Cyclic Nausea and Vomiting Syndrome

The primary symptom is sudden, repeated episodes of nausea and vomiting. Vomiting may occur several times per hour. Episodes tend to last several hours to days and can range from mild to severe in intensity.

Each episode tends to begin at the same time of day and last for the same period of time with the same symptoms and intensity as previous episodes. Episodes tend to begin in the early morning hours.

Other symptoms may include dry heaving, abdominal pain, lethargy, drowsiness, headaches, pale skin, drooling or spitting, extreme thirst, light and sound sensitivity, diarrhea, and fever.

Much like migraines, there may be feeling an episode is coming on, usually with intense sweating and nausea, that can last a few minutes to hours. The nausea is often persistent and intense. This is followed by severe nausea and vomiting, and the patient may be unable to respond to people around them or move and twist or moan in intense abdominal pain. In severe episodes the patient may become dehydrated, dizzy, and faint.

When the vomiting ends the patient will gradually feel better, have improved skin color, appetite, and energy. Episodes are typically followed by alternating disease-free periods. Sometimes cyclic vomiting syndrome transitions to migraine headaches.

If the patient has symptoms of dehydration during the vomiting phase, a parent or loved one should seek medical care for the patient.

The exact cause of cyclic nausea and vomiting syndrome is unknown, but it is believed to be related to a disturbance in the autonomic nervous system. There are more neurons in the gut than in the brain and the disorder may be due to brain-gut dysfunction.

Many patients can identify a trigger that sets off an episode. Common triggers include positive stress, infection, migraines, certain medications and foods, alcohol, physical exhaustion, lack of sleep, motion sickness and changes in the weather.

Cyclic nausea and vomiting syndrome is typically diagnosed by a gastroenterologist after ruling out other potential causes of nausea and vomiting including infections, medication side effects, dietary triggers, or another gastrointestinal condition. The diagnosis is based on the patient’s medical and family history, physical exam, and laboratory testing; and diagnostic tests such as abdominal ultrasound, upper GI contrast study, and exclusion of metabolic and genetic disorders may be needed to rule out other conditions.

Your Brooklyn GI doctor may suspect cyclic nausea and vomiting syndrome
In adults, the patten is three or more episodes in a year and two within the past six month, happening at least one week apart with no nausea or vomiting episodes between and no metabolic, GI, or nervous system disorders, or biochemical disorders; and a personal or family history of migraines.

The goal of treatment is to prevent, shorten and manage episodes. To prevent episodes adults with moderate to severe cyclic nausea and vomiting syndrome may benefit from a tricyclic antidepressant, such as amitriptyline. Anticonvulsant medications or medications may be prescribed to control nausea and vomiting. If the patient as a family history of migraines, anti-migraine medications may be effective. Studies report that certain dietary supplements – Coenzyme Q10 adn L-carnitine can be helpful in preventing vomiting episodes. Treatment for acute attacks include anti-nausea and vomiting medications. In severe cases, hospitalization may be necessary.

Every patient must be treated with a personalized plan including avoiding known triggers, and treatment of underlying psychological disorders.