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Cyclic vomiting syndrome

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 relatively symptom-free periods of time. Each episode is similar to previous ones, meaning that episodes tend to start at the same time of day, last the same length of time and occur with the same symptoms and level of intensity.

Once thought to affect only children, cyclic vomiting syndrome occurs in all age groups. Research suggests that cyclic vomiting syndrome may affect almost 2 percent of school-age children and that the number of cases diagnosed in adults is increasing.

Cyclic vomiting syndrome may be related to migraines. Episodes can be so severe that the person has to stay in bed for days.

The syndrome is difficult to diagnose because vomiting is a symptom of many disorders. Treatment generally involves managing symptoms and lifestyle changes to help prevent the events that can trigger vomiting episodes. Medications, including anti-nausea and migraine therapies, may help lessen symptoms.

Symptoms Causes Risk factors Complications Prevention

The symptoms of cyclic vomiting syndrome include:

  • Severe vomiting that occurs several times per hour and lasts less than one week
  • Three or more separate episodes of vomiting with no apparent cause in the past year

Other symptoms during a vomiting episode may include:

  • Abdominal pain
  • Diarrhea
  • Fever
  • Dizziness
  • Sensitivity to light

The intervals between vomiting episodes are generally symptom-free. But some people experience mild to moderate nausea or abdominal or limb pain between episodes.

Continued vomiting may cause severe dehydration that can be life threatening. Symptoms of dehydration include:

  • Thirst
  • Less urination
  • Paleness
  • Exhaustion and listlessness

The cause of cyclic vomiting syndrome is unknown. But the bouts of vomiting that characterize the syndrome can 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 chocolate or cheese
  • Overeating or eating right before going to bed
  • Hot weather
  • Physical exhaustion
  • 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, 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.

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.

If episodes occur more than once a month or require hospitalization, your doctor may recommend preventive medicine. 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 cheese and chocolate
  • Eating three small meals and three snacks daily at regular times
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