One of our many jobs as parents is caring for our children when they become ill, whether it's with a Migraine or simple sore throat. When cold and flu season is upon us, we are at the ready with tissues, blankets and extra TLC. We can even pull them through the dreaded chicken pox! But from time to time we get sidelined when our child is hit by a condition we've never heard of. Chandra Wilson, who portrays Dr. Bailey on ABC's hit drama, Grey's Anatomy, is one such parent. This past year has been difficult for her and her daughter Sarina, who has been diagnosed with cyclic vomiting syndrome or CVS.
Sarina McFarlane, Wilson's teenage daughter, began to feel sick on a regular basis last year. Each month around same time, she would get extremely nauseous and have spells of extreme vomiting. This would go on for days. Sarina said, "As the days went by I just kept on throwing up, I got dehydrated, wouldn't eat, wouldn't drink." At times, Sarina would vomit up to 40 times a day. Although test after test came back normal, she was still suffering from these horrible monthly cycles. After months of frustration her mother found Dr. Richard Boles, a medical geneticist and researcher on CVS in Los Angeles, who was finally able to put the pieces together.
Cyclic vomiting syndrome can be described as incidents of extreme nausea and vomiting that continue for hours or even days. Each cycle of CVS is so regular that each attack occurs almost exactly as the previous attack did. They start at the same point in the day, last about the same length of time, and have similar duration and strength of symptoms that previous attacks had. These symptoms can be so severe, patients vomit to the point of dehydration and exhaustion.
There are four phases of CVS:
- Symptom-free interval phase - the time between attacks when a patient is symptom free;
- Prodrome phase - this is the "warning sign" that an attack is on its way and can last from a few minutes to a few hours. It typically begins with nausea and may or may not include stomach pain. For some people, taking their medication may help stop an attack, for others they wake up and start vomiting;
- Vomiting Phase - this is when the patient is vomiting in excess, has extreme nausea, cannot eat or drink without vomiting, may be very pale, and feels generally awful;
- Recovery Phase -during this phase the vomiting and nausea has stopped, color returns and patients begin to feel "normal" again.
CVS can be very disruptive, it can wreck havoc on a patient's work, school and family life. so much so it can place a patient in bed for days. However, in between attacks, the patient feels totally normal, healthy and symptom-free. Although CVS was thought to be a childhood illness, it can strike at any age, especially if there is a family history of Migraines. Dr. Samuel Gee first wrote about CVS in London in 1882, but unfortunately it can still take years to get an accurate diagnosis.
Distinguishing the difference between CVS and abdominal Migraine can be confusing at times. CVS has little or less dominant pain than the "pain" of an abdominal Migraine; the attacks can last from about one hour to five days; and according to the ICHD-II, vomiting must occur at least four times during a one hour period for a diagnosis of CVS. Abdominal Migraine pain can be moderate to severe; is often disabling, and lasts up to 72 hours (without successful treatment). The pain of abdominal Migraine typically is around the navel area.
CVS may be triggered by certain foods, infections or a virus, basically all the things that trigger a Migraine attack. Researchers are not clear on what the connection is between Migraine and CVS, but do know that many children with CVS have a family history of Migraine and may develop Migraine as they get older. The treatment for this CVS is to try to identify, manage and avoid triggers, prevent an attack with good lifestyle choices, and when an attack occurs treat it quickly and effectively. Medications that are used to treat CVS include amitriptyline, Inderal (propranolol), and/or Periactin. Some supplements are used as well, such as Coenzyme Q10.
More information, education and research is needed so doctors and patients alike are aware of this condition. Clinical trials are available, and if you'd like more information about those, take a look at ClinicalTrials.gov. With Chandra Wilson as the the national spokesperson for the disorder, the sky may be the limit.
Boles, R.G.; Zaki, E.A.; Lavenbarg, T.; Hejazi, R; Foran, P; Freeborn, J; Trilokekar, S; McCallum, R. "Are pediatric and adult-onset cyclic vomiting syndrome (CVS) biologically different conditions? Relationship of adult-onset CVS with the migraine and pediatric CVS-associated common mtDNA polymorphisms 16519T and 3010A." Neurogastroenterol Motil. 2009; 21(9):936-e72. DOI: 10.1111/j.1365-2982.2009.01305.x.
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International Headache Society. The International Classification of Headache Disorders (ICHD-2). 1.3.1. "Cyclical Vomiting Syndrome."
International Headache Society. The International Classification of Headache Disorders (ICHD-2). 1.3.2. "Abdominal Migraine."
Li, BU; Murray RD; Heitlinger LA; Robbins, JL; Hayes, JR. "Is cyclic vomiting syndrome related to migraine?" J Pediatr. 1999; 134(5):567-72 (ISSN: 0022-3476).
Namita Pareek, M.D.; David R. Fleisher, M.D.; Thomas Abell, M.D. Cyclic Vomiting Syndrome: What a Gastroenterologist Needs to Know." The American Journal of Gastroenterology. 2007;102(12):2832-2840.
National Digestive Diseases Information Clearinghouse. "Cyclic Vomiting Syndrome." NIH Publication No. 09-4548. National Institute of Diabetes and Digestive and Kidney Diseases. December, 2008.
Rodebaugh, Dale. "Migraine in the Stomach." Health. The Durango Herald. February 6, 2011.
Thanks for reading and feel well,
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Last updated April 24, 2011.