My name is Mattias McAndrew, and I am a dedicated migraine clinician with a passion for helping people manage complex headache and migraine conditions that affect their quality of life.
With a bachelor’s degree with honours in physiotherapy, I have spent the past eight years working with people suffering from all sorts of headache and migraine disorders.
Prior to that, I spent a decade in specific exercise prescription.
Through my experience, I have seen the profound impact that physiotherapy can have on neurological and autonomic disorders, including conditions like Cyclic Vomiting Syndrome (CVS).
In this blog, I will explore the science behind CVS, its connection with migraines, and the role physiotherapy can play in its management.
What is Cyclic Vomiting Syndrome?
Cyclic Vomiting Syndrome (CVS) is a functional disorder characterised by recurrent episodes of severe nausea and vomiting that can last for hours or even days, followed by periods of complete symptom remission. It is often triggered by stress, infections, or certain dietary factors and can significantly impact daily life.
Though its exact cause is still unknown, research suggests that it is closely linked to autonomic nervous system dysfunction, with strong connections to migraine disorders (Venkatesan et al., 2019).
The Link Between CVS and Migraines
There is growing evidence to suggest that CVS and migraines share a common pathophysiological mechanism.
Many patients with CVS also experience migraines, and some experts believe that CVS may be a form of migraine affecting the digestive system rather than the head (Fleisher & Gornowicz, 2007).
Both conditions involve hypersensitivity of the brainstem and autonomic dysfunction, which can lead to abnormal pain perception, gastrointestinal distress, and nausea. Research has also found that migraine medications, such as triptans, may help reduce CVS episodes, further supporting this link (Venkatesan et al., 2019).
The Role of Physiotherapy in Managing CVS
While medical management of CVS typically involves medications such as antiemetics, migraine treatments, and lifestyle modifications, physiotherapy can play a crucial role in symptom control by addressing contributing factors such as stress, autonomic dysregulation, and musculoskeletal dysfunction.
Here’s how:
- Autonomic Nervous System Regulation
Given the strong autonomic dysfunction in CVS, physiotherapists can employ techniques to modulate autonomic responses, reducing the severity and frequency of attacks. Techniques such as diaphragmatic breathing, vagus nerve stimulation exercises, and heart rate variability (HRV) training can help improve autonomic balance, making the body more resilient to triggers (Li & Misiewicz, 1999).
- Postural and Musculoskeletal Management
Studies have shown that poor posture, especially forward head posture and upper cervical dysfunction, can exacerbate migraine-related symptoms and autonomic dysfunction (Fleisher & Gornowicz, 2007). Physiotherapy interventions, including manual therapy, myofascial release, and targeted strengthening exercises, can help relieve cervical tension and improve neuromuscular control, reducing the frequency of CVS episodes.
- Stress Reduction and Relaxation Techniques
Stress is a well-known trigger for both CVS and migraines. Physiotherapists can integrate progressive muscle relaxation, mindfulness-based exercises, and gentle movement therapies like yoga or Tai Chi into treatment plans to help patients manage stress and autonomic instability more effectively.
- Vestibular Rehabilitation for Migraine-Associated Dizziness
Patients with CVS often experience dizziness and disequilibrium, particularly those with migraine comorbidity. Vestibular rehabilitation, including balance training, gaze stabilisation exercises, and habituation therapy, can help alleviate these symptoms, improving overall quality of life (Venkatesan et al., 2019).
Clinical Benefits of Physiotherapy for CVS
The integration of physiotherapy into the management of CVS has been shown to provide multiple benefits, including:
- Reduced frequency and intensity of CVS episodes through autonomic regulation techniques.
- Improved posture and musculoskeletal function, particularly in patients with concurrent migraine symptoms.
- Enhanced stress resilience, decreasing the likelihood of attacks triggered by emotional or physical stressors.
- Better balance and coordination, reducing associated dizziness and instability.
Is Physiotherapy Safe for CVS Patients?
Physiotherapy is a safe and non-invasive treatment option for CVS patients.
However, it is essential to work with a physiotherapist who understands the condition and its connection to migraines. Individualised treatment plans that consider the patient’s triggers and symptom patterns are crucial for achieving optimal results.
Conclusion
Cyclic Vomiting Syndrome is a complex and debilitating condition with strong ties to migraines and autonomic dysfunction.
While medical management plays an important role in treatment, physiotherapy offers crucial additional, long term benefits.
By addressing autonomic imbalance, musculoskeletal dysfunction, and stress-related triggers, physiotherapy can help reduce the severity and frequency of CVS episodes, ultimately improving the patient’s quality of life.
If you or someone you know suffers from CVS, consider exploring physiotherapy as part of a comprehensive treatment plan.
Written by:
References
Fleisher, D. R., & Gornowicz, B. (2007). Cyclic vomiting syndrome: A disorder of all ages. Neurogastroenterology & Motility, 19(6), 401–410.
Li, B. U. K., & Misiewicz, L. (1999). Cyclic vomiting syndrome: A brain-gut disorder. Gastroenterology Clinics of North America, 28(3), 725–740.
Venkatesan, T., Levinthal, D. J., Tarbell, S. E., Adams, K. A., Li, B. U. K., & Issenman, R. M. (2019). Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association. Neurogastroenterology & Motility, 31(S2), e13604.
