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Cyclic vomiting syndrome
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Cyclic vomiting syndrome causes bouts of severe nausea and vomiting that can last for days. The disorder, which has no known cause, may affect as many as one in 50 children. Once thought to affect primarily girls, cyclic vomiting syndrome is now believed to affect boys and girls equally.
Symptoms 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 episodes do in children, but 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 migraines as adults.
Symptoms
Cyclic vomiting syndrome causes severe vomiting, nausea and gagging — sometimes as often as 12 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 have about 12. Episodes typically begin late at night or first thing in the morning.
Other common signs and symptoms include pallor and exhaustion. Some people are also sensitive to light during cyclic vomiting episodes and may develop:
- Headache
- Fever
- Dizziness
- Diarrhea
- Abdominal pain
Causes
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 or physical exhaustion
- Menstruation
- Motion sickness
Risk factors
Many children who have cyclic vomiting syndrome have a family history of migraine 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.
Complications
Cyclic vomiting syndrome can cause the following 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, 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 the vomit can corrode tooth enamel.
Preparing for your appointment
You're likely to start by first seeing your family 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're 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 well prepared for your appointment. Here's some information to help you get ready and what to expect from the doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as follow dietary restrictions.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment. Make your description of your symptoms as specific and detailed as possible. For example, your doctor will want to know how often you experience an episode of severe vomiting and any typical triggers you may have noticed.
- Write down key personal information, including any major stresses or recent changes — both positive and negative — in your life. Also include your dietary habits.
- Make a list of your key medical information, including other medical problems for which you're 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, if possible. Sometimes it can be difficult to soak up all the information provided to you 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 will 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 your doctor include:
- What is likely causing my symptoms or condition?
- Are there any other possible causes for these symptoms or this condition?
- Do you think my condition is temporary or chronic?
- What kinds of tests do I need?
- 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 of this condition?
- Do you think my body weight may be contributing to this problem? What is my body mass index (BMI), and what should it be?
- Will I need to follow any dietary or other restrictions?
- Does this condition increase my risk of any other medical problems?
- Are my children or other close relatives at increased risk of this condition?
- I have these other health conditions. How can I best manage them together?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
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 your first 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. Try reducing the amount of citrus products you eat as well as spicy and greasy foods. Reduce or eliminate your use of caffeine, alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin.
Tests and diagnosis
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. Doctors must rule out other conditions that can produce vomiting, such as:
- Inner ear problems
- Metabolic disorders
- Intestinal blockage
- Brain tumors
- Pregnancy
- Eating disorders
Treatments and drugs
There's no cure for cyclic vomiting syndrome. Severe bouts may require hospitalization for administration of intravenous fluids. Anti-nausea drugs and sedatives also may be delivered intravenously.
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
- Triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig)
- Analgesics, such as ibuprofen (Advil, Motrin, others)
Lifestyle and home remedies
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. Some people feel well enough to resume normal eating immediately, while others need to start with clear liquids and then graduate up to solid food.
Prevention
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).
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