Cyclic vomiting syndrome
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Cyclic vomiting syndrome (CVS) is a medical condition characterized by recurrent, abrupt episodes of severe nausea, vomiting, and profound fatigue, with no apparent identifiable cause. These episodes can endure for varying durations, ranging from several hours to multiple days, and their intensity may necessitate bed rest or prompt medical attention. Typically, these episodes tend to start in the early morning hours. Following an episode, individuals with CVS generally return to their normal state of health.
Cyclic vomiting syndrome can affect individuals of all age groups, although it frequently manifests in children between the ages of 3 and 7. While it is more prevalent in children, there has been an increasing number of diagnosed cases in adults.
The diagnosis of this syndrome is challenging because vomiting is a symptom associated with various medical conditions. The treatment for CVS often involves implementing lifestyle modifications to reduce potential triggers for vomiting episodes. Additionally, healthcare providers may prescribe medications, such as anti–nausea and migraine treatments, to help alleviate the severity of symptoms.
Symptoms
Cyclic vomiting syndrome typically occurs in the morning and is characterized by three or more recurrent vomiting episodes that tend to happen at a consistent time and duration. These episodes are separated by intervals of relatively normal health without nausea. Each episode is marked by intense nausea and sweating before vomiting occurs.
During vomiting episodes, additional symptoms may include:
- Abdominal pain
- Diarrhea
- Dizziness
- Light sensitivity
- Headache
- Retching or gagging
Contact your doctor if you notice blood in vomit. Prolonged vomiting can lead to dangerous dehydration. Seek medical help if you or your child show signs of dehydration such as:
- Excessive thirst or dry mouth
- Reduced urination
- Dry skin
- Sunken eyes or cheeks
- Absence of tears when crying
Causes
The exact root cause of cyclic vomiting syndrome remains unknown. Various factors have been proposed as potential contributors, including genetics, digestive challenges, disruptions in the nervous system, and hormonal imbalances. Specific bouts of vomiting may be triggered by:
- Respiratory issues, such as colds, allergies, or sinus problems.
- Emotional stress or excitement, particularly in children.
- Anxiety or panic attacks, especially in adults.
- Consumption of specific foods and beverages, such as alcohol, caffeine, chocolate, or cheese.
- Habits like overeating, eating just before bedtime, or fasting.
- Exposure to hot weather.
- Physical exhaustion.
- Excessive physical activity.
- Menstruation.
- Motion sickness.
Identifying these triggers for vomiting episodes can be valuable in effectively managing cyclic vomiting syndrome.
Risk factors
The relationship between migraines and cyclic vomiting syndrome is not fully understood, but it is observed that many children with cyclic vomiting syndrome either have a family history of migraines or develop migraines as they grow older. In adults, cyclic vomiting syndrome is also linked to personal or familial migraine history. Additionally, chronic marijuana use (Cannabis sativa) has been associated with cyclic vomiting syndrome due to its use for nausea relief. However, prolonged cannabis use can result in cannabis hyperemesis syndrome, characterized by persistent vomiting without breaks and frequent bathing habits. To distinguish between the two conditions, individuals experiencing vomiting episodes should abstain from marijuana use for one to two weeks; if vomiting persists, doctors will continue investigating for cyclic vomiting syndrome.
Diagnosis
Cyclic vomiting syndrome can be challenging to diagnose due to the absence of a specific test for confirmation, and vomiting can be a symptom of numerous conditions that need to be ruled out first.
The healthcare provider will commence by inquiring about the patient’s or your own medical history and performing a physical examination. Additionally, the physician will seek information about the recurring pattern of symptoms.
Following this, the healthcare provider may suggest the following:
- Imaging studies: such as endoscopy, ultrasound, or computed tomography (CT) scans, to examine for obstructions within the digestive system or indications of other digestive disorders.
- Motility tests: To observe the movement of food through the digestive system and to identify potential digestive ailments.
- Laboratory tests: To assess for thyroid abnormalities and other metabolic conditions.
Treatment
Cyclic Vomiting Syndrome (CVS) currently has no known cure, although many individuals with the condition may experience a decrease in vomiting episodes as they reach adulthood. When managing a cyclic vomiting episode, the primary goal is to alleviate and control the associated symptoms.
Patients, whether children or adults, might be prescribed various medications, which could include:
- Anti–nausea drugs
- Pain–relieving medications
- Medications designed to reduce stomach acid production
- Antidepressants
- Anti–seizure medications
For individuals with frequent and prolonged episodes or those with a family history of migraines, healthcare providers may suggest using medications commonly employed to treat migraines. These medications can sometimes help halt or prevent cyclic vomiting episodes.
In cases where severe dehydration is a concern, intravenous (IV) fluids may be administered to maintain adequate hydration levels. Treatment plans are personalized based on the severity and duration of symptoms, as well as the presence of any complications.
