Information on the following diseases can be found in the Related Disorders section of this report:

• Migraine Headache

Cyclic Vomiting Syndrome is a rare digestive disorder that usually occurs between the ages of three and seven years. However, infants, as well as teens and adults, have been known to exhibit the symptoms of the disorder. This disorder is characterized by recurrent periods of nausea, extreme fatigue, and vomiting. Affected individuals may also suffer from midline abdominal pain that is often accompanied by pale facial coloration (pallor), headaches, loss of appetite, stomach discomfort, dizziness, motion sickness, and recurrent vomiting. The vomiting may last for several hours or up to 10 days. Depending upon severity, vomiting may reoccur once a year or several times a week. Some affected individuals may also become dehydrated. Vomiting usually starts in the early morning at a peak of four to six times an hour. Generally, there are 15 to 20 episodes over the next 18 to 24 hours. Affected individuals are often well between attacks. The attacks are usually two to four weeks apart. Many affected individuals are aware of being excited or under stress, or having a cold or flu, before the beginning of an attack of cyclic vomiting. However, often the episodes appear for no apparent reason. Affected individuals tend to experience migraine headaches when they attain adulthood.
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The exact cause of cyclic vomiting syndrome is not known. It is assumed by scientists who have studied the syndrome that it is a type of "abdominal migraine". The determination of cyclic vomiting syndrome can only be made after other causes of recurrent vomiting have been ruled out. No underlying disease has been found to cause cyclic vomiting syndrome.

Possible causes of cyclic vomiting syndrome may be autonomic dysfunction (including GI dysmotility, altered CRF, and vasopressin release of the hypothalamic pituitary level), disorders of fatty acid oxidation and mitochondrial metabolism, intermittent intestinal obstruction, and urea cycle defects.
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Cyclic vomiting syndrome usually occurs in children between the ages of three and seven years. The syndrome may be present earlier; however, it is usually not apparent as a syndrome (a group of symptoms that occur together). The disorder can begin after puberty, or even into adulthood, though this is not as common. The number of children affected by this disorder is unknown. Scientists suspect it is an undiagnosed or misdiagnosed disease. Females are affected slightly more than males.
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Migraine headaches can begin in childhood or middle age. However, they often occur for the first time during adolescence. The problem is more common in females than in males and there is frequently a strong family history of migraine headaches. Migraines, like other types of headaches, are increased in frequency by stress. They can be triggered by foods such as chocolate, red wine, or certain cheeses. Attacks, which are characterized by intense pain in the head caused by dilation of blood vessels, can last several hours or even days. The headache may be accompanied by nausea, vomiting, and extreme sensitivity to light.

Diagnosis
The diagnosis of Cyclic Vomiting Syndrome may be suspected based upon a thorough clinical evaluation and a detailed patient history.

Treatment
There is no known treatment to prevent or shorten attacks of cyclic vomiting. A variety of sedatives and anti-nausea medications have been used to treat the syndrome. Fluid replacement may be necessary if the affected individual experiences dehydration. Other treatment is generally symptomatic and supportive.

A multi-center study, under the direction of Dr. Richard Boles is underway at the University of Southern California. Dr. Boles and his colleagues are using a new technique, TTGE, to study possible point mutations in the mitochondrial DNA of 45 individuals with CVS. For more information, contact:

Kathleen Adams
CVSA USA/Canada
13180 Caroline Court
Elm Grove, WI 53122
(262) 784-6842
(262) 821-5494 (fax)

Research on this disorder is being conducted at the following sites:

David R. Fleisher, M.D.
University of Missouri School of Medicine
Division of Pediatric Gastroenterology
One Hospital Drive
Columbia, MO 65212
Tel: (573) 882-2468
Fax: (573) 882-2742

B UK. Li, M.D.
Professor of Pediatrics, Director GI
Northwestern University
Children’s Memorial Hospital
2300 Children’s Plaza, Box #57
Chicago, IL 60614
(773) 880-4916
(773) 880-3007 (fax)

The CVS Center
Pediatric Gastroenterology
Children’s Memorial Hospital
2300 Children’s Plaza, Box #57
Chicago, IL 60614
(773) 880-8773
(773) 880-4036 (fax)
cvscenter@childrensmemorial.org

Robert M. Issenman, M.D.
McMaster University
Chief of Pediatric Gastroenterology
1200 Main St.
West Hamilton, Ontario L8N 3Z5
Canada

Texts
Sleisenger MH, et al. Gastrointestinal Disease. 4th ed. Philadelphia, PA: W. B. Saunders Co; 1989:1703.

Yamada T, et al., eds. Textbook of Gastroenterology. 2nd ed. Philadelphia, PA: J.B. Lippincott Company; 1995:1320.

REVIEW ARTICLES
Li BU. Cyclic vomiting syndrome: age-old syndrome and new insights. Semin Pediatr Neurol. 2001;8:13-21.

Li BU, Balint JP. Cyclic vomiting syndrome: evolution in our understanding of a brain-gut disorder. Adv Pediatr. 2000;47:117-60.

Ladabaum U, Hasler WL. Novel approaches to the treatment of nausea and vomiting. Dig Dis. 1999;17:125-32.

Boles RG, Williams JC. Mitochondrial disease and cyclic vomiting syndrome. Dig Dis Sci.
1999;44 (8 Suppl):103S-107S.

JOURNAL ARTICLES
Zicari A, Corrado G, Pacchiarotti C, et al. Cyclic vomiting syndrome: in vitro nitric oxide and interleukin-6 release by esophageal and gastric mucosa. Dig Dis Sci. 2001;46:831-35.

Prakash C, Staiano A, Rothbaum RJ, et al. Similarities in cyclic vomiting syndrome across age groups. Am J Gastroenterol. 2001;96:684-88.

Li BU. Cyclic Vomiting Syndrome. Curr Treat Options Gastroenterol. 2000;3:395-402.

Prakash C, Clouse RE. Cyclic vomiting syndrome in adults: clinical features and response to tricyclic antidepressants. Am J Gastroenterol. 1999;94:2855-60.

Hasler W. Serotonin receptor physiology: relation to emesis. Dig Dis Sci. 44(8Suppl):108S-113S.