Cyclical vomiting syndrome


Recurrent episodic attacks of intense nausea and vomiting, usually stereotypical in the individual and with predictable timing of episodes. Attacks may be associated with pallor and lethargy. There is complete resolution of symptoms between attacks.

Diagnostic criteria:
  1. At least five attacks of intense nausea and vomiting, fulfilling criteria B and C
  2. Stereotypical in the individual patient and recurring with predictable periodicity
  3. All of the following:
    1. nausea and vomiting occur at least four times per hour
    2. attacks last for ≥1 hour, up to 10 days
    3. attacks occur ≥1 week apart
  4. Complete freedom from symptoms between attacks
  5. Not attributed to another disorder1.

In particular, history and physical examination do not show signs of gastrointestinal disease.

Comments: Cyclic vomiting syndrome is typically a self-limiting episodic condition occurring in childhood, with periods of complete normality between episodes. The cyclic nature is the hallmark, and attacks are predictable.

This disorder was first included as a childhood periodic syndrome in ICHD-II. The clinical features of this syndrome resemble those found in association with migraine headaches, and multiple threads of research over the last years have suggested that Cyclic vomiting syndrome is a condition related to migraine.