Cyclical vomiting syndrome (CVS) is a rare disorder that mainly affects children. It causes repeated episodes of vomiting and feeling sick.
CVS has no apparent cause – the vomiting episodes aren't the result of an infection or illness.
It can be frightening, but it's possible to manage CVS with lifestyle changes and medication. It usually clears up before adulthood.
Someone with CVS will feel very sick and may vomit for hours or even days at a time. They'll recover from the episode and feel perfectly well before having another episode perhaps a month or so later.
CVS can last for months, years or even decades. The symptoms can be so severe that some people need to be admitted to hospital for treatment.
An episode of CVS has four distinct phases:
During the prodrome phase, the person will:
The vomiting phase involves nausea, vomiting and retching. The person may:
During the recovery phase:
Recovery can be immediate or gradual.
The well phase is a period where there are no symptoms.
The cycle is usually regular and predictable, with the same symptoms starting at the same time of the day and lasting for the same duration.
The cause of CVS is currently unknown, but there may be a link with migraine. Many people with CVS develop migraines, and migraine medicines have been shown to help treat the syndrome.
Vomiting episodes can sometimes be triggered by:
CVS tends to occur in childhood, with around half of those affected having symptoms before the age of three.
CVS often clears up by adulthood but can sometimes continue into it.
Children who get migraines and are sensitive to light and sound are more likely to develop CVS. Having a family history of migraines also increases your risk.
For children, your GP will ask about your child's symptoms and medical history. CVS may be suspected if all of the following criteria are present:
In adults, CVS may be diagnosed if you've had three or more similar vomiting episodes in the past 12 months, with no nausea or vomiting between episodes, and another condition isn't the cause.
The high frequency of vomiting and the fact episodes tend to start at the same time of day indicate CVS, rather than another condition, may be the cause.
Blood or urine tests may be used to rule out an infection or kidney problems. Scans, such as an endoscopy or abdominal ultrasound, may be carried out to see whether there's an abnormality in the digestive tract.
Long-term use of cannabis can cause symptoms very similar to CVS (known as "cannabinoid-induced hyperemesis").
CVS will only be diagnosed after other conditions or potential causes have been ruled out. By this stage, you may have been referred to a gastroenterologist, a specialist in digestive system disorders.
When a vomiting episode starts, it's a good idea to stay in bed in a quiet, dark room and take any medicines prescribed for this stage of the cycle.
Keep taking small sips of fluid to prevent dehydration. Water, diluted squash, diluted fruit juice or semi-skimmed milk are best.
After the vomiting episode has finished:
A child or adult who's been diagnosed with CVS will usually be under the care of a specialist, such as a gastroenterologist.
A number of medicines can be prescribed to help treat and prevent CVS. For example, you or your child may be prescribed:
It may take a while to find a medicine, or combination of medicines, that works for you.
Hospital treatment may be needed if nausea and vomiting is severe. Medicine and fluids may need to be given intravenously (directly into a vein) to relieve symptoms and prevent dehydration. Nutrition may also need to be given intravenously if vomiting continues for days.
It may be possible to prevent or reduce vomiting episodes by:
Some medicines used to prevent migraines may also help.
Severe vomiting and retching episodes can lead to:
The Cyclical Vomiting Syndrome Association UK can provide further information and support for people with CVS and their families.