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Cyclic Vomiting Syndrome

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About Cyclic Vomiting Syndrome

What Cyclic Vomiting Syndrome?

Cyclic vomiting syndrome (CVS) is a rare disorder characterised by recurrent episodes of severe vomiting that occur with predictable cycles or patterns. It primarily affects children but can progress into adulthood. The exact cause of CVS is not well understood, but it is believed to involve dysregulation of the brain-gut axis, leading to abnormal functioning of the digestive system.

Cyclic Vomiting Syndrome Diagnosis

How Do We Diagnose Cyclic Vomiting Syndrome?

The International Classification of Headache Disorders (ICHD) provides diagnostic criteria for cyclic vomiting syndrome, which include recurrent, severe episodes of vomiting lasting hours to days, with symptom-free intervals between episodes. Blood tests may be performed to evaluate electrolyte levels, liver function, and rule out other conditions that may cause similar symptoms.

It is important to exclude other potential causes of vomiting and establish a pattern of recurrent episodes for a diagnosis of cyclic vomiting syndrome.

Cyclic Vomiting Syndrome Symptoms

There are typically symptom-free intervals between episodes, during which the individual feels well.

Intense Nausea

Recurrent episodes of severe vomiting

Abdominal pain

Increased Sensitivity

Sensitivity to triggers such as stress, certain foods or fasting

Fatigue

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Treating Cyclic Vomiting Syndrome With The Watson Headache® Approach

Cyclic Vomiting Syndrome Treatment

 

Treatment for cyclic vomiting syndrome is similar to the approach for abdominal migraine. Identifying triggers and implementing lifestyle changes can help manage this condition, similar to ‘standard migraine’.

The underlying driver of migraine (brainstem sensitivity) is the same for all migraine presentations, so abdominal migraine will respond to similar interventions such as dietary changes, sleep improvements, exercise, and upper neck treatment. The upper neck has direct connections with the control centre for nausea and vomiting which sits in the brainstem. This is why treatment of the upper neck can be effective in changing abdominal migraine symptoms.

Recent research has identified that a key area in the brainstem, named the Solitary nucleus, controls nausea. CVS patients have an increased activation of the solitary nucleus which generates the sensation of nausea. Understanding the relationship between the upper neck and the brainstem’s Solitary Nucleus has enabled treatment options for patients other than medication. Children as young as 3 years old can tolerate treatment without side effects and with potential for rapid and sustained relief.

Other treatment of cyclic vomiting syndrome aims to alleviate symptoms, prevent or reduce the frequency of vomiting episodes, and improve overall quality of life. Treatment options may include medications for acute episodes such as ondansetron or promethazine. These can be prescribed to help manage nausea and vomiting during acute episodes. Preventive medications, such as tricyclic antidepressants, antiepileptic drugs, or serotonin receptor antagonists, may be prescribed to reduce the frequency and severity of vomiting episodes.

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