When it comes to diagnosing migraine and other headache disorders, that International Headache Society’s International Classification of Headache Disorders, 3rd edition (ICHD-3) is the “gold standard.” Following ICHD-3 allows everyone to “stay on the same page” and lessens confusion.
Within the ICHD-3, there’s a section on “episodic syndromes that may be associated with migraine.” One of these is cyclical vomiting syndrome.
To provide you with relevant and accurate information, here is ICHD-3 information on the episodic syndromes and particularly, cyclical vomiting syndrome:
1.6 Episodic syndromes that may be associated with migraine
Previously used terms:
Childhood periodic syndromes; periodic syndromes of childhood.
This group of disorders occurs in patients who also have 1.1 Migraine without aura or 1.2 Migraine with aura, or who have an increased likelihood to develop either of these disorders. Although historically noted to occur in childhood, they may also occur in adults.
Additional conditions that may also occur in these patients include episodes of motion sickness and periodic sleep disorders including sleep walking, sleep talking, night terrors and bruxism.
18.104.22.168 Cyclic vomiting syndrome
Recurrent episodic attacks of intense nausea and vomiting, usually stereotypical in the individual and with predictable timing of episodes. Attacks may be associated with pallor and lethargy. There is complete resolution of symptoms between attacks.
- At least five attacks of intense nausea and vomiting, fulfilling criteria B and C
- Stereotypical in the individual patient and recurring with predictable periodicity
- All of the following:
- nausea and vomiting occur at least four times
- attacks last 1 hour and up to 10 days
- attacks occur 1 week apart
- D. Complete freedom from symptoms between attacks
- E. Not attributed to another disorder.1
1 In particular, history and physical examination do not show signs of gastrointestinal disease.
22.214.171.124 Cyclic vomiting syndrome is typically a self-limiting episodic condition occurring in childhood, with periods of complete normality between episodes. The cyclic nature is the hallmark, and is predictable.
This disorder was not included as a childhood periodic syndrome in ICHD-I, but it was in ICHD-II. The clinical features of this syndrome resemble those found in association with migraine headaches, and multiple threads of research over the last years have suggested that cyclic vomiting syndrome is a condition related to migraine.
One of the problems with which we’re so often faced is that there are no tests that confirm a diagnosis of migraine or these associated syndromes. If cyclical vomiting syndrome is suspected, it’s important that a medical history review, physical exam, and any testing deemed necessary be performed to rule out any gastrointestinal disease.
More helpful information - our “Basics” series:
Migraine with Brainstem Aura – The Basics (formerly called basilar-type migraine)
Headache Classification Committee of the International Headache Society. “The International Classification of Headache Disorders, 3rd edition (beta version).” Cephalalgia. July 2013 vol. 33 no. 9 629-808. 10.1177/0333102413485658.
Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation’s Patient Partners Award and a Distinguished Service Award from the American Headache Society. Teri can be found on her website, and blog, Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.