Cyclical Vomiting Syndrome - The Basics

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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.

Comments:

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.

1.6.1.1 Cyclic vomiting syndrome

Description:

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.

Diagnostic criteria:

  1. At least five attacks of intense nausea and vomiting, fulfilling criteria B and C
  2. Stereotypical in the individual patient and recurring with predictable periodicity
  3. All of the following:
    1. nausea and vomiting occur at least four times
      per hour
    2. attacks last 1 hour and up to 10 days
    3. attacks occur 1 week apart
  4. D. Complete freedom from symptoms between attacks
  5. E. Not attributed to another disorder.1

Note:

1 In particular, history and physical examination do not show signs of gastrointestinal disease.

Comments:

1.6.1.1 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:

Alice In Wonderland Syndrome – The Basics

Cervicogenic Headache – The Basics

Chronic Migraine - The Basics

Cluster Headaches - The Basics

Headache Attributable to IIH – The Basics

Hemicrania Continua - The Basics

Hypnic Headaches – The Basics

Ice Pick Headaches - The Basics

Migraine With Aura - the Basics

Migraine with Brainstem Aura – The Basics (formerly called basilar-type migraine)

Migraine Without Aura - the Basics

New Daily Persistent Headache – The Basics

Paroxysmal Hemicrania – The Basics

Post-Traumatic Headache – The Basics

Primary Exertional Headache - The Basics

Retinal Migraine - The Basics

Sporadic and Familial Hemiplegic Migraine – The Basics

Status Migrainosus - The Basics

Tension-Type Headache - The Basics

Thunderclap Headache – The Basics

Vestibular Migraine – The Basics


Resources:

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.

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