Diagnose Cyclical Vomiting Syndrome

Cyclic Vomiting Syndrome (CVS) is a rare but unpleasant disease. Those afflicted experience severe episodes of nausea and vomiting that last for hours or days. It usually affects kids but can happen to anyone of any age. Because this illness can be debilitating at times, it’s important to recognize the problem early so you can start treatment. The cause of this syndrome is not known, but those who suffer from migraines are more likely to develop CVS. Though there’s no test to diagnose CVS, it can be recognized by evaluating your symptoms and medical history, working with medical professionals, and ruling out other causes of the problem. Treatment is supportive and can include anti-nausea and stomach acid suppressing medications as well as sedatives.

Steps

Keeping Your Own Medical Record

1. Understand the symptoms of CVS. Either a severe vomiting episode that occurs several times per hour and lasts less than one week or three or more separate episodes of vomiting with no apparent cause in the past year are strong indications of CVS. Symptoms may also include abdominal pain, diarrhea, fever, dizziness and sensitivity to light. Chronic vomiting can lead to dehydration and can be life threatening. Watch for symptoms of thirst, decreased urinary output, paleness and exhaustion.
2. Remember the first time you had the problem. Many people are diagnosed as children, as early as age 5. Try to remember the first time you had an episode of severe vomiting. If this began when you were young, it may be more likely to be CVS. If you’re unsure when you had your first episode, try to call a parent, caretaker, or older sibling who may remember. If you were ever treated for vomiting as a kid, contact your pediatric doctor’s office to request your medical records.
3. Keep a symptoms diary. Usually, all of an individual's episodes of CVS will be similar - the same symptoms will last around the same length of time. Keep track of details about your episodes in a journal or diary. This can help your doctor look for patterns and make a diagnosis. Record the following:
   • When your symptoms started – including what time of day, because this tends to be the same throughout episodes
   • When your symptoms stopped, so you know how long they lasted
   • What symptoms you experienced other than nausea and vomiting
   • If anything felt different from previous episodes
   • If there was a trigger – episodes can be triggered by emotional stress or anxiety, food like cheese and chocolate, eating too close to bedtime, motion sickness, sinus problems like colds and allergies, hot weather, physical exhaustion, and menstruation
4. Notice if you’re symptom-free between episodes. Pay close attention to whether you have any symptoms in between episodes. Most people are symptom-free between episodes, but some people have mild nausea or abdominal pain, or limb pain. This detail may help distinguish CVS from other causes of vomiting.

Recognizing Other Associated Symptoms

1. Pay close attention to your headaches. Headaches are a common symptom during CVS episodes. People who have migraines are more likely to have CVS, and CVS sometimes transforms into migraines as you get older. Make a special note if you have headaches or migraines during your episode, or even at other times.
2. Identify if your headaches are migraines. Not all headaches are migraines. Make note of your headache symptoms. A migraine headache has the following features:
   • Throbbing or pulsing pain usually on one side of your head, though it can be both sides
   • Sensitivity to light and sounds, and sometimes smell and touch
   • Blurry vision
   • Lightheadedness
   • Some migraines have “auras” during or before the headache – visual changes like flashes of light or zigzagging vision, weakness, pins and needles, muscle jerks, or hearing sounds
   • Some people with migraines have symptoms before the headache that may warn them it’s coming, like changes in mood (usually feeling more depressed), yawning a lot, food cravings, stiff neck, or increased thirst
3. Notice if you have abdominal pain or diarrhea. It’s common to have other abdominal problems during episodes of vomiting. You may experience abdominal pain and/or have diarrhea. Keep track of these symptoms in your symptoms diary. Note what the pain feels like – “cramping,” “sharp,” “constant,” “comes in waves,” etc. – and notice if it’s the same kind of pain with each episode.
4. Note your energy level during an episode. People often feel physically exhausted during episodes of CVS. Pay attention to your energy level, and make a note if you feel extremely tired. Notice if you start feeling exhausted before or after you start vomiting.
   • It’s also common to have pale, clammy skin during this time, or have a fever (a temperature of 100.4°F/38°C or higher). This can make it difficult to distinguish CVS from viral illnesses that have the same symptoms. The important thing is to notice if you have the same symptoms with each episode.

Ruling Out Other Causes of Vomiting

1. Find out if anyone else got sick when you did. Unfortunately, viral illnesses and contaminated food can also cause severe nausea and vomiting. It can be difficult to know whether your vomiting was caused by one of these problems, or was an episode of CVS. When considering an early or recent episode of vomiting, ask yourself the following:
   • Did anyone else in your household get sick at the same time? If family members or classmates also experienced vomiting, especially with a fever, it may have been due to a stomach virus.
   • Did anyone else get sick after eating what you ate? If contaminated food caused the problem, others who ate the same thing may also have felt sick.
2. Visit your doctor to discuss your symptoms. As soon as you notice a trend in your vomiting episodes, see your doctor. Take your symptoms diary with you so you can provide details about the timing and symptoms of your episodes. Your doctor will talk to you about your past medical history and your family history, and they will do a physical exam. They will review the history of your symptoms and then help you decide the best next steps in treatment.
   • Be sure to tell your doctor if you take any medications or have any other medical conditions.
   • Tell your doctor if you use marijuana (weed, pot). Frequently using marijuana has been linked to CVS.
3. Request to see a specialist. If your family doctor is uncertain about your diagnosis, ask for a referral to a gastroenterologist – a doctor who specializes in stomach and digestion problems. They may be more familiar with CVS than your regular doctor, since CVS is pretty uncommon. A gastroenterologist can prescribe some tests to help diagnose the problem.
4. Have tests done to rule out other causes of vomiting. A number of tests can be done to show whether you have a different problem causing your vomiting. If these tests show no other problems, then your doctor can more accurately diagnose CVS. Some tests you may need to do include:
   • Imaging with a CT scan or endoscopy (a small camera that looks into your throat) to look for structural problems in your throat and stomach
   • Motility tests to see how food moves through your digestive system
   • Blood tests to check your thyroid and other hormones
   • MRI to check for problems in your brain and nervous system

Sources and Citations

See also

• Stop Retching After Vomiting
• Clean Up Vomit
• Vomit While Driving
• Induce Vomiting
• Cure Nausea
• Stop Vomiting
• Avoid Throwing Up
• Prevent Yourself from Vomiting
• Deal With Chronic Unexplained Nausea
• Throw up As Comfortably As Possible

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