National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Cyclic vomiting syndrome

Not a rare disease Not a rare disease
Other Names:
CVS; Familial cyclic vomiting syndrome (subtype)
Cyclic vomiting syndrome (CVS) is a condition characterized by recurrent, prolonged episodes of severe nausea and vomiting. Episodes of vomiting may last hours or days. Other signs and symptoms during episodes may include intense sweating, paleness, weakness and fatigue, abdominal pain, diarrhea, fever, dizziness, and headache. Most people with CVS are symptom-free in between episodes, but some people have milder symptoms.[1][2][3] The condition can begin at any age, but it most often begins in childhood.[1] A subset of people with CVS also have neurologic or neuromuscular disorders; the condition in these cases is referred to as "CVS plus."[4][5][6]

The underlying cause of CVS is unknown. Data suggest there is a strong genetic component for CVS in children, involving changes (mutations) in mitochondrial DNA.[7][8][5] Researchers believe that the condition primarily affects the brain, causing abnormalities in how the brain and gut interact.[3] Many people with CVS report "triggers" for episodes, such as excitement, stress, infections, eating certain foods, and menstruation.[3] People with a family history of migraines may be more likely to develop CVS.[9]

Treatment strategies for controlling symptoms may include avoiding triggers, medications to prevent or relieve nausea, tricyclic antidepressants, anti-migraine medications, and supplements called coenzyme Q-10 and L-carnitine.[8][3][10][1] While some people with CVS outgrow the condition within a few years, others continue to have episodes through adulthood.[8] Children who outgrow CVS may go on to develop migraines.[3] 
Last updated: 10/16/2017

This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.

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Medical Terms Other Names
Learn More:
HPO ID
Percent of people who have these symptoms is not available through HPO
Abdominal pain
Pain in stomach
Stomach pain
[ more ] 		0002027
Anorexia 0002039
Ataxia 0001251
Attention deficit hyperactivity disorder
Attention deficit
Attention deficit disorder
Attention deficit-hyperactivity disorder
Attention deficits
Childhood attention deficit/hyperactivity disorder
[ more ] 		0007018
Autism 0000717
Cardiomyopathy
Disease of the heart muscle
0001638
Cognitive impairment
Abnormality of cognition
Cognitive abnormality
Cognitive defects
Cognitive deficits
Intellectual impairment
Mental impairment
[ more ] 		0100543
Exercise intolerance
Decreased ability to exercise
Inability to exercise
[ more ] 		0003546
Gastrointestinal dysmotility 0002579
Generalized hypotonia
Decreased muscle tone
Low muscle tone
[ more ] 		0001290
Growth delay
Delayed growth
Growth deficiency
Growth failure
Growth retardation
Poor growth
Retarded growth
[ more ] 		0001510
Hearing impairment
Deafness
Hearing defect
[ more ] 		0000365
Intellectual disability
Mental deficiency
Mental retardation
Mental retardation, nonspecific
Mental-retardation
[ more ] 		0001249
Lethargy 0001254
Microcephaly
Abnormally small skull
Decreased circumference of cranium
Decreased size of skull
Reduced head circumference
Small head circumference
[ more ] 		0000252
Migraine
Intermittent migraine headaches
Migraine headache
Migraine headaches
[ more ] 		0002076
Mitochondrial inheritance 0001427
Motor delay 0001270
Multifactorial inheritance 0001426
Muscle weakness
Muscular weakness
0001324
Muscular hypotonia
Low or weak muscle tone
0001252
Nausea 0002018
Pallor 0000980
Seizure 0001250
Strabismus
Cross-eyed
Squint
Squint eyes
[ more ] 		0000486
Vomiting
Throwing up
0002013
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Last updated: 7/1/2020
Treatment of cyclic vomiting syndrome (CVS) aims to prevent episodes (prophylactic therapy), stop episodes (abortive therapy), and provide supportive care while symptoms are present (supportive therapy). There is no specific treatment that has been proven effective in controlled trials, but several therapies based on observation and experience (empiric therapies) have been effective in case series. Treatment options for each person may depend on the person's age, whether there is a family history of migraines, the severity of episodes, and how often episodes occur.[8] People with CVS should consult with their doctor about a personalized treatment plan.

Prophylactic therapy options include:[8][11][7]
  • Avoiding triggers of episodes (e.g. certain foods, physical exhaustion, sleep deprivation, or psychological stress).
  • Various medications (usually for patients with more than one episode per month). Examples include cyproheptadine, amitriptyline (a tricyclic antidepressant), various anti-convulsants, propranolol, and erythromycin. There is consensus among experts that amitriptyline should be used as the first treatment for children over 5 years old, and cyproheptadine for children under 5 years old. Approximately 80% of those with a family history of migraines respond well to anti-migraine medications.
  • Supplements called coenzyme Q-10 and L-carnitine. Retrospective studies have shown these to be very effective.

Abortive therapy options include various anti-migraine and anti-nausea medications such as ondansetron, promethazine, prochlorperazine, and a group of drugs used for migraines called triptans (e.g. sumatriptan).[8][11]

Supportive therapy is needed when both prophylactic and abortive therapies are unsuccessful. Supportive care is an extremely important aspect of treatment while a person is having symptoms. This may involve:[8][11][7]
  • Oral fluids if possible.
  • IV fluids if needed.
  • Sedatives or pain medications to allow for sleep and a break from severe nausea.
Last updated: 10/17/2017
The long-term outlook for people with cyclic vomiting syndrome varies from person to person. Many children with CVS "outgrow" the condition by late childhood or early adolescence, but some continue to have symptoms through adulthood.[7][8] It has been reported that many children with CVS go on to develop migraine headaches by late childhood.[7] Some of these children experience a phase of abdominal migraines in between.[7][8] 

In adults with CVS, the course of the condition and how long it lasts have not been well-studied. There is substantial morbidity associated with CVS in adults, possibly due to lack of awareness and long delays in diagnosis.[8]

Although people with CVS are symptom-free about 90% of the time, the condition can be quite disabling.[8] Children with CVS may miss many days of school and may need home tutoring or home schooling. Because of increased likelihood of episodes during times of stress or excitement, CVS may interfere with birthdays, holidays, and vacations.[8]
Last updated: 10/18/2017

If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments.

If you can’t find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care.

You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists.

Healthcare Resources

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

  • ClinicalTrials.gov lists trials that are related to Cyclic vomiting syndrome. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

    Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine. 
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Cyclic vomiting syndrome. Click on the link to view a sample search on this topic.

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know.

  1. Cyclic vomiting syndrome. Mayo Clinic. August 8, 2017; http://www.mayoclinic.org/diseases-conditions/cyclic-vomiting-syndrome/basics/definition/con-20028160?METHOD=print.
  2. Cyclic Vomiting Syndrome. International Foundation for Functional Gastrointestinal Disorders. March 24, 2016; https://aboutkidsgi.org/upper-gi/cyclic-vomiting-syndrome.html.
  3. Cyclic Vomiting Syndrome. National Organization for Rare Disorders (NORD). 2017; https://rarediseases.org/rare-diseases/cyclic-vomiting-syndrome/.
  4. Kumar N, Bashar Q, Reddy N, et al. Cyclic Vomiting Syndrome (CVS): is there a difference based on onset of symptoms - pediatric versus adult?. BMC Gastroenterol. May 28, 2012; 12:52. https://www.ncbi.nlm.nih.gov/pubmed/22639867.
  5. Cassandra L. Kniffin. Cyclic Vomiting Syndrome; CVS. Online Mendelian Inheritance in Man (OMIM). October 19, 2005; https://www.omim.org/entry/500007.
  6. Cyclic vomiting syndrome. Genetics Home Reference. March, 2014; http://ghr.nlm.nih.gov/condition/cyclic-vomiting-syndrome.
  7. Desilets DJ. Cyclic vomiting syndrome. UpToDate. Waltham, MA: UpToDate; March 31, 2017; https://www.uptodate.com/contents/cyclic-vomiting-syndrome.
  8. Venkatesan T. Cyclic Vomiting Syndrome. Medscape Reference. July 20, 2017; http://emedicine.medscape.com/article/933135-overview.
  9. Cyclic Vomiting Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). March, 2014; https://www.niddk.nih.gov/health-information/digestive-diseases/cyclic-vomiting-syndrome.
  10. Bhandari S, Venkatesan T. Clinical Characteristics, Comorbidities and Hospital Outcomes in Hospitalizations with Cyclic Vomiting Syndrome: A Nationwide Analysis. Dig Dis Sci. August, 2017; 62(8):2035-2044. https://www.ncbi.nlm.nih.gov/pubmed/28050780.
  11. Irwin S, Barmherzig R, Gelfand A. Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome. Curr Neurol Neurosci Rep. March, 2017; 17(3):21. https://www.ncbi.nlm.nih.gov/pubmed/28283964.