Cyclic Vomiting Syndrome

Reviewed by: HU Medical Review Board | Last reviewed: October 2020

Cyclic vomiting syndrome is a form of a migraine attack that happens most often in school-age children. As the name suggests, the person vomits 4 to 5 times per hour for at least an hour. Each episode may last from 1 hour up to 10 days and occur on a regular schedule. These symptoms disappear between attacks. Dehydration is a serious side effect of these attacks.1

Who gets cyclic vomiting syndrome?

Cyclic vomiting syndrome occurs most often in 5- to 7-year old girls. The attacks typically happen every 2 to 4 weeks and begin in the early morning. The episodes begin and end quickly.2,3

Most children with cyclic vomiting syndrome have a family history of migraine. These attacks usually go away sometime in the teenage years and may be replaced with migraine with aura.2,3

How is it diagnosed?

In addition to forceful vomiting, the child also may have stomach pain, headache, and be sensitive to light and sound. Attacks often happen in a pattern that the family can recognize.3

Your doctor will also need to rule out other health conditions that may cause similar symptoms. Blood work, X-rays, brain MRI, or CT scans may be ordered. Signs that the vomiting is caused by something besides migraine include:2

  • Severe bloating in the stomach area
  • Severe stomach pain or tenderness
  • Intestinal blockage
  • Brain swelling
  • Ongoing weight loss

How is it treated?

More than half of children with cyclic vomiting syndrome get severely dehydrated and need intravenous (IV) fluid replacement in a hospital.2

Preventive migraine drugs may be given to reduce the chances of future episodes. During an attack, treatment may include:2,3

  • Cyproheptadine (children under 5)
  • Amitriptyline (children older than 5)
  • Propranolol
  • Triptans (nasal)
  • Anti-nausea drugs
  • Certain sedatives
  • Painkillers

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