II. Epidemiology
-
Incidence in chronic unexplained Vomiting
- Adults: 3 to 14% (mean diagnosis age 25 years)
- Children: <2% (mean diagnosis age 5 years)
- Ethnicity
- More common in caucasian patients
- Gender
- Slightly more common in males
- Associated with frequent Emergency Department visits (mean 15 before diagnosis)
- Delayed Diagnosis is common
- Venkatesan (2010) BMC Emerg Med10:4 +PMID: 20181253 [PubMed]
III. Definitions
IV. Pathophysiology
- Unknown cause and multiple hypotheses
-
Cyclic Vomiting Syndrome is highly associated with Migraine Headaches
- Children: Up to 75% will develop Migraine Headaches
- Adults: Up to 36% have Migraines
- Images
V. Symptoms
- Triggers
- Emotional stress
- Sleep deprivation
- Menstruation
- Tyramine-Vasoactive Amines (e.g. Chocolate, cheese, monosodium Glutamate)
- Daily Cannabinoid use (see Cannabinoid Hyperemesis Syndrome)
- Phases
- Prodromal: Aura (variably present, lasts minutes to days)
- Anorexia
- Abdominal Pain
- Lethargy
- Pallor
- Autonomic Symptoms (Sweating, Salivation)
- Acute Vomiting and Hyperemesis
- Episodic intense Nausea and Vomiting
- Children with 9 to 10 episodes per year on average
- Adults with 14 to 15 episodes per year on average
- Vomiting may occur as often as 8 times every hour
- Onset typically in early morning or middle of the day
- Duration 1 to 5 days
- Children average 3 to 4 days
- Adults average 6 days
- Episodic intense Nausea and Vomiting
- Recovery
- Vomiting ceases
- Energy recovers
- Appetite returns
- Inter-episode Remission
- Asymptomatic between episodes
- Prodromal: Aura (variably present, lasts minutes to days)
VI. Associated Conditions
- Migraine Headaches (frequently cited)
- Menstrual periods (catamenial Cyclic Vomiting Syndrome)
- Diabetes Mellitus
- Pregnancy
VII. Differential Diagnosis
- See Vomiting Causes in Children
- See Vomiting in Pregnancy (Morning Sickness)
- See Vomiting in Cancer
- See Psychogenic Vomiting
- See Medication Induced Vomiting
-
Cannabinoid Hyperemesis Syndrome
- See Cannabinoid Hyperemesis
- May be a subset of Cyclic Vomiting Syndrome
- Chronic Nausea Vomiting Syndrome
- Other rare conditions with similar presentations
- Acute Intermittent Porphyria (associated neurologic findings)
- Disorders of Fatty Acid Metabolism
- Medium-chain-acyl-CoA Dehydrogenase Deficiency
- Carnitine palmityltransferase deficiency (deficiency of the mitochondrial translocation)
VIII. Diagnosis: Cyclic Vomiting Syndrome (CVS)
- Episodic, stereotypical Vomiting
- At least 2 acute episodes in past 6 months
- Rome IV only requires 2 episodes for CVS Diagnosis
- International Headache Society requires 5 episodes for CVS diagnosis
- Each episode occurs at least 1 week apart
- Each episode lasts <1 week
- At least 2 acute episodes in past 6 months
-
Vomiting is absent between episodes
- However, more mild symptoms may be present between episodes
IX. Evaluation
- Exclude serious causes of Chronic Vomiting
- See Chronic Vomiting for red flag findings and recommended laboratory testing
X. Management
- See Antiemetic
- See Vomiting Management in Children
- See Vomiting in Pregnancy
- See Postoperative Nausea and Vomiting
- See Vomiting in Cancer
- Trigger Avoidance
- See triggers above (includes Cannabinoids)
- Abortive management
- See Cannabinoid Hyperemesis Syndrome
- Background
- Little evidence for emergency department management for Cyclic Vomiting Syndrome
- Author has had success in the Emergency Department with Dopaminergic Antiemetics
- Recommends slow infusion over 15 minutes in a piggy back bag to prevent Dystonic Reaction
- Authors greatest success (anecdotal) has been with Droperidol or Olanzapine
- Author has had poor success with Ondansetron in the emergency department for CVS
- Emergency Department
- Intravenous Fluids (e.g. D5LR)
- Dopaminergic agents
- Other agents
- Home abortive management
- Prophylactic Medications
- Efficacy
- Effective for chronic remission (or reduction of episodes) in 70% of cases
- Worse prognosis for remission in several sub-groups
- Poorly controlled Migraine Headaches
- Psychiatric Disorders
- Chronic Opioid use
- Cannabinoid Hyperemesis Syndrome
- Prophylactic agents also commonly used in Migraine Headache Prophylaxis
- Supplements with evidence of benefit
- Efficacy
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Related Studies
| Concepts | Disease or Syndrome (T047) |
| MSH | C536228 |
| ICD10 | G43.A |
| SnomedCT | 154923002, 196747007, 268772005, 18773000 |
| English | Cyclical vomiting NOS, CYCLIC VOMITING SYNDROME, CVS, cyclic vomiting syndrome (diagnosis), cyclic vomiting syndrome, Cyclical vomiting syndrome (disorder), Cyclic vomiting syndrome, Familial cyclic vomiting syndrome, cyclical vomiting, cyclical vomiting disorder, periodic vomiting, cyclical vomiting syndrome, vomiting syndrome cyclical, Cyclical vomiting NOS (disorder), Cyclical Vomiting, Periodic Vomiting, Cyclical Vomiting Syndrome, Cyclical vomiting, Cyclical vomiting syndrome, Periodic vomiting, cyclical; vomiting, periodic; vomiting, vomiting; cyclical, vomiting; periodic |
| Italian | Sindrome del vomito ciclico |
| Japanese | 周期性嘔吐症候群, ｼｭｳｷｾｲｵｳﾄｼｮｳｺｳｸﾞﾝ |
| Czech | Syndrom cyklického zvracení |
| Hungarian | Cyclikus hányás syndroma |
| Spanish | vómitos cíclicos, SAI (trastorno), vómitos cíclicos, SAI, síndrome de vómito cíclico (trastorno), síndrome de vómito cíclico, vómito cíclico, vómito periódico, Síndrome del vómito cíclico |
| Dutch | braken; cyclisch, braken; periodiek, cyclisch; braken, periodiek; braken, habitueel braken-syndroom |
| Portuguese | Síndrome de vómitos cíclicos |
| French | Syndrome des vomissements cycliques |
| German | Cyclic vomiting syndrome |
