Opinion statement
For the last century, empiric therapy has been used to treat the relentless vomiting and resulting dehydration associated with cyclic vomiting syndrome. Despite its unknown pathogenesis, in the last decade, uncontrolled trials of various antimigraine and antiemetic agents have demonstrated rates of efficacy of 40% to 90%. Antimigraine agents are used to prevent or abort episodes, whereas antiemetic agents are used to attenuate symptoms during episodes. A positive family history of migraine headaches renders the patient more likely to respond to antimigraine therapy. In addition to antimigraine therapy, antiemetic ± sedative/anxiolytic, neuroleptic and gastroinestinal prokinetic agents may be useful.
Similar content being viewed by others
References and Recommended Reading
Gee S: On fitful or recurrent vomiting. St. Bart Hosp Rep 1882, 18:1–6.
Diagnostic criteria for cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 1995, 21(suppl):S6–10.
Fleisher DR, Matar M: The cyclic vomiting syndrome: A report of 71 cases and literature review. J Pediatr Gastroenterol Nutr 1993, 17:361–369.
Li BUK, Balint JP: Cyclic vomiting syndrome: Evolution in understanding of a brain-gut disorder. Adv Pediatr 2000, 47:00–00. A comprehensive review.
Abu-Arafeh I, Russell G: Cyclical vomiting syndrome in children: A population based study. J Pediatr Gastroenterol Nutr 1995, 21:454–458.
Li BUK: Proceedings of the International Scientific Symposium on Cyclic Vomiting Syndrome. J Pediatr Gastroenterol Nutr 1993, 21(suppl):S1-S62.
Li BUK, Issenman R, Sarna SK: Proceedings of the 2nd International Symposium on Cyclic Vomiting Syndrome Dig Dis Sci 1999, 44(suppl):1S-120S. Presents the most recent pathophysiologic theories.
Pfau BT, Li BUK, Murray RD, et al.: Differentiating cyclic vomiting from chronic vomiting patterns in children: Quantitative criteria and diagnostic implications. Pediatrics 1996, 97:364–368.
Li BUK, Fleisher DR: Cyclic vomiting syndrome: Clinical features to be explained by a pathophysiologic model. Dig Dis Sci 1999, 44(suppl):13S-18S.
Li BUK, Murray RD, Heitlinger LA, et al.: Heterogeneity of diagnoses in cyclic vomiting. Pediatrics 1998, 102:583–587.
Withers GD, Silburn SR, Forbes DA: Precipitants and aetiology of cyclic vomiting syndrome. Acta Paediatr 1998, 87:272–277.
Li BUK, Murray RD, Heitlinger LA, et al.: Is cyclic vomiting syndrome related to migraine? J Pediatr 1999, 134:567–572. Relates the high therapeutic response to a family history of migraine headaches.
Sato T, Igarashi M, Minami S, et al.: Recurrent attacks of vomiting, hypertension, and psychotic depression: A syndrome of periodic catecholamine and prostaglandin discharge. Acta Endocrinol 1988, 117:189–197. Describes a variant with a hypothalamic surge.
Sato T, Uchigata Y, Uwadana N, et al.: A syndrome of periodic adrenocorticotropin and vasopressin discharge. J Clin Endocrinol Metab 1982, 54:517–522.
Taché Y: Cyclic vomiting syndrome: The corticotropinreleasing-factor hypothesis. Dig Dis Sci 1999, 44(suppl.):79S-86S. Proposes CRF as the key brain-gut mediator.
Boles RG, Williams JC: Mitochondrial disease and cyclic vomiting syndrome. Dig Dis Sci 1999, 44(suppl):103S-107S. Describes mitochondrial disease as a cause.
Rashed H, Abell TL, Familoni BO, et al.: Autonomic function in cyclic vomiting syndrome and classical migraine. Dig Dis Sci 1999, 44(suppl):74S-78S.
To J, Issenman R, Kamath MV: Evaluation of neurocardiac signals in pediatric patients with cyclic vomiting syndrome through power spectral analysis of heart rate variability. J Pediatr 1999, 135:363–366. Characterizes sympathetic hyperreactivity in affected patients.
Theoharides TC: Mast cells and migraines. Perspect Biol Med 1983, 26:672–675.
Fleisher DR: Management of cyclic vomiting syndrome. Proceedings of the International Scientific Symposium on Cyclic Vomiting Syndrome. J Pediatr Gastroenterol Nutr 1995, 21(suppl 1):S52-S56.
Forbes D, Withers G: Prophylactic therapy in cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 1995, 21(suppl 1):S57-S59.
Igarashi M, May WN, Golden GS: Pharmacologic treatment of childhood migraine. J Pediatr 1992, 120:653–657.
US Pharmacopeial Convention. Drug Information for the Health Care Professional 1997.
Li BUK, Sferra TJ: Vomiting. In Pediatric Gastrointestinal Disease, edn 2. Philadelphia; W.B. Saunders, 1999:14–31.
Anderson J, Lockhart J, Sugerman K, et al.: Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriptyline or cyproheptadine. Pediatrics 1997, 100:977–981. The largest study of treatment response in children.
Salmon MA, Walters DD: Pizotifen in the prophylaxis of cyclical vomiting. Lancet 1985, 1:1036–1037.
Symon DNK, Russell G: Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine. Arch Dis Child 1995, 72:48–50. Rigorous therapeutic trial in a related disorder.
Gokhale R, Brady L, Huttenlocher PR, et al.: Use of barbituates in the treatment of cyclic vomiting during childhood. J Pediatr Gastroenterol Nutr 1997:25:64–67.
Vanderhoof JA, Young R, Kaufmann SS: Treatment of cyclic vomiting syndrome in childhood with erythromycin. J Pediatr Gastroenterol Nutr 1993, 17:387–391.
Welch KMA, Darnley D, Simkins RT: The role of estrogen in migraine: A review and hypothesis. Cephalalgia 1984, 4:227–236.
Benson J, Zorn S, Book L: Sumatriptan [Imitrex] in the treatment of cylic vomiting. Ann Pharmacol 1995, 29:997–998.
Huang S, Lavine JE: Efficacy of sumatriptan in aborting attacks of cyclic vomiting syndrome. Gastroenterology 1997, 112:A751.
Pasricha P, Schuster M, Saudek C, et al.: Cyclic vomiting: Association with multiple homeostatic abnormalities and response to ketorlac. Am J Gastroenterol 1996, 91:2228–2232.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Li, B.U.K. Cyclic vomiting syndrome. Curr Treat Options Gastro 3, 395–402 (2000). https://doi.org/10.1007/s11938-000-0054-3
Issue Date:
DOI: https://doi.org/10.1007/s11938-000-0054-3