What is cyclic vomiting syndrome?

Updated: Oct 16, 2019
  • Author: Rima M Dafer, MD, MPH, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Cyclic vomiting of childhood is characterized by recurrent attacks of violent or prolonged vomiting without headache, which may last for hours. [46, 47, 48] Cyclic vomiting syndrome should especially be suspected in this setting when there is an associated family history of migraine.

Attacks may be precipitated by infection, menstruation, or physical or emotional stress. During the attacks, patients characteristically show other symptoms of migraine, such as nausea, lethargy, yawning, and drowsiness. Children with cyclic vomiting may show subtle clumsiness, attention deficit, or development delay.

Cyclic vomiting is thought to result from abnormal activity in the area postrema. Additionally, gastroparesis, which occurs during migraine, has been implicated as an etiologic factor for cyclic vomiting and abdominal migraine. [49, 50, 51]

A serum lactate level is helpful in these children to exclude mitochondrial disorders. Other tests are rarely indicated, including upper and lower gastrointestinal (GI) series and vagal autonomic function testing.

Early use of intravenous (IV) fluids containing adequate glucose (to prevent a catabolic state) and analgesics may abort the attack. Some patients respond to the triptans or ergotamine classes of medication. Antiemetic drugs are usually not effective, but ondansetron may be more efficacious as a result of its central mechanism of action. Preventive medications, such as cyproheptadine and tricyclic antidepressants (TCAs), are preferred in children.


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