Treat Cyclical Vomiting Syndrome

Getting diagnosed with Cyclic Vomiting Syndrome (CVS) can feel pretty upsetting – but diagnosis is half the battle! Now that you know the problem you can start treatment to ease your symptoms. There may not be a specific cause for CVS, but episodes can be triggered by some foods and activities. Learn to recognize and avoid triggers, and visit your doctor to get prescribed the appropriate medications to manage your CVS.

Steps

Taking Medications to Prevent and Manage Symptoms

1. Take anti-nausea medications. Your doctor may prescribe you anti-nausea medicine to take when you start to experience symptoms. These medicines, like Zofran, help you feel less nauseated and can stop or decrease how much you vomit. Ask your doctor about how much to take and when to take it.
2. Use antacids when you feel nauseated. Some medications decrease the amount of acid in your stomach and can help alleviate nausea and vomiting. You can get over-the-counter antacids like Tums, or your doctor can prescribe you stronger medication. You will probably take these only when you start to feel sick, so ask your doctor about proper use.
3. Treat your migraines. 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. Treating your migraines may improve your CVS, and vice versa. Talk to your doctor or a specialist called a neurologist about managing your migraines.
   • There are a number of therapies available. The right one depends on your symptoms, family history, and other medical conditions.
4. Use sedatives. Sedatives are sometimes prescribed to take during an episode. They can help you feel calmer and sleep through some of your worst symptoms. Sedatives are probably not safe for children to take, so discuss this option with your doctor.
   • Some medicines that are prescribed for sedation are lorazepam (Ativan), diphenhydramine (Benadryl), and/or chlorpromazine. These can have side effects and should only be given by your doctor.
5. Take prophylactic antidepressants every day. If you have symptoms more than once a month or your symptoms are severe and debilitating, you may be able to take prophylactic medication – medicine you take all the time to prevent symptoms. Antidepressants are commonly used for this, especially the medication amitriptyline. Your doctor can prescribe this.
   • Some medications, including amitriptyline, are not safe to use in children. Talk to your doctor about whether these medications are appropriate for you.

Trying Alternative Therapies

1. Use coenzyme Q10. This nutritional supplement may help to prevent symptoms of CVS. Get coenzyme Q10 at your pharmacy or local health food store. Talk to your doctor about dosing and whether this is an appropriate therapy for you.
2. Try L-carnitine. L-carnitine is a dietary supplement and antioxidant that some people use to help turn fat into energy. It may help to prevent episodes of CVS if you take it regularly. You can get L-carnitine supplements from your pharmacy or health foods store, and from some foods including red meat (especially lamb) and dairy. The recommended dose is 1-3 grams per day, but this can vary – talk to your doctor about dosing.
   • Do not give this to children before talking to your doctor about it.
   • Talk to your doctor before using L-carnitine if you take any medications or have any other medical conditions.
3. See a therapist or counselor. Many people with CVS also have depression or anxiety. It isn’t clear whether one causes the other or whether the two simply occur together, but treating one may improve the other. See a counselor or therapist for help with depression or anxiety, and you may see improvement in your CVS symptoms.
4. Get lots of sleep in a dark, quiet room. Once your symptoms start, it can help to simply go to bed. Try to rest in a dark, quiet room and sleep as much as you can. This may minimize symptoms, help them end sooner, or at least provide your body some comfort during the worst of your symptoms.

Identifying and Avoiding Triggers

1. Stop using marijuana. Frequent use of marijuana (weed, pot) has been linked to causing episodes of CVS. Stop using marijuana altogether and you may be able to decrease your symptoms. This is especially true for adolescents and young adults.
   • Though marijuana is sometimes used to ease nausea for medical conditions, this is not the case with CVS. Frequent use of marijuana can cause CVS and should be avoided.
2. Treat sinus problems as soon as they develop. Colds, allergies, and other sinus problems may trigger episodes of CVS. Treat symptoms of sinus problems as soon as possible to minimize your risk of triggering an episode. Ask your pharmacist for the best medicine for you – decongestants or antihistamines may help.
3. Decrease your stress level. Stress and anxiety can trigger episodes. Try to reduce stress during symptom-free times. Try yoga, meditation, deep breathing, taking a walk – anything that helps you relax. If you have a stressful lifestyle due to work or family, practice mindfulness meditation or learn stress management skills.
   • If your child with CVS suffers from anxiety, consider seeking professional counseling.
   • Biofeedback training may help you or your child learn to manage stress and reduce symptoms.
4. Eat small amounts. Eat three small meals and three snacks a day instead of eating large meals. Also limit eating within several hours of bedtime. Overeating and eating close to bedtime can trigger an episode.
   • Avoid eating commonly triggering foods like chocolate and cheese.
5. Keep cool in hot weather. Hot weather is a trigger for some people. Wear loose, light-colored clothing in hot weather. Wear a wide-brimmed hat to keep sun off your face and head. Limit the time you spend outdoors in the hottest part of the day – between noon and 3pm.
6. Don’t overexert yourself. Physical exhaustion can trigger an episode. Rest often when exercising. Make sure you get enough sleep – aim for a minimum of 7-9 hours of sleep a night. If you start to feel run down, take a day to do calm activities like reading and napping.
7. Treat motion sickness. Motion sickness can commonly cause nausea and vomiting, and has been known to trigger episodes of CVS. Take action while traveling to prevent motion sickness, such as sitting facing the direction the vehicle is moving (this is important on trains), and focusing your gaze on a distant object. Take Dramamine or another medication to prevent motion sickness.
8. Chart your menstruation. Your period can trigger an episode of CVS. If you know when your period is due, you can be prepared with your CVS medications. Write down what day your period starts each month and count how many days are between the starts of two periods. Take the average of three months – this is about how often your period comes.

Tips

• Start to rehydrate and replace electrolytes once your vomiting has stopped. Start with clear fluids, juice, or sports drinks and gradually add solid food as you can tolerate it.

Warnings

• It’s very important to avoid dehydration while having episodes of vomiting or diarrhea. Try to take small, frequent sips of water, or suck on ice chips or popsicles. If you become dehydrated, go to the hospital for IV (intravenous, or into the vein) fluids. You may be dehydrated if you have infrequent or dark urine, feel very thirsty, have dry lips and tongue, or feel faint and exhausted.
• Always check with your doctor before taking any supplements. Never give supplements to a child without first talking to your doctor.

Sources and Citations

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