Although vomiting is never pleasant, you typically feel better after you’ve gotten sick. But when you can’t stop throwing up, or it doesn’t relieve your nausea, it could signal something other than the stomach flu or food poisoning.
Repeated episodes of vomiting are a symptom of a chronic — and underdiagnosed — health condition called cyclic vomiting syndrome (CVS). Here’s what you need to know about this vomiting illness and how to treat it.
What Is Cyclic Vomiting Syndrome?
Cyclic vomiting syndrome (CVS) is a condition in which you have episodes of severe nausea, vomiting, and retching (dry heaving). Other symptoms can include abdominal pain, sweating, cold flashes, and chills.
People with CVS have at least three similar episodes a year, and still have some nausea and vomiting in between them.
CVS can affect both children and adults. Adults with CVS are more likely to have conditions like migraine, epilepsy, anxiety, depression, and autonomic dysfunction.
4 phases of cyclic vomiting syndrome
People with CVS cycle through four phases:
- Inter-episodic — Between episodes, when you have fewer or no symptoms.
- Prodrome — When you start having symptoms, like nausea and panic, signaling that an episode is about to start.
- Emetic — An episode of severe nausea, vomiting, and retching.
- Recovery — Periods lasting hours to days when you rehydrate and rest post-episode.
What Causes Cyclic Vomiting Syndrome?
Doctors aren’t sure of the exact cause of CVS. But they believe it has something to do with brain-gut interaction — how your nervous system and digestive system interact and communicate.
They do know that one of the most common triggers of CVS is stress, including:
- Negative stress — Such as work or family conflict.
- Positive stress — Like excitement for a trip, event, or activity.
Not surprisingly, CVS can also add to your stress — and feel stressful for your loved ones, too.
How Do You Know if You Have CVS?
Even if you have CVS symptoms, a health care provider might not recognize CVS. They may mistake it for other health issues with similar symptoms. Sometimes, getting a CVS diagnosis and finding the right treatments for it can take several years.
To diagnose cyclic vomiting syndrome, your doctor will need to know how often you have episodes of vomiting, nausea, and retching. They may run tests to make sure your symptoms aren’t the result of another health issue. You may have:
- Blood tests — To rule out metabolic or hormonal disorders.
- Imaging tests (x-ray or CT scan) — To see if an obstruction or blockage is causing your symptoms.
How Does CVS Affect Your Daily Life?
Having CVS can disrupt your daily life, especially during an episode. How long one lasts varies from person to person. They can involve hours to days of vomiting and other symptoms. They can also require trips to the emergency department or hospital stays.
How cyclic vomiting syndrome impacts your life also depends on which type you have. CVS is either mild or moderate-to-severe. These two categories depend on how often you have episodes, how long they last, and the kind of care you tend to need during or after an episode.
Mild CVS
In the case of mild CVS, “mild” only differentiates this category from the moderate-to-severe category. “Mild” doesn’t describe the impact of CVS on your life, but means:
- You can recover relatively quickly after an episode.
- You don’t have to go to the emergency department to rehydrate or to stop an episode.
- You have episodes lasting fewer than two days.
- You have fewer than four episodes in a year.
Moderate-to-Severe CVS
The other cyclic vomiting syndrome category is moderate-to-severe, meaning:
- You experience four or more episodes in a year.
- You have episodes lasting more than two days.
- Your episodes almost always require going to the emergency department or staying at the hospital to rehydrate or to stop the episode.
How to Stop Cyclic Vomiting Syndrome
Although the goal of treatment is to stop having episodes, that’s not always possible. If it’s not, doctors try to reduce how severe CVS episodes are through treatment, which may include:
- Lifestyle changes — Maintaining a consistent sleep routine, staying hydrated, and avoiding fasting can help.
- Medications — These stop or “turn off” an episode and are most effective if taken when you feel an episode coming on, before it starts. If you have moderate-to-severe CVS, your health care provider may also prescribe medicines that extend the time between episodes. These can also reduce the severity and duration of episodes.
- Stress management — Stress is often both a trigger and a result of CVS. Treatment may also include coaching or counseling to help you identify your stress triggers and develop stress management tools.
Addressing the issues happening alongside your CVS, such as anxiety, depression, migraine, or a sleep disorder, can also help. Your health care provider may refer you to specialists who can help you manage and treat these conditions.
Plan Ahead With Your Care Team
Early action is key to stopping a CVS episode. Because you’re the expert on your symptoms, make a plan with your care team and rehearse what actions you’ll take to stop an episode when you feel one coming on.
Your loved ones are another possible part of your action plan, too. Communicating while you’re having a CVS episode isn’t always easy. Talking to your loved ones beforehand can help them support you during the prodrome and emetic phases.
You can also plan for your recovery phase by having electrolyte or nutrient drinks on hand for rehydration.
Visit the UPMC Digestive Health Care website to learn more about CVS treatment options at UPMC.