Cyclic Vomiting Syndrome

Cyclic vomiting syndrome is a condition with symptoms of recurring intense nausea, vomiting and sometimes abdominal pain and/or headaches or migraines. Cyclic vomiting usually develops in children ages 3-7 and usually stops during adolescence. It occurs a little more in females than males, and occurs in all races—especially affecting whites.

Attacks of intense nausea, vomiting, and feeling weak can last from 1 hour to 10 days. A person could vomit several times per hour causing a dangerous loss of fluids from loosing water quickly (dehydration). Symptoms include getting really thirsty, not going to the bathroom (urination), or feeling very tired or weak. It is important to watch for signs of severe dehydration because it may require hospitalization. Other symptoms may include unusually pale skin color (pallor), abdominal pain, diarrhea, headache, and an increased sensitivity to light or sound. Episodes in children generally last only a day or two and typically begin late at night or early in the morning. Adults can have symptoms for almost a week. Attacks of cyclic vomiting can keep a child from going to school, or an adult missing work.

Intense vomiting could also cause:

    • Electrolyte imbalance from loss of important salts that are needed for the body to work properly.

 

    • Peptic esophagitis. The tube that connects the mouth to the stomach (esophagus) becomes injured from stomach acid moving through it while vomiting.

 

    • Hematemesis. The esophagus become irritated and bleeds and mixes with the vomit.

 

    • Mallory-Weiss tear. The lower end of the esophagus may tear open or the stomach may bruise from vomiting or retching.

 

  • Tooth decay. Acid in vomit can hurt tooth enamel.

Causes

The cause of this syndrome is unknown, but specific triggers may exist for some people. The most common trigger is a migraine headache or an infection. Other triggers may include:

  • Emotional stress or excitement
  • Colds, allergies, or sinus problems
  • Infections
  • Certain foods like chocolate or cheese
  • Eating too much or eating right before going to bed
  • Hot weather
  • Physical exhaustion
  • Menstruation
  • Motion sickness
  • Periods without eating (fasting)
  • Lack of sleep
  • Overdoing activities
  • Menstruation.

Symptoms

Symptoms of cyclic vomiting syndrome include:

  • Fever
  • Skin blotching
  • Exhaustion
  • Severe vomiting, nausea and gagging
  • Headache
  • Sensitivity to light

Diagnosis/Testing

Diagnosing a person with cyclic vomiting syndrome can be difficult. A person must have experienced at least three episodes in the past year of intense nausea and vomiting or retching that doesn’t let up and lasts for hours or days. These episodes must be separated by weeks or even months of no symptoms.

It is important to rule out all other possible causes. There is no single test used specifically to diagnose cyclic vomiting syndrome. The condition is diagnosed by excluding other conditions/diseases such as:

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

A CT Scan may be done in order to examine the brain for any abnormalities. Also, a Upper GI Series, abdominal Ultrasound, and/or Upper Endoscopy may be completed in order to test for various gastrointestinal problems or conditions.

Treatment

While cyclic vomiting syndrome cannot be cured, there are a few medications that doctors find useful to prevent or stop an episode. The same medications used for migraines may help 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, Mortrin, or others).

When the child is having an episode, it may be helpful for him/her to stay in bed in a dark and quiet room. It is also important to try and determine what causes or triggers the episodes so that these things can be avoided.