In this blog we are going to look at Cyclical Vomiting Syndrome (CVS), another migraine comorbidity and a rare disorder characterized by recurrent episodes of severe nausea and vomiting. Though it is more common in children, it can occur in people of all ages, with the number of adults being diagnosed on the rise. It is a very difficult condition to identify and is often misdiagnosed because its symptoms so closely mirror those of other illnesses, such as gastroenteritis, and occur periodically rather than continuously.
A CVS episode may last for a few hours to several days and is then followed by a period of symptom-free time. This alternating pattern is what distinguishes CVS from other gastrointestinal disorders. The general diagnosis criteria is:
- at least three episodes of acute vomiting in the past twelve months, with each episode lasting less than one week,
- with two episodes in the last six months, and at least one week between each episode, and
- with no vomiting between episodes (although sometimes there might be nausea)
In addition to intense nausea and vomiting, people with CVS may also experience the following symptoms during an episode:
- Abdominal pain
- Sensitivity to light
- Retching or gagging
The Migraine Link
While the relationship between migraine and CVS isn’t clear, many children with CVS have a family history of migraine or have migraine attacks themselves when they get older. In adults, CVS is also associated with a personal or family history of migraine. 
CVS can resemble abdominal migraine, a disorder primarily seen in children that presents with episodes of abdominal pain, usually without accompanying headache. Both disorders seem to have a strong association with migraine. As many as 80% of children with CVS also have migraine attacks and several epidemiological studies of abdominal migraine have found the rates of both personal and family history of migraine to be well above 50%, and sometimes as high as 90%. 
CVS can be extremely debilitating, both during and after episodes. Severe dehydration can result from intense vomiting and may require hospitalization and IV fluids. Other ways to manage CVS include:
1. Avoiding known triggers—many CVS triggers overlap with migraine triggers. These may include:
- Certain foods and drinks, such as alcohol, chocolate, and cheese
- Physical exhaustion
- Intense exercise
- Motion sickness
2. Making lifestyle changes—many healthy lifestyle habits that can help manage migraine disease can also help with CVS. These include:
- Prioritizing sleep
- Managing stress
- Eating regular, small, well-balanced meals
- Staying hydrated
- Medications—while there is no cure for CVS, some medications may be used to manage and prevent episodes. Some doctors may prescribe medications that reduce the amount of stomach acid such as ranitidine or omeprazole, and other medications include those generally prescribed for:
- Migraine attacks
When a CVS episode subsides, the patient often feels weak and drained. Replenishing fluids is important and may require IV hydration. Pedialyte, Gatorade and other drinks specially formulated to replenish electrolytes can also help, as can homemade electrolyte drinks. As you recover from a CVS episode, it’s important to avoid caffeine which can dehydrate and to reintroduce solid foods slowly.
Tell us! Have you been diagnosed with Cyclical Vomiting Syndrome? How did you go about receiving a diagnosis? What tips can you share for managing a CVS episode?
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