Cyclic Vomiting Syndrome (CVS)

  • 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.

woman with abdominal pain

What is cyclic vomiting syndrome (CVS)?

Cyclic vomiting syndrome (CVS) 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. The cause and pathophysiology is unknown, but researchers suggest genetic components 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.

What are the 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.

What are causes, triggers, and risk factors of cyclic vomiting syndrome?

Episodes of nausea and vomiting can be triggered by several different factors. The most common causes of cyclic vomiting syndrome are infections (chronic sinusitis, tooth decay, for example) and emotional excitement (panic attacks, anxiety, holidays, parties) with positive situations outnumbering negative. Other triggers can include periods without eating (fasting), temperature extremes of hot or cold, lack of sleep, overexertion, allergies, ingesting certain foods (chocolate, cheese, monosodium glutamate), overeating, alcohol consumption, and menstruation.

Researchers have suggested migraine-related mechanisms may be involved. For example, patients with CVS have a family prevalence of migraine headaches and many patients with CVS that eventually resolved developed migraine headaches in adulthood.

Mitochondrial DNA (mDNA) may also play a role. Researchers have demonstrated that 86% of children with CVS and neuromuscular disease had mothers with a history of migraine. In children with CVS, mDNA showed high frequency of polymorphic changes in mDNA termed16519T and 3010A.

In addition, patients with CVS appear to have sympathetic nerve hyperresponsiveness and autonomic dysfunctions so that patients with flushing, paleness to the skin, fever, lethargy, increased saliva production, and diarrhea are at higher risk for developing CVS.

The stress responses -- psychological, physical, and infectious -- are known to trigger episodes of CVS.

Chronic marijuana use has been associated with CVS episodes and may be linked to nausea/vomiting through the endocannabinoid system, which is thought to play a role in nausea, vomiting, and stress control. Some researchers suggest that males younger than 19 years of age with CVS-like symptoms should always be asked about marijuana use.

It is not clear which factors comprise the highest risk factors for CVS. Most researchers consider there to be increased risk for CVS when several factors converge (genetic, autonomic, environmental, and/or nerve/brain functions), thus resulting in multifactorial causes and risk factors for CVS.

Medically Reviewed by a Doctor on 3/10/2016

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