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Cyclic vomiting syndrome


Other Names for this Disease

  • CVS
  • Familial cyclic vomiting syndrome (subtype)
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.

Your Question

My adult son has cyclic vomiting syndrome. Although he has been taking medication, his symptoms continue to escalate. How might this condition be managed? Is there a place where we can find other people who have severe symptoms as a result of this condition? 

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What is cyclic vomiting syndrome?

Cyclic vomiting syndrome (CVS) is a condition characterized by recurrent episodes of severe nausea and vomiting. Episodes can last for hours or days. Each episode is usually similar to previous ones. Other symptoms may include physical exhaustion, pale skin, abdominal pain, diarrhea, headache, and/or fever.[1] CVS can begin at any age but is most often diagnosed in children around 5 years of age. The underlying cause of CVS is not known, but children who suffer from migraines are more likely to develop CVS.[2] Treatment aims to control symptoms and may include anti-nausea drugs, sedatives, medications that suppress stomach acid, and/or antidepressants.[3]
Last updated: 11/12/2014

What are the characteristics of adult cyclic vomiting syndrome?

Cyclic vomiting syndrome causes severe vomiting, nausea and gagging — sometimes as often as 12 times an hour.[4] In adults, episodes tend to occur less often than they do in children, but they last longer.[5][4] Episodes in children generally last only a day or two, but adults can have symptoms for almost a week. Adults tend to have about four episodes a year, while children have about 12. Episodes typically begin at night or first thing in the morning.[4]

Other common symptoms include pallor and exhaustion. Some people also become sensitive to light and may develop:[4]

  • Headache
  • Fever
  • Dizziness
  • Diarrhea
  • Abdominal pain
Based on several recent studies of adult patients with cyclic vomiting syndrome, the most uniform feature of adult patients with cyclic vomiting syndrome was the stereotypical nature of the nausea, vomiting, and abdominal pain with intermittent symptom free periods. The abdominal pain appears to be more pronounced in the adult patients than in pediatric patients.[6] Furthermore, the events or situations that trigger episodes in adults cannot always be pinpointed as easily as they can in children.[5]  
Last updated: 11/21/2008

How might cyclic vomiting syndrome be treated?

Treatment of cyclic vomiting syndrome (CVS) aims to prevent, stop, and/or support the symptoms of the condition. Most treatments have been based upon observational data or clinical experience. Affected people should try to avoid things that appear to trigger episodes (e.g. motion, fasting, certain foods).

If episodes occur more often than monthly, or if they last long or are debilitating, daily prophylactic (preventative) therapy is recommended. Some experts recommend amitriptyline even if there is no history of headache or a family history of migraines. However, its use may be limited due to side effects in infants and toddlers under age 5. If episodes are less frequent or are mild, therapy to try to stop the episode at the onset is often preferred. If this fails after two or three attempts, switching to prophylactic therapy is usually recommended.

Coenzyme Q10 and L-carnitine have also been recommended for prophylactic therapy because data suggest that these dietary supplements may be highly effective, and side effects are mild. Topiramate is an unproven therapy that is gaining in popularity due to anecdotal reports effectiveness, but side effects occur often and can be significant. Stopping an episode with intravenous dextrose and high-doses of ondansetron have reportedly been helpful in anecdotal reports in children.

During an episode, treatment may also include supportive care such as intravenous fluids. Therapy with other medications may depend on whether there is a family history of migraines, the frequency of episodes, and the severity of episodes. Medications used may include ant-migraine drugs, anti-nausea drugs, sedatives, medications that suppress stomach acid, pain relievers, and/or antidepressants.[7]
Last updated: 11/13/2014

What is the long-term outlook for people with cyclic vomiting syndrome?

The course of cyclic vomiting syndrome (CVS) in adults has not been well studied. In one series of 17 adults with CVS, 13 had at least a partial response to antidepressant therapy while an additional 3 responded to other types of treatment. One patient had persistent symptoms during two years of follow-up.[7] There is substantial morbidity associated with CVS in adults, possibly due to lack of awareness and delays in diagnosis.[8] Although people with CVS are well about 90% of the time, the condition can be medically and socially disabling.[8] We are not aware of published data regarding how long CVS typically lasts in affected adults.

Many children affected with CVS outgrow the condition by their preteen or early teenage years.[7] Most reports in the literature indicate that in children the condition lasts an average of 2.5 to 5.5 years, resolving in late childhood or early adolescence. A few people continue to have symptoms through adulthood.[8] However, some authors have observed that up to 75% of children with CVS go on to develop migraine headaches by age 18.[7] Some progress from CVS to abdominal migraines, and then to migraine headaches.[8]
Last updated: 11/13/2014

Where can we connect with other adult patients with cyclic vomiting syndrome and others who have had difficulty managing their symptoms?

You can connect with other patients with cyclic vomiting syndrome by contacting the Cyclic Vomiting Syndrome Association.

Cyclic Vomiting Syndrome Association
3585 Cedar Hill Road, NW.
Canal Winchester, OH 43110
Phone: 614–837–2586
Fax: 614–837–2586
Email: waitesd@cvsaonline.org
Web: www.cvsaonline.org
Web page for adult patients: http://www.cvsaonline.org/CVSAAdults.htm
Last updated: 11/21/2008

References
Other Names for this Disease
  • CVS
  • Familial cyclic vomiting syndrome (subtype)
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.