Cyclic vomiting syndrome

Cyclic vomiting syndrome is a condition that causes sudden episodes of severe nausea and vomiting. Episodes can last for hours or days and alternate with symptom-free periods that can last for several weeks to months. Episodes are similar, meaning that they tend to start at the same time of day, last the same length of time, and happen with the same symptoms and intensity.

Cyclic vomiting syndrome happens in all age groups, but it often begins in children who are 3 to 7 years old. Although it's more common in children, the number of adults with the condition is increasing.

Cyclic vomiting syndrome has no clear cause. The syndrome is difficult to diagnose because vomiting is a symptom of many conditions. Treatment often involves lifestyle changes to help avoid the triggers of vomiting episodes. Medicines, including antinausea and migraine therapies, may help lessen symptoms.

The symptoms of cyclic vomiting syndrome often begin in the morning. Symptoms include:

• Three or more recurrent episodes of vomiting that start around the same time and last for a similar length of time.
• Varying periods of overall typical health without nausea or vomiting between episodes.
• Intense nausea and sweating before an episode starts.

Other symptoms during a vomiting episode may include:

• Belly pain.
• Diarrhea.
• Dizziness.
• Sensitivity to light.
• Headache.
• Retching or gagging.

Call a healthcare professional if you see blood in your or your child's vomit.

Continued vomiting may cause severe dehydration that can be life-threatening. Call a health professional if you or your child is showing symptoms of dehydration, such as:

• Extreme thirst or dry mouth.
• Less urination.
• Dry skin.
• Sunken eyes or cheeks.
• No tears when crying.
• Exhaustion and listlessness.

The underlying cause of cyclic vomiting syndrome is unknown. Some possible causes include genes, digestive difficulties, nervous system conditions and hormones that are not balanced. Specific bouts of vomiting may be triggered by:

• Colds, allergies or sinus conditions.
• Emotional stress or excitement, especially in children.
• Anxiety or panic attacks, especially in adults.
• Certain foods and drinks, such as alcohol, chocolate, cheese, or foods and drinks that have caffeine.
• Overeating, fasting or eating right before going to bed.
• Not enough sleep.
• Hot or cold temperature extremes.
• Physical exhaustion.
• Exercising too much.
• Menstruation.
• 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, cyclic vomiting syndrome also is associated with a personal or family history of migraines.

Long-term use of marijuana, also called cannabis, has been associated with cyclic vomiting syndrome because some people use marijuana to relieve nausea. However, long-lasting marijuana use can lead to a condition called cannabis hyperemesis syndrome. Cannabis hyperemesis syndrome typically leads to lasting vomiting without regular breaks. People with this syndrome often shower or bathe more often than is typical.

Cannabis hyperemesis syndrome can be confused with cyclic vomiting syndrome. To rule out cannabis hyperemesis syndrome, you need to stop using marijuana for a few months to see if vomiting lessens. If it doesn't, your healthcare professional will likely continue testing for cyclic vomiting syndrome.

Cyclic vomiting syndrome can cause these complications:

• Dehydration. Excessive vomiting causes the body to lose water quickly. Severe dehydration may need to be treated in the hospital.
• Injury to the esophagus. The stomach acid that comes up with vomit can damage the tube that connects the mouth and stomach, called the esophagus. Sometimes the esophagus becomes so irritated that it bleeds.
• Tooth decay. The acid in vomit can break down tooth enamel.

Many people know what triggers their cyclic vomiting episodes. Avoiding those triggers can reduce the frequency of episodes. You may feel well between episodes, but it's very important to take medicines as prescribed by your healthcare professional.

If episodes happen more than once a month or require hospitalization, a health professional may recommend preventive medicine, such as amitriptyline, propranolol, cyproheptadine or topiramate.

Lifestyle changes also may help:

• Get enough sleep.
• For children, downplay the importance of upcoming events because excitement can be a trigger.
• Stay away from trigger foods and drinks, such as alcohol, cheese, chocolate, and foods and drinks that have caffeine.
• Eat small meals and low-fat snacks daily at regular times.