Cyclic vomiting syndrome (CVS) is characterized by abrupt, repeated, sometimes prolonged, episodes of severe vomiting, which commonly occur during the night or early morning hours and may last for several hours or days. Cycles alternate with symptom-free periods.

Causes

The exact cause of CVS is unknown, but there appears to be a link between CVS and migraine headaches. In children, CVS can be triggered by emotional stress and excitement. Other triggers include infection, certain foods, menstruation and exhaustion.

Symptoms

Each child with CVS will have his or her own typical pattern of vomiting with a consistent time of onset, duration and symptoms. Common symptoms other than vomiting include:

• abdominal pain
• dizziness or nausea
• fever
• diarrhea
• sensitivity to light
• migraine-type headache

Vomiting can cause dehydration, which can be life threatening. It's important to also watch for signs of dehydration such as increased thirst, decreased urination, paleness, exhaustion and listlessness.

Exams and Tests

Your child's pediatric GI specialist will perform a complete physical examination to exclude other medical conditions, but a history of recurrent, stereotypical vomiting episodes are so classic that further evaluation is unnecessary in 90 percent of patients. Children under two years of age may require some lab tests to exclude other disorders. Lab tests also may be ordered for children whose vomiting leads to dehydration and the need for IV fluid therapy.

Treatment

If you know what triggers CVS for your child, simple lifestyle modifications can make a difference. For example:

• Avoid energy-depleting states (prolonged hunger)
• Avoid sleep deprivation
• Avoid triggering foods

Your child's pediatric gastroenterologist may also prescribe medication. Some of the most common medications used to treat CVS are:

• Ondansetron – may be used to abort or reduce the severity of the vomiting episodes.
• Propanalol – an anti-migraine medication that may be prescribed for the treatment of migraine-associated CVS if the episodes occur more than once a month.
• Cyproheptadine – may be effective in young children and is the first choice of medication in children less than five years old.
• Amitriptyline – has a favorable response rate in children over five years of age.
• Patients with abdominal epilepsy may receive anticonvulsant medications such as phenobarbital or phenytoin.
• Leuprolide is prescribed for the treatment of menstrual cycle-related CVS.

Points to Remember

• Cyclic Vomiting Syndrome is characterized by cycles of severe vomiting that alternate with symptom-free periods.
• You may be able to determine triggers for your child and make lifestyle modifications.
• There may be a link between CVS and migraine headache.
• Monitor your child's hydration level carefully, as vomiting can lead to dehydration which can be dangerous.

For More Information

Cyclic Vomiting Syndrome Association - cvsaonline.org

National Digestive Diseases Information Clearinghouse, National Institutes of Health - digestive.niddk.nih.gov/index.htm