Cyclical Vomiting Syndrome
What is Cyclical Vomiting Syndrome?
The main presentation of Cyclical Vomiting Syndrome (CVS) is episodes of severe vomiting followed most often by complete symptom-free periods, hence the cyclical nature of the disorder1. However, occasionally sufferers may experience mild symptoms in between2. The episodes can last anywhere from 1 hour up to 10 days1. Within each episode, the sufferer will vomit at least 4 times per hour, and an attack can last 1 hour-10 days1, which can often lead to severe dehydration. Notably, the episodes present similarly in terms of duration, time of onset, intensity and type of symptoms as well. CVS is more common in children, with children ages 3-7 most affected. Some cases of CVS can occur in adults as well.
Unfortunately, CVS is often difficult to diagnose as the symptoms can present very similarly to other disorders.
The common signs and symptoms of CVS include:
- recurrent episodes of vomiting that can last up to a week
- with severe nausea
- intense sweating
Accompanying features that may or may not be present with CVS include:
- abdominal pain
While CVS is considered to be a “migraine disorder”, it is rarely associated with headaches. This is due to attacks including headaches being classified as “classic” or “common” migraine.
Abdominal Migraine vs Cyclic Vomiting Syndrome
Though they’re often mistaken for the same condition, there are differences between Abdominal Migraine and Cyclic Vomiting Syndrome.
Cyclic vomiting syndrome refers to waves of intense nausea, vomiting, and other stomach problems for no obvious reason. Cyclic vomiting syndrome may also last up to 10 days, compared to 3 days for Abdominal Migraine. While you may experience nausea and vomiting as a symptom of Abdominal Migraine, Abdominal Migraine is often experienced purely as abdominal pain.
In both cases, sufferers can experience loss of appetite and pale skin during an attack.
What is the cause of Cyclical Vomiting Syndrome?
Currently the exact cause of CVS is not known, however some theories suggest that certain chemicals produced by the body (histamine and serotonin) have a role to play. Other possible causes include genetic differences or hormonal imbalances.
Cyclical Vomiting Syndrome can be hard to diagnose as children may have difficulty distinguishing between stomach flu and an abdominal migraine. Other causes for stomach pain should be ruled out such as Irritable Bowel Syndrome, gastroenteritis, appendicitis, etc.
In children affected with CVS, it is more likely that they will experience migraines or headaches when they reach adulthood.
In those individuals that may be suffering from Cyclical Vomiting Syndrome and have no underlying pathology or disorder that can be recognised, another known cause may be due to a sensitised brainstem.
A SENSITISED BRAINSTEM will perceive non-threatening stimuli (such as eating certain foods) and create pain to be felt where the sensory information was originally detected. This hyper-excitability of the pain sensation is due to the heightened arousal and sensitive brainstem. A sensitive brainstem will relay the sensory information to the brain, but will heighten the sensation so that the brain perceives the information as painful.
I’ve already tried everything. What else can be done to help my Cyclical Vomiting Syndrome?
Over-the-counter painkillers, strong triptan medications, and even tricyclic antidepressants are some of the ways in which CVS sufferers have attempted to rid themselves or their child of the painful attacks. In some cases, these ways can alleviate the symptoms of CVS, however despite all of these treatment options, sufferers may still find themselves having painful attacks.
At the Brisbane Headache and Migraine Clinic™, we have seen countless CVS sufferers. So, if you suffer from CVS, or if you think it sounds like your symptoms, and medication has given you no significant relief, then we believe that you should have a thorough examination of your brainstem.
Imagine living a life free from headaches and migraines and saying goodbye to medications!
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- Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia, 38(1), 1-211. doi: 10.1177/0333102417738202
- Cyclic Vomiting Syndrome – NORD (National Organization for Rare Disorders). (2019). Retrieved from https://rarediseases.org/rare-diseases/cyclic-vomiting-syndrome/