudden, severe nausea and vomiting that can last for hours or days
• Pale skin and extreme tiredness during an episode
• Abdominal pain or belly discomfort
• Loss of appetite and inability to keep food or fluids down
• Sensitivity to light, sound, or smells during vomiting episodes

Symptoms in children

• Episodes often start in the early morning or late at night
• Children may become very quiet or withdrawn before vomiting starts
• They might have a fever or headache during episodes
• Between episodes, children usually act completely normal, which helps distinguish CVS from other causes of vomiting

Symptoms in older adults

• Episodes may be less predictable and last longer
• Adults with CVS often have more intense nausea and may vomit less frequently but feel sick for longer periods
• They may also experience more fatigue before and after an episode
• CVS in adults can sometimes be linked to migraine headaches or anxiety disorders

Causes

Main causes

• The exact cause is unknown, but CVS is thought to be related to a problem in the communication between the brain and the digestive system, specifically in areas that control nausea and vomiting.
• Many researchers believe CVS is a variant of migraine headaches, as the two conditions often occur together.
• Some people with CVS have a family history of migraines or CVS, suggesting a genetic link.

Risk factors

• Having a family member with migraines or cyclic vomiting syndrome
• A personal history of migraines or motion sickness
• Being exposed to triggers such as emotional stress, excitement, infections, lack of sleep, or certain foods (like chocolate or cheese)
• Starting menstruation (in girls) can sometimes trigger first episodes

When to see a doctor

See a doctor urgently if:

• If vomiting is severe and you cannot keep any liquids down for more than 8 hours
• If you or your child has signs of dehydration (dry mouth, no tears, dark urine, decreased urination)
• If there is blood in the vomit or severe abdominal pain

Book a routine appointment if:

• If you or your child has had more than two episodes of repeated vomiting with no clear cause (like a stomach virus)
• If the episodes seem to follow a pattern (same time of day, same triggers) and you have not yet been diagnosed
• If you have been diagnosed with CVS but episodes are becoming more frequent or severe

Diagnosis

There is no single test for CVS. Doctors diagnose it by ruling out other causes of repeated vomiting, such as stomach infections, blockages in the gut, or metabolic disorders. They will take a detailed history of the episodes, including when they start, how long they last, and any triggers.

Tests that may be done

• Blood tests to check for signs of infection, dehydration, or electrolyte imbalances
• Urine tests to look for dehydration or other medical problems
• Imaging tests like an ultrasound or CT scan of the abdomen to check for blockages
• Upper endoscopy (a thin tube with a camera passed into the stomach) to see if there is inflammation or other issues

What to expect at your appointment

Diagnosing CVS can take some time because it requires ruling out other conditions. Your doctor will likely ask you to keep a symptom diary, noting when episodes occur, what you were doing before, what you ate, and how long they last. This diary can be very helpful in spotting patterns. Once other causes are ruled out, and if the pattern fits, a diagnosis of CVS is made.

Treatment

Treatment for CVS focuses on two main goals: stopping or shortening an episode once it starts, and preventing future episodes. There is no cure, but many people can manage their symptoms with a combination of lifestyle changes and medications. Treatment plans are usually tailored to the individual and may involve a team of doctors including a gastroenterologist (stomach and gut specialist) and a neurologist (brain specialist).

Self-care at home

• During an episode, rest in a dark, quiet room to reduce sensory triggers
• Sip small amounts of clear fluids like water, diluted fruit juice, or oral rehydration solution to prevent dehydration
• Avoid solid food until vomiting stops, then gradually add bland foods like crackers, toast, or rice
• Identify and avoid personal triggers such as certain foods, stress, or lack of sleep
• Keep a diary of episodes to identify patterns and triggers

Medical treatments

Medications may be prescribed to stop nausea and vomiting during an episode or to prevent episodes from happening. These can include anti-nausea medicines (antiemetics), medicines that help calm the stomach, and sometimes preventive medications that affect brain signals related to migraines. All medications are prescribed by a doctor based on your specific needs. Therapies such as cognitive behavioral therapy may also help manage stress triggers.

When is surgery considered?

Surgery is not a treatment for cyclic vomiting syndrome itself. However, in severe cases where dehydration is hard to manage, a doctor might talk about placing a feeding tube temporarily to provide fluids and nutrition directly into the stomach. This is very rare.

Living with this condition

Living with CVS means being prepared for episodes. It helps to have a plan – know what to do when an episode starts, have medications on hand, and inform family members, school, or work about your condition. Most people with CVS learn to recognize early warning signs and can take steps to reduce the severity of an episode.

Lifestyle tips

• Get enough sleep every night – a regular sleep schedule can help prevent triggers
• Learn stress management techniques like deep breathing, meditation, or yoga
• Avoid known triggers such as certain foods, strong smells, or skipping meals
• Stay well hydrated, especially during warm weather or when feeling sick
• Carry a 'vomiting kit' with emergency supplies, like a small towel, plastic bags, and a water bottle

Diet and exercise

During episodes, diet needs to be very bland and liquid-based. Between episodes, eat a balanced diet and avoid foods that seem to trigger attacks (common triggers include chocolate, cheese, and foods with monosodium glutamate (MSG)). Gentle exercise like walking is usually fine, but avoid strenuous activity during or right after an episode. Staying active between episodes can help reduce stress.

Mental health and emotional wellbeing

CVS can be emotionally challenging because it is unpredictable and can interfere with school, work, and social life. It is normal to feel anxious, frustrated, or sad. Talking to a counselor or joining a support group can help. If you feel depressed or overwhelmed, please reach out to a mental health professional. You are not alone.

Prevention

CVS cannot be prevented entirely, but you can try to reduce how often episodes happen by avoiding known triggers. Keeping a consistent sleep schedule, managing stress, and avoiding trigger foods can help. Some people benefit from preventive medications taken daily to reduce the frequency of attacks.

Complications

If left untreated

• Dehydration from repeated vomiting, which can lead to electrolyte imbalances (imbalance of salts in your blood) and kidney problems
• Damage to the teeth from stomach acid (dental erosion)
• Esophagitis (inflammation of the tube from mouth to stomach) from vomiting
• Malnutrition if episodes are very frequent or severe

Long-term outlook

The outlook for CVS is generally good. Many children outgrow the condition by their teenage years or early adulthood. For adults, episodes may become less frequent over time. With a good management plan, most people can live a normal, active life between episodes. While CVS can be frustrating, effective treatments and lifestyle adjustments can greatly improve quality of life.

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