Cyclic vomiting syndrome, or cyclical vomiting, is a rare illness that causes episodes of severe nausea and vomiting. In between the episodes, most people are symptom-free. Although the cause of the condition is not yet known, many people have triggers that they can learn to avoid and symptoms they can manage with natural remedies.
What Is Cyclic Vomiting Syndrome?
Cyclic vomiting syndrome (also called CVS) is a condition in which someone periodically has bouts of severe nausea and vomiting. In general, they feel well in between episodes, which can last from a few hours to several days. In addition, individuals tend to have similar episode characteristics each time they experience a bout of nausea/vomiting with cyclic vomiting syndrome. For example, the symptoms may happen at the same time of day or after a similar activity or trigger. Each episode may also last about the same amount of time. Unfortunately, episodes of nausea and vomiting can be debilitating, making it nearly impossible for people with the condition to take part in regular activities until symptoms subside.
Cyclic vomiting syndrome typically begins in childhood. However, adults may develop the condition, and it is becoming more common in adults over time. It may be defined as having three or more episodes in a six-month period with no apparent cause, or having five or more episodes ever. (1) For most people, the problem resolves in a few months to a few years, but some people have the condition for decades.
The condition is rare and can be a challenge to diagnose because nausea and vomiting are common symptoms for many other illnesses. Cyclic vomiting syndrome may be hard to distinguish from abdominal migraines or cannabis hyperemesis syndrome — a condition caused by chronic marijuana use that also results in excessive nausea and vomiting.
Children with cyclic vomiting syndrome often outgrow the condition but are then more likely to develop migraines as adults.
Signs & Symptoms
Signs and symptoms of cyclic vomiting syndrome include: (2)
- Recurrent periods of severe nausea and vomiting, lasting from a few hours to a few days (Attacks tend to last longer in adults than in children.)
- Similar characteristics for each episode (This may include time of day, how long they last, severity, other symptoms that happen at the same time and circumstances that came just before the episode. Many people have the episodes early in the morning.)
- Severe nausea that does not improve after vomiting
- Dry heaving often continues even after the stomach is emptied.
- In children, projectile vomiting and bouts of rapid-fire vomiting can happen. Vomiting may occur several times per hour, or even every few minutes for children.
During an episode, symptoms may also include: (1, 2)
- Excessive sweating
- Compulsively drinking water to try to dilute stomach bile and make vomiting easier
- Pale skin
- Lack of energy, inability to walk around
- Social withdrawal
- Appearing almost unconscious
- Green or yellow color to the vomit
- Severe stomach pain
- Loss of appetite
- Sensitivity to light and sound
- Dizziness or light-headedness
- Dehydration or weight loss
Causes & Risk Factors
There is no known cause for cyclic vomiting syndrome. Some research indicates the problem may be related to a miscommunication disorder between the brain and the gut. However, many people with the condition can pick out a trigger or a set of circumstances that precede the episodes. These triggers may cause an episode of vomiting to start. Common triggers include: (1, 2)
- Excitement or stress, particularly in young children
- Stress, anxiety or panic attacks, particularly in adults
- Certain foods (common dietary triggers include MSG, chocolate, caffeine and cheese)
- Eating right before bed
- Physical exhaustion
- Heavy exercise
- Lack of sleep
- Motion sickness
- Weather changes
- Hot weather
- Allergies or sinus issues
- Colds or infections
Risk factors for cyclic vomiting syndrome include: (2)
- Having migraines
- A family history of migraines
- Anxiety or panic disorders
- Being female (only a slight increase in risk compared to males)
- Being a child between three and seven years old
- Having gastroesophageal reflux
Cyclic vomiting syndrome diagnosis is done through a careful medical history and symptom evaluation. You will have a physical exam. In most cases, doctors have to rule out many conditions that can cause repeated episodes of vomiting. It can take years for some people to find the right diagnosis.
There is no formal test for the condition, but you may be given tests to rule out other health problems. These tests may include blood and urine tests, imaging of the gastrointestinal tract (such as an ultrasound or endoscopy) and motility tests (to check how food moves through your system).
Between episodes, cyclic vomiting syndrome treatment involves trying to prevent new episodes, either through avoiding the trigger or taking medication. It may take several episodes to find out how to stop vomiting episodes for you, or how to relieve your symptoms. Medical options include: (3)
- Drugs to relieve nausea or pain
- Drugs to prevent vomiting (antiemetics)
- Medication to suppress seizures or stomach acid
- Antidepressants (to reduce vomiting)
- Migraine drugs
Once an episode has started, the goal of treatment is symptom relief. If you or your family have a history of migraines, you may be told to take a migraine prescription when an episode starts. If vomiting causes dehydration, you may need to be hospitalized to receive fluid through a vein in the arm (IV fluids). Many people also need pain medicine, sedation and anti-nausea or antiemetic medication during episodes.
5 Natural Remedies for Cyclic Vomiting Syndrome
There is no cure for cyclic vomiting syndrome, but there are many ways you may be able to better manage symptoms. Some of these are natural remedies that can help you avoid episodes and even relieve some symptoms.
Before you change your habits or diet or start taking a new supplement, speak with a healthcare professional. Some options for trying to manage CVS naturally include:
1. Identify and avoid your triggers
This is a key strategy for people with CVS. Unfortunately, to do it effectively you have to know what your triggers are.
- Think about the events that have happened just before your episodes. Do they share anything in common, such as excitement or anxiety, weather, physical fatigue, food, menstruation or illness? If so, you may already have a good idea of your potential triggers.
- If you can’t find anything in common, you may need to start a diary to record preceding events and circumstances the next few times you have an episode. Be very thorough, from the temperature to your meals and activities, emotional state and more.
- Once you know your triggers, avoid them. Some of the strategies below discuss ways to minimize or avoid common triggers, such as emotional stress and physical exhaustion. If your trigger seems to be a certain type of food, cut it out of your diet or cut back on how much you have. If your trigger seems to be an entire food group, talk to a nutritionist to make sure you know how to get a balanced diet even without those types of foods.
- Track when your episodes occur. Once you start avoiding a possible trigger, you should be able to tell if your episodes are less frequent by looking at the length of time between episodes before versus after the change. You may also be able to find other possible triggers once one trigger is removed by finding similarities in circumstances with the future, hopefully rarer, episodes.
2. Fight symptoms during an episode
For most people with CVS, the intensity of symptoms are similar from one episode to the next. However, you may be able to identify things to do during an episode that give you some relief. Options include:
- Try natural relief options for migraines. Migraines and CVS are closely linked. If you benefit from migraine treatment, you may have significantly fewer episodes of CVS. General headache remedies may also bring relief.
- Explore natural nausea remedies. These can include teas, such as ginger or chamomile tea. They may also include aromatherapy or use of essential oils such as peppermint or lemon.
- Reduce your fever symptoms. Many people find that a warm shower or bath helps their nausea. Provided the shower or bath is not too hot, it may also help control fever symptoms and relieve the sensation of feeling constantly sweaty.
- Fight dehydration. Loss of fluids is an obvious side effect of CVS and is the most common reason people with CVS need hospitalization. Drinking water helps relieve the discomfort of vomiting stomach bile for some people. It can also help you stay hydrated. Know the key signs of dehydration and electrolyte imbalance to make sure you’re taking in enough fluid, and when to go for emergency care.
- Minimize diarrhea. Although your entire gastrointestinal tract may seem to be going haywire, you may be able to fight diarrhea by resting, staying hydrated and eating only bland foods during your episodes.
- Ease dizziness. Many people with CVS feel some relief from symptoms overall when they lay down in a dark, quiet place. Closing your eyes may help ease dizziness. Avoid hot places and rehydrate with coconut water or an electrolyte drink. Ask for assistance if you need it to walk or stand so that you don’t fall during your episode.
- Recover from dehydration and fatigue when an episode ends. Drink clear liquids, broths, fruit juices or electrolyte drinks. There is no known cyclic vomiting syndrome diet to help avoid CVS or help during episodes, other than avoiding trigger foods. You can return to a normal, balanced diet as soon as you feel able. (4)
3. Ask about supplements
Some formal research supports the use of co-enzyme Q10 (CoQ10), riboflavin and L-carnitine for people with CVS. The condition is believed to have some link to the mitochondria in the body’s cells. Mitochondria give our cells energy to grow. Co-enzyme Q10 and L-carnitine naturally help cells move energy and clear waste. Early research in people with CVS shows the supplements may be helpful. (2)
- Co-enzyme Q10 may prevent or fight CVS episodes. More than two-thirds of people taking co-enzyme Q10 in a research study had at least a 50 percent reduction in either the number of episodes of CVS, how long the episodes lasted, the number of times they vomited or how severe their nausea was. (5)
- L-carnitine may increase the length of time between episodes. A small study of people with CVS found that long-term supplementation with L-carnitine increased length of time between episodes from an average of 1.7 months to 1.1 years. The average dose taken was 50 milligrams per kilogram of body weight. (6)
- Combining co-enzyme Q10 and L-carnitine may be even more effective. In a study combining these two supplements, nearly every patient with CVS had dramatic reductions in the number of episodes they had, with 23 of 29 cases resolving completely. An additional few people had the number of episodes reduced by 50 to 75 percent. It is important to note, however, that when the two supplements didn’t work well enough on their own for some people, amitriptyline was added (a depression drug that helps reduce vomiting). (7)
- Riboflavin may reduce CVS episodes. Also used as a preventative supplement for people with migraines, a small study in children with CVS found that taking riboflavin effectively helped prevent episodes of CVS. It worked without combining it with any other CVS medications. (8)
4. Minimize emotional stress
Emotional stress, both good and bad, has a strong role in many cases of CVS. Many children with the condition have episodes around exciting events, such as holidays and birthday parties. Adults with CVS often have anxiety-related episodes.
If you have a warning period prior to a CVS episode, start using stress relief techniques immediately to potentially fight the stress response or even a panic attack playing into the episode. You may be able to restore your internal balance and avoid the episode altogether.
Try these strategies for managing stress in the hopes of reducing episodes: (3)
- Downplay events that may excite your child with CVS. Remaining calm and collected as a parent can help your child avoid emotional extremes when something exciting happens.
- Prepare for important events. Returning to school, taking exams and attending stressful or exciting events can trigger CVS episodes. By preparing in advance (for example, talking about what will happen, taking steps to help yourself or your child feel ready and therefore less anxious or overwhelmed), some people experience less stress during the event.
- Try cognitive behavioral therapy or biofeedback. These techniques can help many people adjust their thinking about stressful situations. Biofeedback also helps people identify what is happening in their bodies so they can work to address it. Together, the approaches have been used to manage CVS, even after medications have failed. The two approaches may help improve your sense of self-control and stress management. (9)
- Find your own stress management techniques. Deep breathing, restorative yoga or meditation, spending time with friends and family, reading, listening to calming music and many other techniques may help you keep stress and anxiety in check. You can also try natural anxiety remedies, including aromatherapy and exercise.
5. Get plenty of rest
A common trigger for CVS includes physical exhaustion. Whether it’s lack of sleep or an excessive workout, physical fatigue is no friend of someone with CVS.
- Aim for enough sleep every night. According to the National Sleep Foundation, adults should have at least seven hours every night, teens should have at least eight, school-age children should have at least nine and preschoolers should have at least 10 hours. (10)
- Rest during episodes. A quiet, dark room can help many people relax. Sleep may be the only relief from intense symptoms for people during an episode. In severe cases, going to the hospital for sedation may be the only way to manage symptoms and induce sleep during an episode and should not be avoided. (11)
- Avoid excessive exertion. For example, don’t run a marathon. Less obvious activities that may lead to exhaustion include long days on your feet, activity-packed events such as school physical fitness days or double-header games and traveling. When you are recovering from an illness, surgery, childbirth or other physical or emotional stressors, give yourself extra time to rest before returning to your routine.
If you suspect you or your child has symptoms of cyclic vomiting syndrome, see a healthcare provider. Symptoms of this condition can overlap with many other conditions and a proper diagnosis can be critical to getting the right treatment.
Excessive vomiting can cause serious dehydration, which can be fatal. If someone with cyclic vomiting syndrome feels very weak or cannot keep any liquids down, or if urine is dark, go to the emergency room. Fluids can be given directly into the veins to help keep hydration at a healthy level until the episode passes.
Seek emergency care if your vomit contains blood. You should also seek urgent medical care if you feel you need medication to help with symptoms such as nausea, vomiting, sleep or pain.
Follow your health care provider’s instructions for treating CVS episodes. Cyclic vomiting syndrome treatment guidelines recommend different levels of intervention based on severity of nausea and vomiting. For some patients, your care plan may involve going to the hospital as soon as vomiting starts to avoid dehydration. (12) Do not take herbs, supplements or other drugs without the advice of a healthcare professional. Even natural remedies can interact with medication or cause serious side effects, including nausea, diarrhea and dizziness.
- Cyclic vomiting syndrome, or CVS, is a rare condition that causes occasional episodes of repeated vomiting. The episodes usually share a trigger and other characteristics, such as the time of day they happen or how long they last.
- The true cause of CVS is unknown, but it is believed to be a problem in communication between the gut and the brain. In most cases, episodes are triggered by emotional stress (even excitement) or anxiety.
- The condition is most common in people with migraines or a family history of migraines.
- Symptoms include severe nausea and vomiting lasting hours to several days. People with CVS may be incapacitated during these episodes.
- Conventional medical treatment may include medicines to fight migraines, seizures, depression, nausea and vomiting. In some cases, medication can be taken to try to prevent episodes, but most drugs are given once an episode begins, to try to stop or lessen symptoms.
- Cyclic vomiting syndrome natural treatment options include identifying and avoiding triggers, fighting symptoms during an episode, asking about coenzyme Q10 or L-carnitine, minimizing emotional stress and getting plenty of rest.
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