Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Cyclic vomiting syndrome

David J Desilets, MD, PhD
Section Editors
Nicholas J Talley, MD, PhD
Marc C Patterson, MD, FRACP
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Cyclic vomiting syndrome (CVS) is an idiopathic disorder characterized by recurrent, stereotypical bouts of vomiting with intervening periods of normal health [1]. Although it appears to primarily affect children, it is being recognized increasingly in adults.

CVS was first described in France in 1861 [2]. The first English-language publication, in 1882, described three essential clinical features of the disorder, which still hold true today [3]:

Three or more recurrent discrete episodes of vomiting

Varying intervals of completely normal health between episodes

Episodes are stereotypical with regard to timing of onset, symptoms, and duration

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Mar 31, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Li BU. Cyclic vomiting syndrome: light emerging from the black box. J Pediatr 1999; 135:276.
  2. Lombard HC. Evrose de la digestion, caracteriseo par des crises periodiques de vomissements et une profonde modification de l'assimilation. Gazette Medicale de Paris 1861:312.
  3. Gee S. On fitful or recurrent vomiting. St Bartholomew Hospital Reports 1882; 18:1.
  4. Li BU, Lefevre F, Chelimsky GG, 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.
  5. Abu-Arafeh I, Russell G. Cyclical vomiting syndrome in children: a population-based study. J Pediatr Gastroenterol Nutr 1995; 21:454.
  6. Lucarelli S, Corrado G, Pelliccia A, et al. Cyclic vomiting syndrome and food allergy/intolerance in seven children: a possible association. Eur J Pediatr 2000; 159:360.
  7. Prakash C, Staiano A, Rothbaum RJ, Clouse RE. Similarities in cyclic vomiting syndrome across age groups. Am J Gastroenterol 2001; 96:684.
  8. Withers GD, Silburn SR, Forbes DA. Precipitants and aetiology of cyclic vomiting syndrome. Acta Paediatr 1998; 87:272.
  9. HOYT CS, STICKLER GB. A study of 44 children with the syndrome of recurrent (cyclic) vomiting. Pediatrics 1960; 25:775.
  10. Lee WS, Kaur P, Boey CC, Chan KC. Cyclic vomiting syndrome in South-East Asian children. J Paediatr Child Health 1998; 34:568.
  11. Haan J, Kors EE, Ferrari MD. Familial cyclic vomiting syndrome. Cephalalgia 2002; 22:552.
  12. Prakash C, Clouse RE. Cyclic vomiting syndrome in adults: clinical features and response to tricyclic antidepressants. Am J Gastroenterol 1999; 94:2855.
  13. Scobie BA. Recurrent vomiting in adults. A syndrome? Med J Aust 1983; 1:329.
  14. Abell TL, Kim CH, Malagelada JR. Idiopathic cyclic nausea and vomiting--a disorder of gastrointestinal motility? Mayo Clin Proc 1988; 63:1169.
  15. Fleisher DR, Matar M. The cyclic vomiting syndrome: a report of 71 cases and literature review. J Pediatr Gastroenterol Nutr 1993; 17:361.
  16. Boles RG, Zaki EA, Lavenbarg T, et al. Are pediatric and adult-onset cyclic vomiting syndrome (CVS) biologically different conditions? Relationship of adult-onset CVS with the migraine and pediatric CVS-associated common mtDNA polymorphisms 16519T and 3010A. Neurogastroenterol Motil 2009; 21:936.
  17. Welch KM. Scientific basis of migraine: speculation on the relationship to cyclic vomiting. Dig Dis Sci 1999; 44:26S.
  18. Jernigan SA, Ware LM. Reversible quantitative EEG changes in a case of cyclic vomiting: evidence for migraine equivalent. Dev Med Child Neurol 1991; 33:80.
  19. Li BU, Murray RD, Heitlinger LA, et al. Is cyclic vomiting syndrome related to migraine? J Pediatr 1999; 134:567.
  20. To J, Issenman RM, Kamath MV. Evaluation of neurocardiac signals in pediatric patients with cyclic vomiting syndrome through power spectral analysis of heart rate variability. J Pediatr 1999; 135:363.
  21. Chelimsky TC, Chelimsky GG. Autonomic abnormalities in cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr 2007; 44:326.
  22. Li BU, Balint JP. Cyclic vomiting syndrome: evolution in our understanding of a brain-gut disorder. Adv Pediatr 2000; 47:117.
  23. Boles RG, Chun N, Senadheera D, Wong LJ. Cyclic vomiting syndrome and mitochondrial DNA mutations. Lancet 1997; 350:1299.
  24. Boles RG, Adams K, Li BU. Maternal inheritance in cyclic vomiting syndrome. Am J Med Genet A 2005; 133A:71.
  25. Wang Q, Ito M, Adams K, et al. Mitochondrial DNA control region sequence variation in migraine headache and cyclic vomiting syndrome. Am J Med Genet A 2004; 131:50.
  26. Boles RG, Adams K, Ito M, Li BU. Maternal inheritance in cyclic vomiting syndrome with neuromuscular disease. Am J Med Genet A 2003; 120A:474.
  27. Boles RG, Lovett-Barr MR, Preston A, et al. Treatment of cyclic vomiting syndrome with co-enzyme Q10 and amitriptyline, a retrospective study. BMC Neurol 2010; 10:10.
  28. Boles RG. High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series. BMC Neurol 2011; 11:102.
  29. Van Calcar SC, Harding CO, Wolff JA. L-carnitine administration reduces number of episodes in cyclic vomiting syndrome. Clin Pediatr (Phila) 2002; 41:171.
  30. Zaki EA, Freilinger T, Klopstock T, et al. Two common mitochondrial DNA polymorphisms are highly associated with migraine headache and cyclic vomiting syndrome. Cephalalgia 2009; 29:719.
  31. Sato T, Igarashi N, Minami S, et al. Recurrent attacks of vomiting, hypertension and psychotic depression: a syndrome of periodic catecholamine and prostaglandin discharge. Acta Endocrinol (Copenh) 1988; 117:189.
  32. Taché Y. Cyclic vomiting syndrome: the corticotropin-releasing-factor hypothesis. Dig Dis Sci 1999; 44:79S.
  33. Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut 2004; 53:1566.
  34. Roche E, Foster PN. Cannabinoid hyperemesis: not just a problem in Adelaide Hills. Gut 2005; 54:731.
  35. Sontineni SP, Chaudhary S, Sontineni V, Lanspa SJ. Cannabinoid hyperemesis syndrome: clinical diagnosis of an underrecognised manifestation of chronic cannabis abuse. World J Gastroenterol 2009; 15:1264.
  36. Simonetto DA, Oxentenko AS, Herman ML, Szostek JH. Cannabinoid hyperemesis: a case series of 98 patients. Mayo Clin Proc 2012; 87:114.
  37. Fleisher DR, Gornowicz B, Adams K, et al. Cyclic Vomiting Syndrome in 41 adults: the illness, the patients, and problems of management. BMC Med 2005; 3:20.
  38. Li BU, Issenman RM, Sarna SK. Consensus statement--2nd International Scientific Symposium on CVS. The Faculty of The 2nd International Scientific Symposium on Cyclic Vomiting Syndrome. Dig Dis Sci 1999; 44:9S.
  39. Hikita T, Kodama H, Ogita K, et al. Cyclic Vomiting Syndrome in Infants and Children: A Clinical Follow-Up Study. Pediatr Neurol 2016; 57:29.
  40. Symon DN, Russell G. Abdominal migraine: a childhood syndrome defined. Cephalalgia 1986; 6:223.
  41. Fitzpatrick E, Bourke B, Drumm B, Rowland M. Outcome for children with cyclical vomiting syndrome. Arch Dis Child 2007; 92:1001.
  42. Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal Disorders. Gastroenterology 2016; 150:1380.
  43. Schulte-Bockholt A, Kugathasan S, Mesrobian HG, Werlin SL. Ureteropelvic junction obstruction: an overlooked cause of cyclic vomiting. Am J Gastroenterol 2002; 97:1043.
  44. Olson AD, Li BU. The diagnostic evaluation of children with cyclic vomiting: a cost-effectiveness assessment. J Pediatr 2002; 141:724.
  45. Vanderhoof JA, Young R, Kaufman SS, Ernst L. Treatment of cyclic vomiting in childhood with erythromycin. J Pediatr Gastroenterol Nutr 1993; 17:387.
  46. Andersen JM, Sugerman KS, Lockhart JR, Weinberg WA. Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriptyline or cyproheptadine. Pediatrics 1997; 100:977.
  47. Benson JM, Zorn SL, Book LS. Sumatriptan in the treatment of cyclic vomiting. Ann Pharmacother 1995; 29:997.
  48. Pasricha PJ, Schuster MM, Saudek CD, et al. Cyclic vomiting: association with multiple homeostatic abnormalities and response to ketorolac. Am J Gastroenterol 1996; 91:2228.
  49. Boyle CA. Management of menstrual migraine. Neurology 1999; 53:S14.
  50. Clouse RE, Sayuk GS, Lustman PJ, Prakash C. Zonisamide or levetiracetam for adults with cyclic vomiting syndrome: a case series. Clin Gastroenterol Hepatol 2007; 5:44.
  51. http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2014/39943a-eng.php (Accessed on June 16, 2014).
  52. Pareek N, Fleisher DR, Abell T. Cyclic vomiting syndrome: what a gastroenterologist needs to know. Am J Gastroenterol 2007; 102:2832.