Cyclic Vomiting Syndrome (CVS) Symptoms, Causes (Migraine), and Treatments

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Causes of Vomiting

There are numerous causes of nausea and vomiting. These symptoms may be due to the following:

  • Acute gastritis (direct irritation of the stomach lining)
  • Central causes in which signals from the brain cause nausea and vomiting
  • Other illnesses not due to stomach problems
  • Medications and medical treatments
  • Mechanical obstruction of the bowel

Cyclic vomiting syndrome (CVS) definition and facts

  • 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.
  • Cyclic vomiting syndrome is generally considered to be a variant of migraines by medical researchers.
  • Research also explored the brain gut connection as a theory as one cause of the syndrome. However, good evidence for this theory is not supported currently.
  • Symptoms and signs of cyclic vomiting syndrome are repeated attacks of intense nausea, vomiting, and lethargy that last anywhere from an hour to 10 days. Other symptoms and signs may include:
  • The most common causes and triggers of the syndrome are emotional excitement and infections. Other triggers can include:
  • Cyclic vomiting syndrome has four phases: symptom-free, prodrome, vomiting, and recovery.
  • The disease is diagnosed by the patient's history and symptoms; there is no definitive test for cyclic vomiting syndrome.
  • Treatment is done by the patient learning to avoid the causes or triggers of the disorder. During the prodrome, vomiting, and recovery phases, medications are often used to treat the symptoms (for example, antinausea medications, NSAIDs, anti-migraine medications, fluid replenishment, and others).
  • Complications may include pain, reflux, fainting, depression, panic disorder, irritable bowel syndrome, and injury to the esophagus.
  • "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 four to 2,000 per 100,000 children, but seems to occur less frequently in adults although the data is not clear.
  • Medical 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 or contribute to the development of the disorder.

What is cyclic vomiting syndrome (CVS)?

Cyclic vomiting syndrome is a disorder that causes recurrent episodes of nausea, vomiting, and tiredness (lethargy) that are also termed as “paroxysmal and stereotypic”. This condition is diagnosed most often in young children, but it can affect people of any age. It was first described by Samuel Gee in 1882; the etiology and pathophysiology is unknown but researchers suggest genetic component may play a significant role in this syndrome. CVS is characterized by episodes of rapid vomiting followed with periods of completely normal health - clinicians suggest this off and on again stereotypic vomiting pattern that usually consists of four phases is the diagnostic feature of the syndrome.

4 Phases of cyclic vomiting syndrome

Cyclic vomiting syndrome has four phases:

  1. Symptom-free interval phase: This phase is the period between episodes when no symptoms are present.
  2. Prodromal 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 this phase can stop an episode in progress. Sometimes there is no warning. A person may simply wake up in the morning and begin vomiting.
  3. Vomiting phase: This phase consists of nausea and vomiting; an inability to eat, drink, or take medicines without vomiting; paleness; drowsiness; and exhaustion.
  4. Recovery phase: This phase begins when the nausea and vomiting stop. Healthy color, appetite, and energy return.
Medically Reviewed by a Doctor on 4/4/2017

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