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Cyclic Vomiting Syndrome

What it is and how to treat it?

Cyclic Vomiting is a condition defined by regular and prolonged periods of severe nausea and vomiting. It is often separated by periods of relative wellness. 

The condition will usually begin in childhood but can affect any age. Adult episodes are often longer-lasting, up to 8 days, but are less frequent. Each episode will be similar for the individual. For example, beginning at the same time of the day, similar severity, duration and associated symptoms.

Symptoms of Cyclic Vomiting

Symptoms include episodes of vomiting lasting hours or days. 

Other symptoms may include:

  • Intense sweating

  • Paleness of the skin 

  • Weakness 

  • Fatigue 

  • Abdominal pain 

  • Diarrhoea

  • Fever

  • Dizziness

Some individuals will also have a reduced appetite and weight loss. People may also exhibit migraine symptoms including headaches or a sensitivity to light and sound.

Diagnosing Cyclic Vomiting is difficult and poorly done. Cyclic Vomiting is currently primarily diagnosed by elimination.  Cyclic Vomiting Syndrome is often referred to as “Abdominal Migraine”. However abdominal migraine is recurrent episodes of abdominal pain in which vomiting may not occur.

Understanding Cyclic Vomiting Syndrome

Cyclic Vomiting Syndrome is associated with Migraines, but the exact cause of the condition is unknown. Researchers believe the syndrome develops due to irregularities in the normal interaction between the brainstem and the gut. The vagus nerve that innervates the gut is a cranial nerve originating in the brainstem.

The brainstem can become sensitised by irregular input, more specifically, by noxious information from the upper cervical spine. This can lead to changes in the autonomic nervous system.

The autonomic nervous system regulates involuntary body functions such as: heart rate, blood pressure, sweating, and release of certain hormones. Vomiting itself is an autonomic disruption.

How to Treat Cyclic Vomiting Syndrome

Managing Cyclic Vomiting Syndrome normally includes two options: preventative drug therapy and symptom management. Unfortunately, both options involve suppressant medication.  To achieve long-term medication-free preventative management you will need to find out the source of your sensitised brainstem.

Researchers agree that the upper cervical spine can cause sensitisation of the brainstem. The high amount of neck pain in Migraine patients indicates the importance of assessing the neck. The neck is a treatable structure and can be the underlying cause of brainstem sensitisation and therefore Cyclic Vomiting Syndrome.

At The Headache Clinic, our clinicians will complete a skilled assessment of the cervical spine, to determine its role in the sensitisation of the brainstem. 

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