Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Pain and Headache Reports
Published in: Current Pain and Headache Reports 4/2018

01-04-2018 | Childhood and Adolescent Headache (S Evers, Section Editor)

Cyclic Vomiting Syndrome in Children

Authors: Anne Donnet, Sylvain Redon

Published in: Current Pain and Headache Reports | Issue 4/2018

Login to get access

Abstract

Purpose of Review

Cyclic vomiting syndrome (CVS) is a misrecognized and probably underdiagnosed episodic syndrome associated with migraine, occurring preferentially in childhood. Attacks are stereotyped for each individual, with predictable periodicity. This review summarizes recent clinical and paraclinical observations in this syndrome, and current approaches in explorations and therapeutics.

Recent Findings

Clinical phenotype during prodromal, vomiting, and recovery phases contains visceral and neuropsychological symptoms, but also cranial and systemic symptoms. Some clinical arguments as circadian or circannual periodicity suggest a chronobiological disease. Red flags in clinical presentation are proposed to distinguish other etiologies of recurrent gastrointestinal disturbances and guide paraclinical explorations. Functional magnetic resonance imaging in both CVS and migraine displayed diminished insular connectivity with the sensorimotor network, suggesting a common pathophysiology.

Summary

Pathophysiology of CVS is not well defined, and there is probably a multifactorial origin. Distinction with other differential diagnoses is a challenge for clinicians. Further research, in particular with functional imaging, are required to define pathophysiology of CVS. Control trials are missing in pediatric population. Injectable or intranasal sumatriptan are often effective. For prophylaxis, amitriptyline, cyproheptadine, or propranolol are the most common treatments, depending on age and comorbidities. Non-pharmacologic measures as lifestyle modification also seem to be effective as preventive treatment.
Literature
1.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.CrossRef
2.
Li BU, Misiewicz L. Cyclic vomiting syndrome: a brain-gut disorder. Gastroenterol Clin N Am. 2003;32(3):997–1019.CrossRef
3.
Abu-Arafeh I, Russel G. Cyclical vomiting syndrome in children: a population based study. J Pediatr Gastroenterol Nutr. 1995;21:454–8.CrossRefPubMed
4.
Chogle A, Velasco-Benitez CA, Koppen IJ, Moreno JE, Ramírez Hernández CR, Saps M. A population-based study on the epidemiology of functional gastrointestinal disorders in young children. J Pediatr. 2016;179:139–43.CrossRefPubMed
5.
Abell TL, Adams KA, Boles RG, et al. Cyclic vomiting syndrome in adults. Neurogastroenterol Motil. 2008;20:269–84.CrossRefPubMed
6.
Evans RW, Whyte C. Cyclic vomiting syndrome and abdominal migraine in adults and children. Headache. 2013;53(6):984–93.CrossRefPubMed
7.
8.
Li BU, Murray RD, Heitlinger LA, Robbins JL, Hayes JR. Heterogeneity of diagnoses presenting as cyclic vomiting. Pediatrics. 1998;102(3 Pt 1):583–7.CrossRefPubMed
9.
Lagman-Bartolome AM, Lay C. Pediatric migraine variants: a review of epidemiology, diagnosis, treatment, and outcome. Curr Neurol Neurosci Rep. 2015;15(6):34.CrossRefPubMed
10.
Lin YP, Ni YH, Weng WC, Lee WT. Cyclic vomiting syndrome and migraine in children. J Formos Med Assoc. 2011;110(6):382–7.CrossRefPubMed
11.
• Redon S, Mareau C, Guedj E, Donnet A. Cyclic vomiting syndrome in adults and children: a hypothesis. Headache. 2017;57(6):943–51. Most recent phenotype description of CVS with recent ICHD criteria CrossRefPubMed
12.
Tarbell SE, Li BU. Anxiety measures predict health-related quality of life in children and adolescents with cyclic vomiting syndrome. J Pediatr. 2015;167(3):633–8.CrossRefPubMed
13.
Tarbell SE, LI BU. Health-related quality of life in children and adolescents with cyclic vomiting syndrome: a comparison with published data on youth with irritable bowel syndrome and organic gastrointestinal disorders. J Pediatr. 2013;163(2):493–7.CrossRefPubMed
14.
15.
Moses J, Keilman A, Worley S, Radhakrishnan K, Rothner AD, Parikh S. Approach to the diagnosis and treatment of cyclic vomiting syndrome: a large single-center experience with 106 patients. Pediatr Neurol. 2014 Jun;50(6):569–73.CrossRefPubMed
16.
Zeevenhooven J, Koppen IJ, Benninga MA. The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017;20(1):1–13.CrossRefPubMedPubMedCentral
17.
18.
Rothner AD, Parikh S. Migraine variants or episodic syndromes that may be associated with migraine and other unusual pediatric headache syndromes. Headache. 2016;56(1):206–14.CrossRefPubMed
19.
Mortimer MJ, Good PA. The VER as a diagnostic marker for childhood abdominal migraine. Headache. 1990;30:642–5.CrossRefPubMed
20.
•• Ellingsen DM, Garcia RG, Lee J, Lin RL, Kim J, Thurler AH, et al. Cyclic vomiting syndrome is characterized by altered functional brain connectivity of the insular cortex: a cross-comparison with migraine and healthy adults. Neurogastroenterol Motil. 2017;29(6) https://​doi.​org/​10.​1111/​nmo.​13004. First imaging paper showing arguments for a common pathophysiology in CVS and migraine
21.
•• Gelfand AA, Gallagher RC. Cyclic vomiting syndrome versus inborn errors of metabolism: a review with clinical recommendations. Headache. 2016;56(1):215–21. Most recent review proposing criteria for metabolic explorations and summarizing metabolic testing to consider in CVS. CrossRefPubMed
22.
Michael M, Tsatsou K, Ferrie CD. Panayiotopoulos syndrome: an important childhood autonomic epilepsy to be differentiated from occipital epilepsy and acute non-epileptic disorders. Brain and Development. 2010;32(1):4–9.CrossRefPubMed
23.
Li BU, Lefevre F, Chelimsky GG, Boles RG, Nelson SP, Lewis DW, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008;47:379–93.CrossRefPubMed
24.
Brezin F, Wiedemann A, Feillet F. Cyclic vomiting syndrome in children. Arch Pediatr 2017;24(11):1129–1136.
25.
Zaki EA, Freilinger T, Klopstock T, Baldwin EE, Heisner KR, Adams K, et al. Two common mitochondrial DNA polymorphisms are highly associated with migraine headache and cyclic vomiting syndrome. Cephalalgia. 2009;29(7):719–28.CrossRefPubMed
26.
27.
Shin M, Douglass LM, Milunsky JM, Rosman NP. The genetics of benign paroxysmal torticollis of infancy: is there an association with mutations in the CACNA1A gene? J Child Neurol. 2016;31(8):1057–61.CrossRefPubMed
28.
Lee J, Wong SA, Li BU, Boles RG. NextGen nuclear DNA sequencing in cyclic vomiting syndrome reveals a significant association with the stress-induced calcium channel (RYR2). Neurogastroenterol Motil. 2015;27(7):990–6.CrossRefPubMed
29.
Chon GSK. Electrogastrography in cyclic vomiting syndrome. Dig Dis Sci. 1999;44(8 Suppl):64S–73S.
30.
Turchetti A, Guglielmi S, Fossati C, Matrunola M, Corrado G. Gastric emptying time in cyclic vomiting syndrome in children. Eur Rev Med Pharmacol Sci. 2004;8(6):295–8.PubMed
31.
Hikita T, Kodama H, Kaneko S, Amakata K, Ogita K, Mochizuki D, et al. Sumatriptan as a treatment for cyclic vomiting syndrome: a clinical trial. Cephalalgia. 2011;31(4):504–7.CrossRefPubMed
32.
Calhoun AH, Pruitt AP. Injectable sumatriptan for cyclic vomiting syndrome in adults: a case series. Headache. 2014;54(9):1526–30.CrossRefPubMed
33.
Slutsker B, Konichezky A, Gothelf D. Breaking the cycle: cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome. Psychol Health Med. 2010;15(6):625–31.CrossRefPubMed
34.
Hershey AD, Powers SW, Vockell AL, LeCates S, Kabbouche MA, Maynard MK. PedMIDAS: development of a questionnaire to assess disability of migraines in children. Neurology 2001 11;57(11):2034–2039.
35.
Haghighat M, Rafie S, Dehghani S, Fallahi GH, Nejabat M. Cyclic vomiting syndrome in children: experience with 181 cases from southern Iran. World J Gastroenterol. 2007;13(12):1833–6.CrossRefPubMedPubMedCentral
36.
• Badihian N, Saneian H, Badihian S, Yaghini O. Prophylactic therapy of cyclic vomiting syndrome in children: comparison of amitriptyline and cyproheptadine: a randomized clinical trial. Am J Gastroenterol. 2017; https://​doi.​org/​10.​1038/​ajg.​2017.​194. Most recent randomized trial in children with CVS, confirming efficacy of both amitriptyline and cyproheptadine at any age.
37.
Lee LY, Abbott L, Mahlangu B, Moodie SJ, Anderson S. The management of cyclic vomiting syndrome: a systematic review. Eur J Gastroenterol Hepatol. 2012 Sep;24(9):1001–6.CrossRefPubMed
38.
39.
Martinez-Esteve Melnikova A, Schäppi MG, Korff C. Riboflavin in cyclic vomiting syndrome: efficacy in three children. Eur J Pediatr. 2016;175(1):131–5.CrossRefPubMed
40.
Van Driessche A, Sermijn E, Paemeleire K, Van Coster R, Vogelaers D. Cyclic vomiting syndrome: case report and short review of the literature. Acta Clin Belg. 2012 Mar-Apr;67(2):123–6.PubMed
41.
Vanderhoof JA, Young R, Kaufman SS, Ernst L. Treatment of cyclic vomiting in childhood with erythromycin. J Pediatr Gastroenterol Nutr. 1993 Nov;17(4):387–91.CrossRefPubMed
42.
Hikita T, Kodama H, Nakamoto N, Kaga F, Amakata K, Ogita K, et al. Effective prophylactic therapy for cyclic vomiting syndrome in children using valproate. Brain and Development. 2009;31(6):411–3.CrossRefPubMed
43.
44.
Haghighat M, Dehghani SM, Shahramian I, Imanieh MH, Teimouri A, Noori NM. Combination of erythromycin and propranolol for treatment of childhood cyclic vomiting syndrome: a novel regimen. Gastroenterol Hepatol Bed Bench. 2015;8(4):270–7.PubMedPubMedCentral
Metadata
Title
Cyclic Vomiting Syndrome in Children
Authors
Anne Donnet
Sylvain Redon
Publication date
01-04-2018
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 4/2018
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-018-0684-6

Other articles of this Issue 4/2018

Current Pain and Headache Reports 4/2018 Go to the issue

Other Pain (A Kaye and N Vadivelu, Section Editors)

Recommendations for Substance Abuse and Pain Control in Patients with Chronic Pain

Episodic Migraine (S Nahas, Section Editor)

The Role of Endothelin in the Pathophysiology of Migraine—a Systematic Review

Other Pain (A Kaye and N Vadivelu, Section Editors)

Spinal Cord Stimulation, MILD Procedure, and Regenerative Medicine, Novel Interventional Nonopioid Therapies in Chronic Pain

Anesthetic Techniques in Pain Management (D Wang, Section Editor)

A Review of Current Treatment Options for Coccygodynia

Secondary Headache (M Robbins, Section Editor)

Cerebral Hyperperfusion Syndrome After Carotid Revascularization and Acute Ischemic Stroke

Other Pain (A Kaye and N Vadivelu, Section Editors)

Novel Interventional Nonopioid Therapies in Headache Management