Cyclic vomiting syndrome

Shannon Babineau MD (Dr. Babineau of Goryeb Children's Hospital has no relevant financial relationships to disclose.)
Originally released October 20, 1998; last updated August 1, 2016; expires August 1, 2019
Bernard Maria MD, editor. (Dr. Maria of Icahn School of Medicine at Mount Sinai and Director of Pediatric Neurology and Developmental Medicine at Goryeb Children)
Originally released October 20, 1998; last updated August 1, 2016; expires August 1, 2019

Overview

Cyclic vomiting syndrome is considered 1 of the functional abdominal disorders and migraine variants. It is typified by stereotyped intense bouts of vomiting, at least 4 times per hour, lasting for hours to days followed by stretches of wellness. It has been recognized in children for over 100 years and it is being recognized as a condition that affects adults as well. Its pathophysiology is still not well understood, however, identification of autonomic and mitochondrial dysfunction have helped towards a better understanding.

Key points

 

• Cyclic vomiting syndrome should be considered in any person with stereotyped episodes of vomiting with interspersed wellness.

 

• Early consideration of the diagnosis of cyclic vomiting syndrome can minimize time to diagnosis and use of low-yield testing.

 

• Cyclic vomiting syndrome is a variant of migraine and management is based on typical migraine treatment paradigms.

Historical note and terminology

Cyclic vomiting was first described by Dr. Samuel Gee in 1882. He wrote: “These cases seem to be all of the same kind, their characteristic being fits of vomiting, which recur after intervals of uncertain length. The intervals themselves are free from signs of disease.” His observations were later included into the definition of “the periodic syndrome of childhood” described by Wyllie and Schlesinger in 1933. They described young children with stereotyped episodes of pyrexia, headache, vomiting, and abdominal pain that persisted as migraine in the older child. Eventually “the periodic syndrome” was parsed into benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of childhood, cyclic vomiting syndrome, and abdominal migraine. These conditions are now identified as migraine precursors or variants. The majority of children with these conditions have a family history of migraine or the child him/herself will develop migraine later in life. There seems to be overlap in underlying pathophysiology as well as in potential treatment modalities linking these conditions with each other and with migraine. The first diagnostic criteria for cyclic vomiting syndrome were proposed in 1994 and the most recent criteria were published in 2008 by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Consensus Statement (Li et al 2008). The Rome Foundation Rome III and the International Classification of Headache Disorders version 3 beta also offer criteria.

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