What is cyclic vomiting syndrome?

Cyclic vomiting syndrome is a condition that causes you to vomit many times in a row for no known reason. You first have a sense that an episode is about to start. This is followed by nausea, and vomiting that can continue for hours to days. This may happen over and over for several days. Then you have no nausea or vomiting for weeks or months before the cycle starts again.

What other signs and symptoms may I have?

• Retching or heaving (vomiting but nothing comes out), or gagging
• Feeling dizzy or tired
• Sensitivity to light or sound
• Abdominal pain, loss of appetite, or diarrhea
• A fever

What causes or increases my risk for cyclic vomiting syndrome?

• Migraine headaches, or your mother had migraines
• An anxiety disorder
• A problem with your digestive system or your nervous system
• A hormone imbalance
• Using large amounts of marijuana

How is cyclic vomiting syndrome diagnosed and treated?

• No test is available to diagnose cyclic vomiting syndrome. Your healthcare provider will examine you and ask about your symptoms. He or she will ask if you have had 3 or more episodes in the past year. Your provider will ask if you or anyone in your family has cyclic vomiting syndrome or migraines. Tests may be used to rule out medical conditions that can cause vomiting. An endoscopy is a test that uses a scope to see your stomach and intestines. CT or MRI scans may be used to check for blockages or other problems. A motility test checks how well food moves through your digestive system.
• Your symptoms may be controlled with medicines. Medicines may be used to prevent or stop migraine headaches. This may be given if you have a history of migraines or are at risk because of a family history of migraines. Medicine may also be used to reduce the amount of acid your stomach makes. You may also be given medicine to reduce nausea.

What can I do to prevent or manage episodes?

• Avoid triggers. Certain foods can trigger episodes, such as chocolate, cheese, and monosodium glutamate (MSG). Caffeine can also trigger an episode. Your healthcare provider or dietitian can help you identify foods that trigger an episode. This will help you create meal plans to avoid those triggers. Other triggers include too much exercise, motion sickness, or being in hot weather too long.
• Drink more liquids as directed. Vomiting can lead to dehydration. It is important to drink more liquids to help replace lost body fluids. Ask your healthcare provider how much liquid to drink each day and which liquids are best for you. Your provider may recommend that you drink an oral rehydration solution (ORS). ORS contains water, salts, and sugar that are needed to replace the lost body fluids. Ask what kind of ORS to use, how much to drink, and where to get it.
• Eat smaller meals, more often. Eat small amounts of food every 2 to 3 hours, even if you are not hungry. Food in your stomach may decrease your nausea.
• Control stress. Stress or anxiety can trigger an episode. Find ways to relax and manage your stress. Get more rest and sleep.
• Do not drink alcohol. Alcohol may upset or irritate your stomach. Too much alcohol can also cause nausea and vomiting.
• Do not use marijuana (cannabis). Repeated use of marijuana over a long period of time (chronic use) can cause episodes. This is called cannabis hyperemesis syndrome. If you have an episode caused by marijuana use, a hot shower may relieve your symptoms. Ask your healthcare provider for information if want to quit using marijuana and need help quitting.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

• amitriptyline
• nortriptyline
• sumatriptan
• zolmitriptan

When should I seek immediate care?

• You see blood in your vomit or your bowel movements.
• You have sudden, severe pain in your chest and upper abdomen after hard vomiting or retching.
• You have swelling in your neck and chest.
• You are dizzy, cold, and thirsty, and your eyes and mouth are dry.
• You are urinating very little or not at all.
• You have muscle weakness, leg cramps, and trouble breathing.
• Your heart is beating much faster than normal.
• You continue to vomit for more than 48 hours.

When should I contact my healthcare provider?

• You have frequent dry heaves (vomiting but nothing comes out).
• You have questions or concerns about your condition or care.

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