Cyclic vomiting syndrome (CVS) is a condition marked by recurring episodes of severe vomiting with no clear cause. These episodes can last anywhere from several hours to a few days and alternate with periods of no symptoms. Each episode tends to follow a similar pattern in terms of timing, duration, and intensity.

Who is Affected?

CVS can affect individuals of any age, but it often begins in children aged 3 to 7 years. While more common in children, the number of cases identified in adults is on the rise. Diagnosing CVS can be challenging because vomiting is a symptom associated with many other disorders.

Treatment Approaches

Managing CVS often involves lifestyle adjustments to minimize potential triggers. Medications, including anti-nausea and migraine treatments, can help reduce the severity of symptoms.

Recognizing Symptoms

Symptoms of CVS typically start in the morning and include:

• Three or more recurrent vomiting episodes that begin around the same time and last for a similar duration
• Periods of generally normal health between episodes without nausea
• Intense nausea and sweating before an episode starts

Other symptoms during an episode may include:

• Abdominal pain
• Diarrhea
• Dizziness
• Sensitivity to light
• Headache
• Retching or gagging

When to Seek Medical Attention

Contact your doctor if you notice blood in your or your child's vomit. Persistent vomiting can lead to severe dehydration, which can be life-threatening. Signs of dehydration include:

• Excessive thirst or dry mouth
• Reduced urination
• Dry skin
• Sunken eyes or cheeks
• Lack of tears when crying
• Exhaustion and listlessness

Causes and Triggers

The exact cause of CVS is unknown. Possible contributing factors include genetic predispositions, digestive system issues, nervous system abnormalities, and hormonal imbalances. Specific triggers for vomiting episodes may include:

• Colds, allergies, or sinus problems
• Emotional stress or excitement, particularly in children
• Anxiety or panic attacks, particularly in adults
• Certain foods and drinks, such as alcohol, caffeine, chocolate, or cheese
• Overeating, eating before bed, or fasting
• Hot weather
• Physical exhaustion or excessive exercise
• Menstruation
• Motion sickness

Identifying and avoiding triggers can help manage CVS.

Risk Factors

There appears to be a link between migraines and CVS, though the relationship is not entirely understood. Many children with CVS have a family history of migraines or develop migraines themselves later in life. Adults with CVS also often have a personal or family history of migraines.

Chronic marijuana use has been linked to CVS, as some individuals use marijuana to relieve nausea. However, long-term marijuana use can cause cannabis hyperemesis syndrome, characterized by persistent vomiting without normal periods between episodes. This condition can be mistaken for CVS. To distinguish between the two, abstain from marijuana for at least one to two weeks to see if vomiting decreases.

Potential Complications

CVS can lead to several complications, including:

• Dehydration: Rapid loss of water due to excessive vomiting, sometimes requiring hospital treatment.
• Esophageal Damage: Stomach acid from vomit can injure the esophagus, occasionally leading to bleeding.
• Tooth Decay: Stomach acid can erode tooth enamel.

Preventive Measures

Knowing your triggers and avoiding them can reduce the frequency of CVS episodes. Even when feeling well, it is crucial to follow your doctor's medication plan. For those experiencing frequent episodes or requiring hospitalization, preventive medications like amitriptyline, propranolol, cyproheptadine, and topiramate may be recommended.

Lifestyle changes that may help include:

• Ensuring adequate sleep
• Minimizing excitement about upcoming events for children
• Avoiding trigger foods such as alcohol, caffeine, cheese, and chocolate
• Eating small, low-fat meals and snacks at regular intervals