– Recurrent severe vomiting at regular intervals
– Accompanied by nausea, abdominal pain, headache
– Primarily affects children, can occur in adults
– Episodes are intense, lasting hours or days, followed by symptom-free periods

• Exact cause unknown
• Involves autonomic nervous system dysfunction
• Imbalance of neurotransmitters, especially serotonin
• Genetic predisposition, particularly with a family history of migraines or CVS
• Triggers include stress, infections, certain foods, and hormonal changes

• Family history of migraines/CVS
• Personal history of migraines or motion sickness
• Psychological factors: anxiety, depression

• Dysregulation of autonomic nervous system
• Abnormal brain neurotransmitter systems, especially serotonin
• Abnormal signals to the digestive system cause severe vomiting
• Underlying mechanisms are still under study

– Gastroesophageal reflux disease (GERD)
– Cyclic vomiting associated with migraine
– Gastrointestinal disorders, metabolic disorders, psychogenic vomiting
– Inflammatory bowel disease – Crohn’s disease, Ulcerative colitis
– Migraines
– Addison’s disease
– Diabetes mellitus with ketoacidosis
– Phaeochromocytoma
– Cannabinoid hyperemesis syndrome (associated with chronic cannabis use)

– Rare condition; exact prevalence is unknown
– Primarily affects children, onset typically occurs between 3-7 years
– Can occur in adults, more common in females

– Recurrent severe vomiting with a regular pattern
– Intense nausea, sweating, and paleness during episodes
– Vomiting episodes last for about 20-30 minutes
– Between episodes, individuals return to normal health
– Additional symptoms may include weight loss, reduced appetite, abdominal pain, diarrhea, dizziness, photophobia, and headaches

1. Prodromal Phase: Intense sweating, nausea, and paleness
2. Vomiting Phase: Episodes of vomiting, retching, and nausea
3. Recovery Phase: Cessation of vomiting, improved appetite and energy
4. Well Phase: Symptom-free period

– Emotional stress
– Anxiety
– Infections, especially sinusitis
– Certain foods (e.g. chocolate, cheese, monosodium glutamate)
– Prolonged fasting
– Dehydration
– Hot weather
– Menstrual periods
– Excessive exercise
– Sleep deprivation

– Severity varies; some may require hospitalization during episodes
– After an episode, patients are typically symptom-free for several weeks or months

– Clinical diagnosis based on presentation and symptom patterns
– Pregnancy test for women to rule out pregnancy as a possible cause

– Routine blood tests are done to exclude underlying conditions and assess overall health

– At least five episodes, minimum of three over six months
– Intense nausea and vomiting lasting 1 hour to 10 days, at least one week apart
– Stereotypical pattern and symptoms
– Vomiting at least four times an hour for at least one hour during episodes
– Return to baseline health between episodes
– Symptoms not attributed to another disorder

– Stereotypical episodes with acute onset and duration of less than one week
– Minimum of three discrete episodes in the preceding year
– Absence of nausea and vomiting between episodes
– No metabolic, gastrointestinal, or central nervous system structural or biochemical disorders

• Identify and avoid triggers like specific foods, stress, sleep deprivation, and dehydration
• Prophylactic medications: Amitriptyline, propranolol, and topiramate for frequent episodes
• Acute episode treatment: Ondansetron, prochlorperazine, triptans
• Supportive care during episodes: IV fluids and analgesia

• Involve family in care for emotional support
• Assess and manage anxiety to improve quality of life

• Individualized plans developed in collaboration with healthcare professionals

• Varied prognosis: Ranges from spontaneous resolution to recurrent episodes
• Most cases resolve in late childhood or early adolescence

• Dehydration
• Electrolyte imbalances
• Weight loss or failure to thrive (in children)
• Dental erosion
• Psychological distress
• Impact on social functioning, school/work attendance, and quality of life

• Essential for monitoring and ensuring adherence to the management plan

• About half of children with CVS may develop migraines later in life

• Ensure adequate sleep
• Practice stress management
• Avoid trigger foods
• Consider migraine prophylaxis in appropriate cases