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updated November 24, 2010

Cyclic vomiting syndrome

Filed under: Digestive Health
Cyclic vomiting syndrome causes bouts of severe nausea and vomiting that can last for days. The disorder has no known cause.

Symptoms of cyclic vomiting syndrome typically begin between the ages of 3 and 7 years. While the disorder occurs most often in children, cyclic vomiting syndrome can begin at any age. Adult episodes tend to occur less often than do episodes in children, but adult episodes usually last longer.

Cyclic vomiting syndrome appears to be associated with migraines in some cases. Most children outgrow cyclic vomiting syndrome when they're teenagers. However, children with this condition are at increased risk of developing migraines.

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Cyclic vomiting syndrome causes:

  • Severe vomiting
  • Nausea
  • Loss of appetite
  • Gagging
  • Pale complexion, often appears before a vomiting episode
  • Extreme fatigue

These signs and symptoms may occur an average of six times an hour. 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 may have 10 or more. Episodes typically begin late at night or early in the morning.

In addition, some people with cyclic vomiting syndrome may develop:

  • Sensitivity to light
  • Headache
  • Fever
  • Dizziness
  • Diarrhea
  • Abdominal pain

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The cause of cyclic vomiting syndrome is unknown, but the bouts of vomiting that characterize the condition can be triggered by:

  • Colds, allergies or sinus problems
  • Emotional stress or excitement
  • Foods such as chocolate or cheese
  • Overeating or eating right before going to bed
  • Hot weather
  • Physical exhaustion
  • Menstruation
  • Motion sickness

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Many children who have cyclic vomiting syndrome have a family history of migraines or begin having migraines themselves when they get older. Abdominal migraine — a type of migraine more common in children — causes abdominal pain but not the severe vomiting associated with cyclic vomiting syndrome.

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Cyclic vomiting syndrome can cause these complications:

  • Dehydration. Excessive vomiting causes the body to lose water quickly. This can also lead to an imbalance in electrolytes, the important salts needed to keep the body working properly. In severe cases of dehydration, hospital treatment is required.
  • Injury to the esophagus. The stomach acid that comes up with the vomit can damage the tube that connects the mouth and stomach (esophagus). Sometimes the esophagus becomes so irritated it bleeds.
  • Tooth decay. The acid in vomit can corrode tooth enamel.

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If your child or you have signs and symptoms of cyclic vomiting, you're likely to start by seeing your child's pediatrician or your primary care doctor. However, in some cases when you call to set up an appointment, you may be referred immediately to a digestive disorders specialist called a gastroenterologist. If you or your child is in the middle of a severe vomiting episode, your doctor may recommend immediate medical care.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared. Here's some information to help you get ready and what to expect from the doctor.

What you can do

  • Keep a record of any symptoms you've noticed, including any that may seem unrelated to the reason for which you scheduled the appointment. Make your description as specific and detailed as possible. For example, the doctor will want to know how often you or your child experiences an episode of severe vomiting and any typical triggers, such as food or activity, you may have noticed.
  • Write down key personal information, including any major stresses or recent changes — both positive and negative — in your or your child's life. Also include your dietary habits.
  • Make a list of your or your child's key medical information, including other medical problems for which you or your child is being treated. Also write down the names of any medications, vitamins, supplements, or other natural remedies you're taking.
  • Take a family member or friend along. Sometimes it can be difficult to take in all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your child's doctor is limited, so preparing a list of questions may help you make the most of your time together. List your questions from most important to least important in case time runs out.

For cyclic vomiting syndrome, some basic questions to ask the doctor include:

  • What's the most likely cause of these symptoms?
  • Are there any other possible causes for these symptoms or this condition?
  • Do you think my condition is temporary or long lasting?
  • Are any tests needed?
  • What treatment do you recommend?
  • Will I need to take medications long term? What are the possible side effects of those medications?
  • Are there lifestyle changes I can make to help prevent future episodes?
  • Do I need to follow any dietary restrictions?
  • Does cyclic vomiting syndrome increase the risk of other medical problems?
  • Are my children or other close relatives at increased risk of this condition?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

  • When did you begin experiencing symptoms?
  • How often do you experience an episode of severe vomiting?
  • How many times do you typically vomit during an episode?
  • How long do your episodes typically last?
  • Are your symptoms accompanied by abdominal pain?
  • Have you noticed any warning signs that an episode is coming, such as losing your appetite or feeling unusually tired?
  • Have you noticed any common triggers for an episode of severe vomiting, such as intense emotions, illness or menstruation?
  • Have you been trying to lose weight? How?
  • Have you been diagnosed with any other medical problems, including mental health conditions?
  • What treatments, including over-the-counter medications and home remedies, are you taking for other conditions? Have you been taking laxatives?
  • Does anything seem to improve your symptoms or shorten the duration of an episode?
  • Do you have any history of severe headaches?
  • Does anyone in your family have a history of this condition or of migraines?

What you can do in the meantime
Your doctor will likely want to see you immediately if you're currently having an episode of severe vomiting. If the vomiting has passed, however, your recovery will be aided by getting lots of rest, increasing your intake of fluids and following an easy-to-digest diet. It's also a good idea to avoid caffeinated beverages or foods containing caffeine.

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The doctor will ask you about your or your child's medical history and will conduct a physical exam.

To be diagnosed with cyclic vomiting syndrome, a person must have experienced at least three episodes in the past year of intense nausea and unremitting vomiting or retching — lasting hours or days. These episodes must be separated by weeks or months of symptom-free intervals.

There's no specific test that will confirm the diagnosis of cyclic vomiting syndrome. But, doctors must rule out other conditions that can produce vomiting, such as:

  • Metabolic disorders
  • Intestinal blockage
  • Brain tumors
  • Pregnancy
  • Eating disorders

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There's no cure for cyclic vomiting syndrome. To control the signs and symptoms, you or your child may need:

  • Anti-nausea drugs
  • Sedatives
  • Acid-suppressing medications
  • Hospitalization for intravenous fluids to prevent dehydration

In many cases, the same types of medications used for migraines often help stop or even prevent episodes of cyclic vomiting. These medications include:

  • Tricyclic antidepressants, such as amitriptyline and nortriptyline (Pamelor)
  • Triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig)
  • Analgesics, such as ibuprofen (Advil, Motrin, others)

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People with cyclic vomiting syndrome generally need to get adequate sleep. Once vomiting begins, it may help to stay in bed and sleep in a dark, quiet room.

When the vomiting phase has stopped, it's very important to drink water and replace lost electrolytes with fruit juices or sports drinks. You or your child might not feel like eating right away. Some people need to start with clear liquids and then gradually add solid food back into their diet. But, others may feel well enough to begin eating a normal diet soon after they stop vomiting.

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Several alternative treatments may help prevent vomiting episodes, though none have been well studied. These treatments include:

  • L-Carnitine. This natural substance is made in the body and helps turn fat into energy.
  • Coenzyme Q10. Another natural substance made in the body, coenzyme Q10 assists with the basic functions of cells.

Always check with your doctor before taking any supplements to be sure you or your child are taking a safe dose of the supplement, and that it won't adversely interact with any medications you're taking.

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Because you never know when the next episode might occur, cyclic vomiting syndrome can be difficult on the whole family. Children may be especially concerned about when the next episode may come, and they may worry constantly that they'll be with other children when it happens.

You or your child may benefit from connecting with others who understand what it's like to live with the uncertainty of cyclic vomiting syndrome. Ask your doctor about support groups in your area, or contact the Cyclic Vomiting Syndrome Association at 414-342-7880.

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Many people know what triggers their cyclic vomiting episodes. Avoiding those triggers can reduce the frequency of episodes.

If episodes occur more than once a month or require hospitalization, doctors typically recommend daily preventive medicine. Commonly used drugs to prevent cyclic vomiting episodes include amitriptyline and propranolol (Inderal).

In addition to taking preventive medications, lifestyle changes may help prevent future vomiting episodes, including:

  • Getting adequate sleep
  • Downplaying the importance of upcoming events, because excitement can be a trigger
  • Avoiding trigger foods, such as cheese and chocolate
  • Eating meals at regular times
  • Participating in regular aerobic activity, but not to the point of fatigue

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