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 symptom-free periods. Episodes are similar, meaning that they tend to start at the same time of day, last the same length of time, and occur with the same symptoms and intensity.
Cyclic vomiting syndrome occurs in all age groups, though it often begins in children around 3 to 7 years old. Although more common in children, the number of cases diagnosed in adults is increasing.
The syndrome is difficult to diagnose because vomiting is a symptom of many disorders. Treatment often involves 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 often begin in the morning. Signs and symptoms include:
- Severe vomiting that occurs several times an hour, continues for hours to days, but lasts less than one week
- Three or more separate episodes of vomiting with no apparent cause in the past six months, or five or more episodes occurring at any time
- Severe nausea
- Intense sweating
Other signs and symptoms during a vomiting episode may include:
- Abdominal pain
- Sensitivity to light
- Retching or gagging
The time between vomiting episodes is usually symptom-free.
When to see a doctor
Call your doctor if you see blood in your or your child's vomit.
Continued vomiting may cause severe dehydration that can be life-threatening. Call your doctor if you or your child is showing symptoms of dehydration, such as:
- Excess thirst
- Less urination
- Dry skin
- Exhaustion and listlessness
The underlying cause of cyclic vomiting syndrome is unknown. Some possible causes include genes, digestive difficulties, nervous system problems and hormone imbalances. Specific bouts of vomiting may 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 caffeine, chocolate or cheese
- Overeating, eating right before going to bed or fasting
- Hot weather
- Physical exhaustion
- Exercising too much
- 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 because some people use marijuana to treat their symptoms.
However, cannabis can lead to a condition called cannabis hyperemesis syndrome, which typically leads to persistent vomiting without normal intervening periods. People with this syndrome often demonstrate frequent showering or bathing behavior.
Cannabis hyperemesis syndrome can be confused with cyclic vomiting syndrome. To rule out cannabis hyperemesis syndrome, you need to stop using marijuana for at least one to two weeks to see if vomiting lessens. If it doesn't, your doctor will continue testing for 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.
Many people know what triggers their cyclic vomiting episodes. Avoiding those triggers can reduce the frequency of episodes. While you may feel well between episodes, it's very important to take medications as prescribed by your doctor.
If episodes occur more than once a month or require hospitalization, your doctor may recommend preventive medicine, such as amitriptyline, propranolol (Inderal), cyproheptadine and topiramate. 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 caffeine, cheese and chocolate
- Eating small meals and small carbohydrate-containing snacks daily at regular times