By Mayo Clinic Staff
Cyclic vomiting syndrome is characterized by episodes of severe vomiting that have no apparent cause. Episodes can last for hours or days and alternate with relatively symptom-free periods of time. Each episode is similar to previous ones, meaning that episodes tend to start at the same time of day, last the same length of time and occur with the same symptoms and level of intensity.
Once thought to affect only children, cyclic vomiting syndrome occurs in all age groups. Research suggests that cyclic vomiting syndrome may affect almost 2 percent of school-age children and that the number of cases diagnosed in adults is increasing.
Cyclic vomiting syndrome may be related to migraines. Episodes can be so severe that the person has to stay in bed for days.
The syndrome is difficult to diagnose because vomiting is a symptom of many disorders. Treatment generally involves managing symptoms and lifestyle changes to help prevent the events that can trigger vomiting episodes. Medications, including anti-nausea and migraine therapies, may help lessen symptoms.
The symptoms of cyclic vomiting syndrome include:
- Severe vomiting that occurs several times per hour and lasts less than one week
- Three or more separate episodes of vomiting with no apparent cause in the past year
Other symptoms during a vomiting episode may include:
- Abdominal pain
- Sensitivity to light
The intervals between vomiting episodes are generally symptom-free. But some people experience mild to moderate nausea or abdominal or limb pain between episodes.
Continued vomiting may cause severe dehydration that can be life threatening. Symptoms of dehydration include:
- Less urination
- Exhaustion and listlessness
The cause of cyclic vomiting syndrome is unknown. But the bouts of vomiting that characterize the syndrome can be triggered by:
- Colds, allergies or sinus problems
- Emotional stress or excitement, especially in children
- Anxiety or panic attacks, especially in adults
- Foods, such as chocolate or cheese
- Overeating or eating right before going to bed
- Hot weather
- Physical exhaustion
- Motion sickness
Identifying the triggers for vomiting episodes may help with managing cyclic vomiting syndrome.
The relationship between migraines and cyclic vomiting syndrome isn't clear. But many children with cyclic vomiting syndrome have a family history of migraines or have migraines themselves when they get older. In adults, the association between cyclic vomiting syndrome and migraine may be lower.
Chronic use of marijuana (cannabis sativa) also has been associated with cyclic vomiting syndrome.
Cyclic vomiting syndrome can cause these complications:
- Dehydration. Excessive vomiting causes the body to lose water quickly. Severe cases of dehydration may need to be treated in the hospital.
- Injury to the food tube. The stomach acid that comes up with the vomit can damage the tube that connects the mouth and stomach (esophagus). Sometimes the esophagus becomes so irritated it bleeds.
- Tooth decay. The acid in vomit can corrode tooth enamel.
You're likely to start by seeing your primary care doctor or your child's pediatrician. But you may be referred immediately to a digestive diseases specialist (gastroenterologist). If you or your child is in the middle of a severe vomiting episode, the doctor may recommend immediate medical care.
Here's some information to help you get ready for your appointment and know what to expect from the doctor.
What you can do
- Keep a record of any symptoms, including how often vomiting occurs and any typical triggers you may have noticed, such as food or activity.
- Write down key medical information, including other diagnosed conditions.
- Write down key personal information, including dietary habits and any major stresses or recent changes — both positive and negative — in your child's life or yours.
- Bring a list of all medications, as well as any vitamins or supplements, that you or your child takes.
- Write down questions to ask the doctor.
Questions to ask the doctor
Some basic questions to ask the doctor include:
- What is the most likely cause of these symptoms?
- Are any tests needed?
- Do you think this condition is temporary or long lasting?
- What treatments do you recommend?
- Is there a medication that can help?
- Are there any dietary restrictions that can help?
Don't hesitate to ask other questions.
What to expect from the doctor
Be ready to answer questions your doctor may ask:
- When did you or your child begin experiencing symptoms?
- How often does an episode of severe vomiting occur, and how many times do you or does your child typically vomit?
- How long do the episodes typically last?
- Do you or does your child experience abdominal pain?
- Have you noticed any warning signs that an episode is coming, such as loss of appetite or feeling unusually tired, or any common triggers, such as intense emotions, illness or menstruation?
- Have you or has your child been diagnosed with any other medical problems, including mental health conditions?
- What treatments, including over-the-counter medications and home remedies, are you or your child taking for other conditions?
- Does anything seem to improve the symptoms or shorten the duration of an episode?
- Do you or does your child have any history of severe headaches?
- Does anyone in your family have a history of cyclic vomiting syndrome or of migraines?
What you can do in the meantime
The doctor will likely want to see you or your child immediately if an episode of severe vomiting is underway. But if the vomiting has passed, recovery will be aided by getting lots of rest, increasing intake of fluids and following an easy-to-digest diet. It's also a good idea to avoid caffeinated beverages or foods containing caffeine.
Cyclic vomiting syndrome can be difficult to diagnose. There's no specific test that will confirm the diagnosis, and vomiting is a sign of many diseases and disorders that must first be ruled out.
The doctor will start by asking about your child's or your medical history and conducting a physical exam.
After that, the doctor may recommend:
- Imaging studies — such as endoscopy, CT scan or magnetic resonance enterography — to check for blockages in the digestive system or signs of other digestive conditions
- Motility tests to monitor the movement of food through your digestive system and to check for digestive disorders
- Laboratory tests to check for thyroid problems and other metabolic conditions
- MRI to check for a brain tumor and other central nervous system disorders
There's no cure for cyclic vomiting syndrome, so treatment focuses on controlling the signs and symptoms. You or your child may be prescribed:
- Anti-nausea drugs
- Medications that suppress stomach acid
The same types of medications used for migraines can sometimes help stop or even prevent episodes of cyclic vomiting. These medications may be recommended for people whose episodes are frequent and long-lasting.
Research indicates that almost half the people with cyclic vomiting syndrome also have depression or anxiety. But the extent to which depression and anxiety cause cyclic vomiting or result from cyclic vomiting isn't clear. Your child's doctor or yours may recommend behavioral therapy to help with any depression or anxiety.
Lifestyle changes can help control the signs and symptoms of cyclic vomiting syndrome. People with cyclic vomiting syndrome generally need to get adequate sleep. Once vomiting begins, it may help to stay in bed and sleep in a dark, quiet room.
When the vomiting phase has stopped, it's very important to drink water and replace lost electrolytes. Some people may feel well enough to begin eating a normal diet soon after they stop vomiting. But if you don't or your child doesn't feel like eating right away, you might start with clear liquids and then gradually add solid food.
If vomiting episodes are triggered by stress or excitement, try during a symptom-free interval to find ways to reduce stress and stay calm. Eating three small meals and three snacks daily, instead of three large meals, also may help.
Alternative and complementary treatments may help prevent vomiting episodes, although none of these treatments has been well studied. These treatments include:
- Biofeedback training to learn techniques for managing stress, which can trigger vomiting episodes.
- L-carnitine, a natural substance that is made in the body and is available as a supplement. L-carnitine helps your body turn fat into energy.
- Coenzyme Q10 (ubiquinone), another natural substance made in the body that is available as a supplement. Coenzyme Q10 assists with the basic functions of cells.
L-carnitine and coenzyme Q10 may work by helping your body overcome difficulty in converting food into energy (mitochondrial dysfunction). Some researchers believe mitochondrial dysfunction may be a factor causing both cyclic vomiting syndrome and migraine.
Always check with your doctor before taking any supplements to be sure you or your child is taking a safe dose and that the supplement won't adversely interact with any medications you're taking. Some people may experience side effects from L-carnitine and Coenzyme Q10 that are similar to the symptoms of cyclic vomiting syndrome, including nausea, diarrhea and loss of appetite.
Because you never know when the next episode might occur, cyclic vomiting syndrome can be difficult for the whole family. Children may be especially concerned, and may worry constantly that they'll be with other children when an episode happens.
You or your child may benefit from connecting with others who understand what it's like to live with the uncertainty of cyclic vomiting syndrome. Ask your doctor about support groups in your area.
Many people know what triggers their cyclic vomiting episodes. Avoiding those triggers can reduce the frequency of episodes.
If episodes occur more than once a month or require hospitalization, your doctor may recommend preventive medicine. Lifestyle changes also may help, including:
- Getting adequate sleep
- Downplaying the importance of upcoming events because excitement can be a trigger
- Avoiding trigger foods, such as cheese and chocolate
- Eating three small meals and three snacks daily at regular times
April 19, 2013
Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed Feb. 15, 2013.
- Choung RS, et al. Cyclic vomiting syndrome and functional vomiting in adults: association with cannabinoid use in males. Neurogastroenterology & Motility. 2012;24:20.
- Cyclic vomiting syndrome. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/cvs/index.aspx. Accessed Feb. 18, 2013.
- Kumar N, et al. Cyclic vomiting syndrome (CVS): Is there a difference based on onset of symptoms — pediatric versus adult? BMC Gastroenterology. 2012;12:52.
- Drumm BR, et al. Cyclical vomiting syndrome in children: A prospective study. Neurogastroenterology & Motility. 2012;24:922.
- Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/208746819-6/0/1608/0.html. Accessed Feb. 18, 2013.
- Hejazi RA, et al. Review article: Cyclic vomiting syndrome in adults - rediscovering and redefining an old entity. Alimentary Pharmacology & Therapeutics. 2011;34:263.
- AskMayoExpert. When should patients with nausea and vomiting be referred for subspecialty evaluation? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
- Longo DL, et al. Harrison's Principles of Internal Medicine. 18th ed. New York, N.Y.: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=9112783. Accessed Feb. 15, 2013.
- Slutsker B, et al. Breaking the cycle: Cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome. Psychology, Health & Medicine. 2010;15:625.
- Boles RG. High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series. BMC Neurology. 2011;11:102.
- Rakel D. Integrative Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/das/book/body/208746819-2/0/1494/0.html. Accessed March 3, 2013.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. March 4, 2013.