Cyclic Vomiting Syndrome

Cyclic Vomiting Syndrome

Cyclic vomiting syndrome (CVS) is characterized by abrupt, repeated, sometimes prolonged episodes of severe vomiting. CVS commonly occurs during the night or early morning hours and may last for several hours or days. Cycles alternate with symptom-free periods. Patients with CVS often have a personal or family history of migraine.

The exact cause of CVS is unknown, but there appears to be a link between CVS and migraine headaches. In children, CVS can be triggered by emotional stress and excitement. Other triggers include infection, certain foods, menstruation and exhaustion.

Children with CVS will have a pattern of vomiting with a consistent time of onset, duration and symptoms. Common symptoms of CVS include:

  • Abdominal pain
  • Diarrhea
  • Dizziness or nausea
  • Fever
  • Migraine-type headache
  • Sensitivity to light

Vomiting can cause dehydration, which can be life-threatening. It is important to watch for signs of dehydration, including:

  • Decreased urination
  • Exhaustion
  • Increased thirst
  • Listlessness or disinterest
  • Paleness

Diagnosis of Cyclic Vomiting Syndrome

If your child is vomiting repeatedly and shows other symptoms of CVS, a pediatric gastroenterologist will perform exams and tests to make a diagnosis. Exams and tests include:

  • Physical exam. A pediatric specialist will perform a complete physical examination to exclude other medical conditions. The history of recurrent, stereotypical vomiting episodes is so common with CVS that further evaluation is unnecessary in 90 percent of patients.
  • Blood tests. Children under 2 years of age may require blood tests including a complete blood count (CBC) and blood chemistries (CMP) to exclude other disorders. Lab tests also may be ordered for children whose vomiting leads to dehydration and need for IV fluid therapy.

Treatments

Treatments for CVS include:

  • Lifestyle changes. If you know what triggers CVS for your child, simple modifications can make a difference. For example:
    • Avoid energy-depleting states such as prolonged hunger
    • Avoid sleep deprivation
    • Avoid foods that trigger symptoms
  • Medicine. Your child's pediatric gastroenterologist may also prescribe a medicine. Some of the most common medicines used to treat CVS are:
    • Ondansetron. Ondansetron may be used to stop or reduce the severity of the vomiting episodes.
    • Propranolol. Propranolol is an anti-migraine medicine that may be prescribed for the treatment of migraine-associated CVS, if migraines occur more than once a month.
    • Cyproheptadine. Cyproheptadine is an antihistamine which relaxes the fundus of the stomach (the upper part of the stomach) and has a sedative effect. This may help prevent episodes of vomiting in young children and is the first choice of medicine in children less than 5 years old.
    • Amitriptyline. Amitriptyline is an antidepressant that can be used in small doses to prevent migraines. It has a favorable response rate in children over 5 years of age.
    • Anticonvulsant medications. Anticonvulsant medicines, such as phenobarbital or phenytoin, may be used in children with abdominal epilepsy.
    • Leuprolide. Leuprolide is prescribed for the treatment of menstrual cycle-related CVS.

Key Points to Remember

  • CVS is characterized by cycles of severe vomiting that alternate with symptom-free periods.
  • You may be able to determine triggers for your child and make lifestyle modifications.
  • Your child may experience migraine headaches with CVS.
  • Monitor your child's hydration level carefully. Vomiting can lead to dehydration, which can be dangerous.

Support Services & Resources

Visit the websites below to find support groups and services and learn more about CVS.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

National Institute of Diabetes and Digestive and Kidney Diseases

This website offers extensive information about CVS for patients and families, including causes, symptoms, treatments and clinical trials.

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

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