Cyclic vomiting syndrome

Cyclic vomiting syndrome can be difficult to diagnose. There's no specific test to confirm the diagnosis, and vomiting is a sign of many conditions that must be ruled out first.

A healthcare professional typically starts by asking about your or your child's medical history and doing a physical exam. A care professional also may want to know about the pattern of symptoms that you or your child experiences.

After that, these tests may be recommended:

• Imaging studies — such as endoscopy, ultrasound or a CT scan — to check for blockages in the digestive system or signs of other digestive conditions.
• Motility tests to watch the movement of food through the digestive system and to check for digestive conditions.
• Laboratory tests to check for thyroid conditions and other metabolic conditions.

There's no cure for cyclic vomiting syndrome, though many children no longer have vomiting episodes by the time they reach adulthood. For those experiencing a cyclic vomiting episode, treatment focuses on managing the symptoms.

You or your child may be prescribed:

• Antinausea medicines.
• Pain-relieving medicines.
• Medicines that suppress stomach acid.
• Antidepressants.
• Antiseizure medicines.

The same types of medicines used for migraines can sometimes help stop or even prevent episodes of cyclic vomiting. These medicines may help people whose episodes are frequent and long lasting, or people with a family history of migraine.

Fluids may need to be given in a vein, also called IV, to prevent dehydration. Your treatment typically depends on how bad symptoms are, how long they have lasted and whether you have any complications related to cyclic vomiting syndrome.

Lifestyle changes can help manage the symptoms of cyclic vomiting syndrome. People with cyclic vomiting syndrome generally need to get enough 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 fluids, such as an oral electrolyte solution (Pedialyte). You also can try a sports drink (Gatorade, Powerade, others) diluted with 1 fluid ounce of water for every fluid ounce of sports drink.

Some people may feel well enough to begin eating a regular 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 well-balanced, nutritious meals between episodes also may help.

Alternative and complementary treatments may help prevent vomiting episodes, although none of these treatments has been well studied. These treatments include:

• Coenzyme Q10, also called ubiquinone, a natural substance made in the body that is available as a supplement. Coenzyme Q10 assists with the basic functions of cells.
• L-carnitine, a natural substance that is made in the body and is available as a supplement. L-carnitine helps the body turn fat into energy.
• Riboflavin, also called vitamin B-2, a vitamin found in certain foods and available as a supplement. Riboflavin plays a role in the body's mitochondrial processes.

Coenzyme Q10, L-carnitine and riboflavin may work by helping your body overcome difficulty in converting food into energy. This difficulty is called mitochondrial dysfunction. Some researchers believe mitochondrial dysfunction may be a factor causing both cyclic vomiting syndrome and migraines.

Be sure to see a healthcare professional to have the diagnosis of cyclic vomiting syndrome confirmed before starting any supplements. And always check with your health professional before taking any supplements. This way, you'll be sure that you or your child is taking a safe dose and that the supplement won't cause other medicines you're taking to work differently. Some people may experience side effects from coenzyme Q10, including diarrhea.

Because you never know when the next episode might occur, cyclic vomiting syndrome can be difficult for your whole family. Children may be especially concerned and they may constantly worry 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 cyclic vomiting syndrome. Ask your healthcare team about support groups in your area or online.

You're likely to start by seeing someone on your primary healthcare team or your child's pediatrician. But you may be referred immediately to a doctor who specializes in digestive diseases, called a gastroenterologist. If you or your child is in the middle of a severe vomiting episode, a health professional may tell you to get immediate medical care.

Here's some information to help you get ready for your appointment and know what to expect.

What you can do

• Keep a record of any symptoms, including how often vomiting happens 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 medicines, vitamins and supplements that you or your child takes.
• Write down questions to ask the healthcare professional.

Questions to ask the doctor

Some basic questions to ask include:

• What's 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 medicine that can help?
• Are there any dietary restrictions that can help?

Don't hesitate to ask other questions that you think of during your appointment.

What to expect from the doctor

You may be asked a few questions, including:

• When did you or your child begin experiencing symptoms?
• How often does an episode of severe vomiting happen, and how many times do you or your child typically vomit?
• How long do the episodes typically last?
• Do you or does your child experience stomach 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 nonprescription medicines and home remedies, are you or your child taking for other conditions?
• Does anything seem to improve the symptoms or shorten how long an episode lasts?
• 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 migraines?
• Do you or does your child use cannabis in any form? If so, how often?

What you can do in the meantime

A healthcare professional will likely want to see you or your child right away if an episode of severe vomiting is underway. But if the vomiting has passed, get plenty of rest, drink extra fluids and follow an easy-to-digest diet. It's also a good idea to avoid caffeinated beverages or foods containing caffeine, as these may trigger symptoms.