Cyclical vomiting syndrome

Cyclical vomiting syndrome (CVS) was described over 100 years ago, but it is often underdiagnosed and undertreated, even after a diagnosis is made. It is relatively common, affecting almost 2% of school-age children in some studies. Although it is traditionally seen as a childhood disease related to migraine, CVS does occur in adults. The main characteristic of CVS is the stereotypical recurrent nature of episodes of intense nausea and vomiting lasting from few hours to few days and followed by a complete resolution of symptoms. The diagnosis is predominantly a clinical one and there are internationally accepted criteria for diagnosis. The management of acute attacks of CVS aims to relieve symptoms, reduce the duration of attacks and prevent dehydration and hospital admission. Management also includes appropriate counselling on healthy lifestyle, provision of individual management plans and preventive medications. The aim of management is to reduce the number of attacks and improve quality of life. About half the children with CVS start to have migraine with or without aura in late adolescence and around 40% continue with CVS into early adult life. This article is aimed at healthcare professionals looking after children with CVS and describes the clinical presentation, the criteria required for diagnosis and outlines the different treatment options.