Cyclic Vomiting Syndrome: Everything You Need to Know

Medically Reviewed By Carissa Stephens, R.N., CCRN, CPN
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Cyclic vomiting syndrome (CVS) is an uncommon condition that causes frequent periods of severe nausea and vomiting. Each episode can last from a few hours to several days. There may be no symptoms between episodes. CVS can affect both adults and children. With CVS, symptoms of nausea may be so severe that you cannot walk, talk, or leave your bed during an episode. Additional symptoms during this time can include dizziness, pale skin, a lack of energy, abdominal pain, and headaches.

Some children with CVS will grow out of the condition. However, for others, it transitions into migraine headaches. The exact cause of the condition is unknown, but there are risk factors that make an individual more likely to experience it than others.

Read on to learn more about the symptoms and risk factors associated with CVS. This article also discusses diagnosis and treatment options.

What is cyclic vomiting syndrome?

A man is comforting a young child
Evgenij Yulkin/Stocksy United

CVS is a gastrointestinal condition that causes recurrent episodes of vomiting and severe nausea. These episodes tend to occur suddenly, and they can last anywhere from a few hours to several days.

Most people with CVS do not experience any symptoms between episodes. In fact, they may go weeks or months without experiencing another episode of severe nausea and vomiting.

Learn more about acute nausea and vomiting here.

Who can experience cyclic vomiting syndrome?

CVS typically develops during early childhood, usually around the ages of 3–7 years. The condition can continue into adolescence, at which point symptoms might disappear.

Some people who experience CVS as a child may experience migraine headaches as an adult. In some cases, the condition may persist into adulthood or even develop later in life.

CVS is an uncommon condition. Around 3 in 100,000 children receive a diagnosis each year.

Is cyclic vomiting syndrome fatal?

CVS is typically not a fatal or life threatening condition. However, it can hinder quality of life, such as by preventing the person from going to work or enjoying special occasions.

Is cyclic vomiting syndrome a psychological condition?

The exact cause of CVS is not known. However, there is a suggestion that it may occur due to a range of physical, infectious, and psychosocial factors.

Causes of CVS can include panic attacks, anxiety disorders, and depression. For this reason, it may be possible to manage the condition with the help of a psychiatrist, who will be able to address the physical and psychological triggers of CVS.

What are the symptoms of cyclic vomiting syndrome?

The main symptoms of CVS are nausea and vomiting. Nausea typically persists following an episode of vomiting.

Other symptoms of CVS include:

  • headaches
  • fever
  • pale skin
  • retching for several hours
  • a lack of energy
  • increased sensitivity to light, sound, and smells
  • symptoms that occur as a result of repeated vomiting, including:
    • dehydration
    • inflammation of the esophagus from harsh stomach acid
    • erosion of tooth enamel

Phases of cyclic vomiting syndrome

There are four main phases of an episode of CVS. The condition typically follows a cycle similar to the following:

  • Prodrome phase: During the prodrome phase, you will be able to feel that an episode of vomiting is going to begin. You may experience intense sweating and nausea for a few minutes to a few hours. You may also look pale.
  • Vomiting phase: During this phase, you may vomit up to five or six times in an hour. You may also experience stomach pain and an inability to talk or move. This phase can last up to 10 days. Other symptoms during this phase include:
    • diarrhea
    • a high temperature
    • dizziness
    • sensitivity to light
    • tiredness
    • drooling
    • excess saliva
  • Recovery phase: Vomiting, nausea, and retching no longer occur during the recovery phase. Associated symptoms also begin to improve. Recovery may take a few hours, or it can take a few days.
  • Well phase: The well phase is the period between episodes, during which there are typically no symptoms of CVS present.

For most people, this cycle of phases is predictable. Symptoms tend to occur at the same time of day or night and last the same length of time with each episode.

What causes cyclic vomiting syndrome?

The exact cause of CVS is unknown. However, some researchers believe that it relates to the nervous system, including the brain and peripheral nerves. They suggest that the symptoms of CVS develop when the neurons in the brain do not properly interact with the neurons in the abdomen.

More research is necessary t

o determine the cause of CVS. Scientists are also considering genetic and hormonal factors.

Learn more about vomiting here.

Is cyclic vomiting syndrome linked to migraine?

There are some cases of CVS that display a link with migraine. Around 80% of children who experience CVS are also prone to migraine headaches or have a family history of migraine.

More research is necessary to determine whether or not CVS is directly linked to migraine.

View our articles on migraine and migraine nausea for more information about links between the symptoms.

What triggers cyclic vomiting syndrome?

Although the cause of CVS is not yet clear, it may be possible to identify certain factors that trigger your episodes.

Some triggers for CVS include:

  • physical stress, including infections or exhaustion
  • emotional stress, such as excitement or anxiety
  • certain foods and drinks, including chocolate, cheese, and anything that contains caffeine, alcohol, or monosodium glutamate
  • certain eating habits, such as fasting, overeating, or eating just before going to bed
  • very cold or very hot weather
  • motion sickness
  • menstruation
  • allergies

For some people who experience episodes of CVS, there may not be any triggers.

Diagnosing cyclic vomiting syndrome

In order to reach a diagnosis of CVS, a doctor will carry out various tests and ask questions about your family and medical history. They may also perform tests to help them rule out other conditions that might be causing your nausea and vomiting.

Physical examinations and tests can include:

  • checking your abdomen for any unusual tenderness, sounds, or pain
  • checking your muscle strength, reflexes, nerves, and balance
  • blood tests, which can rule out or show signs of anemia, dehydration, inflammation, and liver problems
  • urine tests, which can rule out or check for signs of dehydration, infection, and kidney problems
  • upper gastrointestinal endoscopy, which can help determine if problems in your upper digestive tract could be causing your nausea and vomiting
  • imaging tests, such as an MRI scan or an ultrasound of the abdomen
  • a gastric emptying test, wherein you eat a bland meal that contains a small amount of radioactive material, allowing the doctor to see how quickly your stomach empties

Your doctor will also consider various other factors, such as how often episodes occur and how long they last. They may diagnose CVS if:

  • A child experiences at least five episodes over any period of time or at least three episodes over 6 months.
  • Each episode lasts between 1 hour and 10 days, with at least 1 week between them.
  • Each episode occurs at a similar time of day and lasts the same length of time.
  • Vomiting happens at least four times within an hour.
  • There are no symptoms between episodes.
  • There is no other known cause of the symptoms.

How to manage a cyclic vomiting syndrome episode

Following a diagnosis, your doctor will be able to provide you with advice on how to manage CVS the next time you experience an episode. Advice can include:

  • remaining in bed in a dark and quiet room
  • taking any medication you have been prescribed to take during the cycle
  • staying hydrated by taking small sips of water or diluted squash
  • drinking plenty of fluids after an episode of vomiting
  • gradually beginning to eat your typical diet at the end of the episode

Treatment options for cyclic vomiting syndrome

Your doctor may prescribe medications or recommend over-the-counter drugs to help treat CVS. What they suggest will depend on the phase of the cycle you are in.

Examples of medications used to treat CVS can include:

  • ondansetron (Zofran) or promethazine (Phenergan), which can help with nausea
  • lorazepam (Ativan), which can reduce anxiety
  • sumatriptan (Imitrex), which can relieve migraine headaches
  • ibuprofen, which can provide pain relief
  • famotidine (Pepcid), ranitidine (Zantac), omeprazole (Prilosec), or esomeprazole (Nexium), which can reduce stomach acid

If you experience dehydration, you may also need to go to the hospital to receive fluids through an IV drip. This means receiving fluids directly into your body through a vein.

While you are in the recovery phase, your doctor may recommend drinking liquids containing glucose and electrolytes. These can include:

  • fruit juices
  • sports drinks
  • caffeine-free soft drinks
  • broths
  • oral rehydration solutions

Your doctor may also prescribe medications for you to take between episodes to help prevent the onset of another one. These drugs can include:

  • amitriptyline, which can help with pain relief
  • cyproheptadine, which is an antihistamine that relieves allergy symptoms
  • propranolol and topiramate, which can prevent migraine headaches

What are the complications of cyclic vomiting syndrome?

Vomiting and retching during a CVS episode may result in complications. These can include:

  • dehydration
  • esophagitis, wherein the tissues of the esophagus become inflamed
  • Mallory-Weiss tears in the tissue of the lower esophagus
  • tooth decay due to stomach acid exposure

Contact your doctor if you experience any of these complications. They may offer additional treatments as well as an IV drip to help with rehydration.

Learn more about the symptoms and complications of dehydration here.

How to prevent cyclic vomiting syndrome

It may be possible to prevent some of the symptoms associated with CVS. Examples of steps you can take to help reduce vomiting episodes include:

  • avoiding any known triggers
  • making sure you get enough sleep
  • managing stress and anxiety
  • treating any allergies or sinus problems

Some people also eat small, carbohydrate-based snacks between meals, at bedtime, and before exercise to help prevent episodes of vomiting.

Your doctor may prescribe medications to help prevent migraine episodes.

Summary

CVS is an uncommon condition that tends to begin in childhood and last until adolescence. It can sometimes persist into adulthood, or it may turn into migraine.

Each episode tends to follow a pattern, with symptoms of nausea and vomiting appearing at around the same time and lasting the same duration in each cycle. These symptoms can last a few days or a few weeks.

During an episode of CVS, symptoms can be so severe that you may not be able to talk or walk. Between episodes, you may not have any symptoms at all.

It is possible to treat CVS with certain medications. These include drugs to help reduce nausea and prevent the onset of migraine headaches.

Contact your doctor if you experience any symptoms of CVS. They will be able to perform tests to rule out any other possible conditions before providing a diagnosis.

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Medical Reviewer: Carissa Stephens, R.N., CCRN, CPN
Last Review Date: 2022 Mar 9
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