Cyclic vomiting syndrome

Cyclic vomiting syndrome is a condition that causes sudden episodes of severe nausea and vomiting. Episodes can last for hours or days and alternate with symptom-free periods that can last for several weeks to months. Episodes are similar, meaning that they tend to start at the same time of day, last the same length of time, and happen with the same symptoms and intensity.

Cyclic vomiting syndrome happens in all age groups, but it often begins in children who are 3 to 7 years old. Although it’s more common in children, the number of adults with the condition is increasing.

Cyclic vomiting syndrome has no clear cause. The syndrome is difficult to diagnose because vomiting is a symptom of many conditions. Treatment often involves lifestyle changes to help avoid the triggers of vomiting episodes. Medicines, including antinausea and migraine therapies, may help lessen symptoms.

The symptoms of cyclic vomiting syndrome often begin in the morning. Symptoms include:

• Three or more recurrent episodes of vomiting that start around the same time and last for a similar length of time.
• Varying periods of overall typical health without nausea or vomiting between episodes.
• Intense nausea and sweating before an episode starts.

Other symptoms during a vomiting episode may include:

• Belly pain.
• Diarrhea.
• Dizziness.
• Sensitivity to light.
• Headache.
• Retching or gagging.

Call a healthcare professional if you see blood in your or your child’s vomit.

Continued vomiting may cause severe dehydration that can be life-threatening. Call a health professional if you or your child is showing symptoms of dehydration, such as:

• Extreme thirst or dry mouth.
• Less urination.
• Dry skin.
• Sunken eyes or cheeks.
• No tears when crying.
• Exhaustion and listlessness.

The underlying cause of cyclic vomiting syndrome is unknown. Some possible causes include genes, digestive difficulties, nervous system conditions and hormones that are not balanced. Specific bouts of vomiting may be triggered by:

• Colds, allergies or sinus conditions.
• Emotional stress or excitement, especially in children.
• Anxiety or panic attacks, especially in adults.
• Certain foods and drinks, such as alcohol, chocolate, cheese, or foods and drinks that have caffeine.
• Overeating, fasting or eating right before going to bed.
• Not enough sleep.
• Hot or cold temperature extremes.
• Physical exhaustion.
• Exercising too much.
• Menstruation.
• Motion sickness.

Identifying the triggers for vomiting episodes may help with managing cyclic vomiting syndrome.

The relationship between migraines and cyclic vomiting syndrome isn’t clear. But many children with cyclic vomiting syndrome have a family history of migraines or have migraines themselves when they get older. In adults, cyclic vomiting syndrome also is associated with a personal or family history of migraines.

Long-term use of marijuana, also called cannabis, has been associated with cyclic vomiting syndrome because some people use marijuana to relieve nausea. However, long-lasting marijuana use can lead to a condition called cannabis hyperemesis syndrome. Cannabis hyperemesis syndrome typically leads to lasting vomiting without regular breaks. People with this syndrome often shower or bathe more often than is typical.

Cannabis hyperemesis syndrome can be confused with cyclic vomiting syndrome. To rule out cannabis hyperemesis syndrome, you need to stop using marijuana for a few months to see if vomiting lessens. If it doesn’t, your healthcare professional will likely continue testing for cyclic vomiting syndrome.

Cyclic vomiting syndrome can cause these complications:

• Dehydration. Excessive vomiting causes the body to lose water quickly. Severe dehydration may need to be treated in the hospital.
• Injury to the esophagus. The stomach acid that comes up with vomit can damage the tube that connects the mouth and stomach, called the esophagus. Sometimes the esophagus becomes so irritated that it bleeds.
• Tooth decay. The acid in vomit can break down tooth enamel.

Many people know what triggers their cyclic vomiting episodes. Avoiding those triggers can reduce the frequency of episodes. You may feel well between episodes, but it’s very important to take medicines as prescribed by your healthcare professional.

If episodes happen more than once a month or require hospitalization, a health professional may recommend preventive medicine, such as amitriptyline, propranolol, cyproheptadine or topiramate.

Lifestyle changes also may help:

• 十分な睡眠をとる。
• For children, downplay the importance of upcoming events because excitement can be a trigger.
• Stay away from trigger foods and drinks, such as alcohol, cheese, chocolate, and foods and drinks that have caffeine.
• Eat small meals and low-fat snacks daily at regular times.

Cyclic vomiting syndrome can be difficult to diagnose. There’s no specific test to confirm the diagnosis, and vomiting is a sign of many conditions that must be ruled out first.

A healthcare professional typically starts by asking about your or your child’s medical history and doing a physical exam. A care professional also may want to know about the pattern of symptoms that you or your child experiences.

After that, these tests may be recommended:

• Imaging studies — such as endoscopy, ultrasound or a CT scan — to check for blockages in the digestive system or signs of other digestive conditions.
• Motility tests to watch the movement of food through the digestive system and to check for digestive conditions.
• Laboratory tests to check for thyroid conditions and other metabolic conditions.

There’s no cure for cyclic vomiting syndrome, though many children no longer have vomiting episodes by the time they reach adulthood. For those experiencing a cyclic vomiting episode, treatment focuses on managing the symptoms.

You or your child may be prescribed:

• Antinausea medicines.
• Pain-relieving medicines.
• Medicines that suppress stomach acid.
• Antidepressants.
• Antiseizure medicines.

The same types of medicines used for migraines can sometimes help stop or even prevent episodes of cyclic vomiting. These medicines may help people whose episodes are frequent and long lasting, or people with a family history of migraine.

Fluids may need to be given in a vein, also called IV, to prevent dehydration. Your treatment typically depends on how bad symptoms are, how long they have lasted and whether you have any complications related to cyclic vomiting syndrome.

Lifestyle changes can help manage the symptoms of cyclic vomiting syndrome. People with cyclic vomiting syndrome generally need to get enough 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 fluids, such as an oral electrolyte solution (Pedialyte). You also can try a sports drink (Gatorade, Powerade, others) diluted with 1 fluid ounce of water for every fluid ounce of sports drink.

Some people may feel well enough to begin eating a regular diet soon after they stop vomiting. But if you don’t or your child doesn’t feel like eating right away, you might start with clear liquids and then gradually add solid food.

If vomiting episodes are triggered by stress or excitement, try during a symptom-free interval to find ways to reduce stress and stay calm. Eating well-balanced, nutritious meals between episodes also may help.

Alternative and complementary treatments may help prevent vomiting episodes, although none of these treatments has been well studied. These treatments include:

• Coenzyme Q10, also called ubiquinone, a natural substance made in the body that is available as a supplement. Coenzyme Q10 assists with the basic functions of cells.
• L-carnitine, a natural substance that is made in the body and is available as a supplement. L-carnitine helps the body turn fat into energy.
• Riboflavin, also called vitamin B-2, a vitamin found in certain foods and available as a supplement. Riboflavin plays a role in the body’s mitochondrial processes.

Coenzyme Q10, L-carnitine and riboflavin may work by helping your body overcome difficulty in converting food into energy. This difficulty is called mitochondrial dysfunction. Some researchers believe mitochondrial dysfunction may be a factor causing both cyclic vomiting syndrome and migraines.

Be sure to see a healthcare professional to have the diagnosis of cyclic vomiting syndrome confirmed before starting any supplements. And always check with your health professional before taking any supplements. This way, you’ll be sure that you or your child is taking a safe dose and that the supplement won’t cause other medicines you’re taking to work differently. Some people may experience side effects from coenzyme Q10, including diarrhea.

Because you never know when the next episode might occur, cyclic vomiting syndrome can be difficult for your whole family. Children may be especially concerned and they may constantly worry that they’ll be with other children when an episode happens.

You or your child may benefit from connecting with others who understand what it’s like to live with cyclic vomiting syndrome. Ask your healthcare team about support groups in your area or online.

You’re likely to start by seeing someone on your primary healthcare team or your child’s pediatrician. But you may be referred immediately to a doctor who specializes in digestive diseases, called a gastroenterologist. If you or your child is in the middle of a severe vomiting episode, a health professional may tell you to get immediate medical care.

Here’s some information to help you get ready for your appointment and know what to expect.

What you can do

• Keep a record of any symptoms, including how often vomiting happens and any typical triggers you may have noticed, such as food or activity.
• Write down key medical information, including other diagnosed conditions.
• Write down key personal information, including dietary habits and any major stresses or recent changes — both positive and negative — in your child’s life or yours.
• Bring a list of all medicines, vitamins and supplements that you or your child takes.
• Write down questions to ask the healthcare professional.

Questions to ask the doctor

Some basic questions to ask include:

• What’s the most likely cause of these symptoms?
• Are any tests needed?
• Do you think this condition is temporary or long lasting?
• What treatments do you recommend?
• Is there a medicine that can help?
• Are there any dietary restrictions that can help?

Don’t hesitate to ask other questions that you think of during your appointment.

What to expect from the doctor

You may be asked a few questions, including:

• When did you or your child begin experiencing symptoms?
• How often does an episode of severe vomiting happen, and how many times do you or your child typically vomit?
• How long do the episodes typically last?
• Do you or does your child experience stomach pain?
• Have you noticed any warning signs that an episode is coming, such as loss of appetite or feeling unusually tired, or any common triggers, such as intense emotions, illness or menstruation?
• Have you or has your child been diagnosed with any other medical problems, including mental health conditions?
• What treatments, including nonprescription medicines and home remedies, are you or your child taking for other conditions?
• Does anything seem to improve the symptoms or shorten how long an episode lasts?
• Do you or does your child have any history of severe headaches?
• Does anyone in your family have a history of cyclic vomiting syndrome or migraines?
• Do you or does your child use cannabis in any form? If so, how often?

What you can do in the meantime

A healthcare professional will likely want to see you or your child right away if an episode of severe vomiting is underway. But if the vomiting has passed, get plenty of rest, drink extra fluids and follow an easy-to-digest diet. It’s also a good idea to avoid caffeinated beverages or foods containing caffeine, as these may trigger symptoms.