Updated: 9/22/23
Cyclic Vomiting Syndrome is a rare but complex disorder characterized by recurrent episodes of severe vomiting, nausea, and exhaustion. For the majority of patients, these episodes can last for several hours or days, which makes it difficult to carry out daily activities. While the primary cause of CVS is still unknown, it is believed that genetic and environmental factors play a significant role in its development. In this blog post, we will dive into the symptoms that CVS presents, its possible risk factors, and the latest treatment options available.
What is Cyclic Vomiting Syndrome?
Cyclic vomiting syndrome (CVS) is a highly debilitating disorder that mainly occurs in young children. Patients with this syndrome experience consistent, constant and recurrent episodes of nausea, vomiting and physical exhaustion. The episodes may extend from about an hour to as long as 10 days. Affected individuals may vomit several times within a single hour. This results in a case of rapid dehydration. The symptoms—nausea, vomiting and lethargy—may occur either randomly or regularly based on a number of factors that may trigger the episodes. One common trigger is stress. Fasting, food allergies, menstruation, consuming certain foods or a lack of sleep may also trigger the condition.
Physicians also consider CVS a migraine variant. Migraines are severe headaches often accompanied by vomiting, pain, nausea and extreme sensitivity to light and sound. Similarly, the symptoms of cyclic vomiting syndrome are nearly identical to those of abdominal migraine, which is mainly characterized by severe cramping and bouts of intense stomach pain. Statistics suggest that a high percentage of patients with CVS or abdominal migraines have a family history of migraines.
Cyclic Vomiting Syndrome Symptoms
The symptoms of cyclic vomiting syndrome often begin very early in the morning or as the patient wakes up. In children, episodes may last for several hours or even several days. Specifically, they may projectile vomit, every five to 15 minutes. The condition is less common in adults, but the episodes usually last for days rather than hours. These episodes usually run like clockwork, depending on the individual. They often begin at the same time of the day and occur with the same intensity and symptoms. Certain cases may be more frequent than others.
Vomiting
CVS is characterized by sudden and recurrent episodes of vomiting, which can last for a few hours to several days. These episodes can happen without any warning, and you may feel nauseous, sweaty, and tired during that time. The vomiting can be severe, and it may lead to dehydration, electrolyte imbalances, and malnutrition if left untreated. Thus, it is not uncommon for CVS patients to end up in emergency rooms due to severe vomiting and dehydration.
There are several reasons that a patient may vomit. It may be a result of an underlying ailment or it may be circumstantial, a one-time occurrence. However, the type of vomiting that occurs in CVS is incomparable because the patient vomits constantly and uncontrollably. Patients usually vomit until the stomach ejects all of its food content. After the stomach is empty, they may continue to gag or dry heave. In addition to the vomiting, the patient may also experience diarrhea.
Nausea
Nausea is a feeling of discomfort in the stomach that often precedes vomiting. Patients with CVS experience frequent and intense episodes of nausea that may last for several hours. The nausea may be triggered by certain foods or smells, and can be difficult to manage. Anti-nausea medications may help relieve symptoms, but they do not cure CVS.
Patients with CVS describe very intense, persistent nausea. In most cases, nausea serve as a precursor or a warning that a patient may vomit. It may also be a symptom of an underlying condition. The feeling usually disappears after they get sick. However, this is not the case with CVS. The patient usually continues to feel nauseous even after they vomit. There may be several different triggers, such as smelling something unpleasant.
Lethargy
CVS can make the patient feel excessive fatigue and sluggishness. It may cause a decrease in alertness and mental capacity. Cyclic vomiting syndrome causes extreme physical and mental stress. Fatigue is a common side effect of CVS. Patients may feel weak and tired after an episode of vomiting, making it difficult to engage in daily activities. The fatigue can last for several hours or days, depending on the severity of the vomiting. It is important for patients to rest and stay hydrated during these episodes to help manage their symptoms.
Other Symptoms
Another common symptom of CVS is intense abdominal pain. Patients may also have pale skin as a result of cyclic vomiting syndrome. The constant vomiting eliminates stomach contents and fluids and may induce sweating, both of which can cause dehydration. The patient may experience weight loss and a loss of appetite. The condition can also cause migraine-like neurological symptoms such as well as dizziness or vertigo. Some patients with CVS experience sensitivity to light and noise during an episode of vomiting. The symptoms may be triggered by sensory overload, stress, or anxiety. Patients may find relief by avoiding bright lights or loud noises during an episode. The patient may also experience weak muscles.
What Triggers Cyclic Vomiting Syndrome?
Although the precise cause of CVS remains unknown, there are several triggers that may lead to an episode.
Food and Dietary Triggers
Certain foods are known to trigger CVS. These may include foods that are high in fat or dairy, caffeine, or foods with a high sugar content. Additionally, certain food dyes and other additives can trigger an episode, particularly in children. Identifying your personal food triggers and working to avoid them can be an effective way to prevent an episode.
Physical exertion
For some people with CVS, physical exertion can trigger an episode. This may include activities such as sports, exercise, and even sexual activity. It is important to listen to your body and avoid activities that may trigger an episode. Developing an exercise regimen that is gentle and mindful, such as yoga or walking, may help prevent episodes.
Sleep disturbances
Insufficient sleep or disrupted sleep patterns can also be a trigger for CVS. Many people with CVS report that episodes are more likely to occur when they are sleep-deprived or have changes in their sleep schedule. Sleep hygiene, such as setting a regular bedtime and avoiding stimulating activities before sleep, can be helpful in managing CVS.
Cyclic Vomiting Syndrome in Adults
Diagnosing CVS in adults can be challenging since the symptom patterns can mimic other gastrointestinal conditions like migraines, cyclic gastroenteritis, and inflammatory bowel disease. To successfully diagnose CVS, your doctor may require a detailed medical history and a physical exam. They may also recommend blood tests, stool samples, imaging scans, and gastrointestinal studies to rule out other potential causes
What Causes Cyclic Vomiting Syndrome?
Physicians have not identified a specific cause for CVS. However, there are several risk factors that may increase the risk. Even though vomiting and nausea are gastrointestinal symptoms, physicians believe the condition stems from the brain. Research suggests that abnormalities in the brain can interfere with its connection to the digestive system.
Stress
Another common risk factor associated with CVS is stress. Individuals experiencing high levels of stress have been found to be at a higher risk of developing CVS. When the body experiences stress, the digestive system’s functioning is affected, leading to a CVS episode. Therefore, managing stress is crucial in reducing the likelihood of developing CVS.
The body expresses different reactions to stress. An extremely overactive reaction may trigger episodes of CVS. The body may release large amounts of a hormone called corticotropin-releasing factor (CRF) from the hypothalamus, stimulating the adrenal cortex. The adrenal cortex is the outer part of the adrenal glands that controls how the body responds to stress. Statistics show that patients who experience cyclic vomiting syndrome have very high-stress levels that may trigger the symptoms.
Anxiety and Depression
Depression, anxiety, and panic disorders are often associated with cyclic vomiting syndrome, and stressful events such as work pressure, relationship problems, and school can increase the risk of CVS episodes. It’s important for individuals to be proactive in dealing with stress and determine ways to manage and reduce its impact. Patients with CVS often also suffer from other related psychological comorbidities, such as anxiety and depression. This also relates to how the patient processes stress and the stress hormone activity in the body.
Family History
One major risk factor for CVS is having a family history of the condition. If a person has a parent or sibling who has suffered from CVS, they are more likely to develop this disorder themselves. Researchers believe that genetics play a role in the development of CVS, but they are yet to determine the specific genes involved. Since CVS can affect any age group, an individual with a family history of CVS should be mindful of potential symptoms and take preventative measures to reduce their risk. If a family member has been diagnosed with CVS, it is important to consult with clinicians and seek advice on preventative actions.
Migraine
Approximately 80% of patients with CVS also have a history of migraines, suggesting a close link between these two conditions. Researchers have not been able to establish a clear relationship between CVS and migraines, but some experts suggest that the same underlying biological factors cause both conditions.
Some physicians consider cyclic vomiting syndrome as a migraine variant because according to research, there is a strong connection between the two. A considerable amount of patients with CVS also have migraines or the condition may run in the family. A migraine is a severe headache that causes nausea or vomiting. Physicians call CVS an abdominal migraine because both conditions cause severe, recurring attacks. If a patient has CVS as a child, the symptoms usually subside as they get older, but they may start to experience migraines instead if they do not experience them already.
Other Risk Factors
Autonomic disturbances may surface between episodes, including fainting or reflex sympathetic dystrophy, a chronic pain condition. More frequently, the patient experiences other gastrointestinal symptoms, including gastroesophageal reflux (GERD), irritable bowels, constipation or delayed gastric emptying that causes bloating.
Research also connects CVS to autistic spectrum disorders, attention deficit hyperactivity disorder (ADHD) and seizures. If a patient has CVS along with these developmental conditions, researchers refer to it as cyclic vomiting syndrome plus.
Cyclic Vomiting Syndrome and Autism
Cyclic Vomiting Syndrome (CVS) and Autism Spectrum Disorder (ASD), both complex conditions on their own, have a link that is not widely known. Studies have shown that children with ASD have a higher incidence of CVS, a condition that causes severe vomiting, nausea, and abdominal pain. Although the exact reason why they are linked is still unclear, understanding the relationship between the two is crucial for effective management and treatment.
Cyclic Vomiting Syndrome Treatment
Treating cyclic vomiting syndrome mainly aims to treat the symptoms that accompany it because of how severe the condition can be. To diagnose the condition, the physician assesses the patient’s history and performs a blood and urine test, as well as an X-ray to rule out other conditions that may trigger cyclic vomiting. Then the physician will come up with a plan to help the patient manage the condition.
Medical Treatment
Cyclic vomiting syndrome has no definite cure. But physicians aim to help manage the unpleasant symptoms. Doctors might prescribe medications for a number of drugs including anti-nausea drugs, pain relieving medications or anti-migraine pills if the patient has a history of migraines. Patients may stop or prevent CVS episodes with drugs that aim to treat migraines.
Also, researchers are studying whether anti-seizure and anti-vomiting medications may help. A doctor may administer fluids through an IV to rehydrate the patient. Treatment depends on the individual and not every treatment will successfully reduce every patient’s symptoms. It may take time to find the right treatment method.
Antiemetic Medications
The first line of treatment for CVS is usually antiemetic medications. These drugs work to control nausea and vomiting to prevent episodes from occurring or to lessen their severity. Some commonly prescribed antiemetic medications include ondansetron, promethazine, and prochlorperazine.
While beneficial in controlling the symptoms of CVS, these medications can have side effects such as dry mouth, drowsiness, and dizziness. Therefore, it is important to work closely with your doctor to find the best antiemetic medication and dosage that works for you.
Tricyclic Antidepressants
Tricyclic antidepressants such as amitriptyline and nortriptyline have also been successful in the treatment of CVS. These medications work to regulate the levels of serotonin in the brain, which can help prevent episodes from occurring.
Like antiemetic medications, tricyclic antidepressants can have side effects such as dry mouth, drowsiness, and weight gain. Your doctor will work with you to monitor your dosage and ensure that you are getting the benefits of these medications without experiencing undesirable side effects.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that has been successful in the treatment of CVS. This type of therapy focuses on identifying and changing negative thought patterns that may contribute to CVS symptoms.
CBT can be helpful in reducing stress and anxiety, which can be contributing factors to CVS symptoms. This form of therapy has been successful in helping patients reduce the frequency and severity of their episodes.
Diet
Although it will not cure the condition, making different lifestyle changes may help manage symptoms and recover after a cyclical vomiting episode. Sometimes the condition results from food allergies, so identifying certain foods that trigger it can help prevent recurring nausea and vomiting.
When a patient experiences a CVS episode, it’s important to rehydrate and redistribute nutrients throughout the body. Do not skip meals between episodes. After an episode, it is a good idea to consume clear liquids and gradually return to a normal, well-balanced diet. Choose drinks with glucose and electrolytes to rehydrate, including fruit juices, sports drinks or broths. To prevent a recurrence, avoid foods that have triggered past episodes. Some patients react to chocolate, cheese, alcohol or foods with monosodium glutamate.
Proper nutrition is important in managing CVS. In some cases, patients may need to take nutritional supplements or receive IV fluids to manage dehydration caused by vomiting. Some studies have found that a ketogenic diet – which is low in carbohydrates and high in healthy fats – has been successful in reducing symptoms in some CVS patients.
Cyclic Vomiting Syndrome Supplements
Riboflavin (Vitamin B2)
Riboflavin has been shown to help alleviate migraines, which is a common trigger for CVS. While the exact mechanism behind its anti-migraine effects is unknown, studies have demonstrated that high doses of riboflavin can reduce the frequency and severity of headaches. Taking 400mg of riboflavin daily can be an effective way to reduce the symptoms of CVS, including nausea and vomiting. As always, consult your doctor before taking any supplements.
Vitamin B6
Several studies have shown that vitamin B6 (pyridoxine) helps decrease the frequency and severity of cyclic vomiting episodes. You can find vitamin B6 in dark leafy greens, legumes, nuts, salmon, chicken, and turkey. Alternatively, you may find vitamin B6 supplements helpful. It’s also important to note that over supplementing with vitamin B6 can be toxic, so following instructions carefully is necessary.
Coenzyme Q10 (COQ10)
Also called ubiquinone, Coenzyme Q10 is an antioxidant that helps make sure that the body’s cells function properly. It also helps to eliminate free radicals and regulate metabolic processes in the body. It may be an effective supplement for CVS because it also helps manage migraines. According to research, subjects experienced a decrease in migraines with 100 mg of COQ10 three times a day for three months. Even though the body produces it naturally, supplements may be a good way to get a consistent dosage. As a supplement, take 50 to 200 mg of Coenzyme Q10 powder once a day. Discuss dosages with a physician before starting or changing a supplement regimen.
Ginger
Ginger has long been used as a natural remedy for nausea, making it an ideal supplement for those with CVS. It works by blocking certain receptors in the digestive system that can trigger feelings of nausea and vomiting. Ginger extract supplements or whole ginger root can be consumed in various forms, such as tea, capsules, or tinctures. Experts recommend taking at least 1g of ginger per day to help manage CVS symptoms.
L-Carnitine
The body produces L-carnitine naturally as well. It helps the body convert fat into energy, which patients suffering from CVS may require. Studies claim that it is an effective management tool for CVS to prevent vomiting episodes, especially in combination with COQ10. Supplements can help patients control their dietary intake. For supplemental use, take Acetyl L-carnitine in 600 mg doses up to three times a day.
Magnesium
Magnesium is a vital mineral that plays a crucial role in a wide range of bodily functions, including nerve and muscle function, heart health, and energy production. Low levels of magnesium have been linked to an increased risk of migraines, which can trigger CVS episodes. In addition to increasing your intake of magnesium-rich foods, such as leafy greens and nuts, taking a magnesium supplement can also be beneficial. Experts recommend taking a daily dose of 400-500mg of magnesium to support overall health and manage CVS symptoms.
CBD Oil
CBD oil is derived from the cannabis plant and has gained immense popularity in recent years due to its numerous health benefits. It’s thought to alleviate a range of conditions, including anxiety, depression, and chronic pain, all of which can trigger CVS episodes. CBD oil works by binding to receptors in the endocannabinoid system. It’s responsible for regulating pain, mood, and inflammation. Taking a daily dose of 10-20mg of CBD oil can help mitigate CVS symptoms and boost overall health. Consult with your physician first before starting a regimen.
The Bottom Line
Cyclic vomiting syndrome is an exhausting condition that causes constant, recurring episodes of vomiting, nausea, intense stomach pain and extreme fatigue. It is most common in children, but adults may experience the condition as well with longer episodes. Researchers believe that the condition is the result of an interference between brain and digestive system communication. There is no specific cause, but there are a variety of risk factors, such as stress, anxiety and depression. Researchers also associate it with developmental or learning disorders, such as ADHD or autistic spectrum disorders.
There are also dietary changes a patient can make to help manage or prevent the symptoms, including identifying food allergies and consuming electrolytes to rehydrate after a vomiting episode. Supplements like Coenzyme Q10, L-carnitine and riboflavin (Vitamin B2) may also help those suffering from CVS, but they are not a proper medical treatment. Always consult a doctor to discuss how bulk supplements may benefit your health before you start a regimen.
In conclusion, Cyclic Vomiting Syndrome is a complex disorder that affects individuals of all ages. Although it is a rare disorder, it can significantly impact the life of those affected and those around them. Recognizing the symptoms early and getting necessary medical attention can minimize the severity and duration of episodes. Remember that there is no one-size-fits-all treatment option for CVS. Working closely with a medical professional is crucial to managing symptoms effectively.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.