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Cyclic vomiting syndrome and abdominal migraine

Cyclic vomiting syndrome and abdominal migraine

Both cyclic vomiting syndrome and abdominal migraine are relatively unusual conditions that present with recurrent and severe paroxysmal vomiting or abdominal pain, separated by periods of weeks or months of good health.

But while cyclic vomiting syndrome is characterized by recurrent, stereotypical episodes of intense nausea and vomiting lasting hours to days, abdominal migraines are characterized by recurrent, acute-onset, incapacitating, non-colicky midline abdominal pain lasting for hours and accompanied by pallor and anorexia. Vomiting may accompany abdominal migraines, but is often less severe, while midline and upper midline abdominal pain may be present with cyclic vomiting syndrome.

The labels “cyclic vomiting syndrome” and “abdominal migraine” have, on occasion, been used interchangeably, but there are significant differences between migraine-associated cyclic vomiting and non-migraine-associated cyclic vomiting that support their separation.

Abdominal migraine, cyclic vomiting syndrome, and migraine headaches all seem to be manifestations of migraine diathesis. Each is a functional, episodic disorder with attacks separated by symptom free intervals.

Patients with any of these disorders may experience headache, abdominal pain, nausea, and other symptoms of migraine during their respective attacks. However, the semantic distinction of these three syndromes is based on their predominant symptoms: headache predominates in migraine; intense, sustained, midline abdominal pain predominates in abdominal migraine; and nausea and vomiting predominate in CVS.

Rome IV Criteria for diagnosing CVS and Abdominal migraine.
B. Functional Gastroduodenal Disorders
B3. NAUSEA AND VOMITING DISORDERS
B3b. Cyclic Vomiting Syndrome
H. Childhood Functional GI disorders Child/Adolocent

H2. FUNCTIONAL ABDOMINAL PAIN DISORDERS

H2c. Abdominal Migraine

Must include all of the following: Must include all of the following:
  1. Stereotypical episodes of vomiting regarding onset (acute) and duration (less than one week).
  2. At least three discrete episodes in the prior year and two episodes in the past 6 months, occurring at least 1 week apart.
  3. Absence of vomiting between episodes, but other milder symptoms can be present between cycles.
  1. Paroxysmal episodes of intense, acute periumbilical, midline, or diffuse abdominal pain lasting 1 hour or more (should be the most severe and distressing symptom).
  2. Episodes are separated by weeks to months.
  3. The pain is associated with two or more of the following:

a.     Anorexia

b.     Nausea

c.     Vomiting

d.     Headache

e.     Photophobia

f.      Pallor

  1. After appropriate evaluation, the symptoms cannot be fully explained by another medical condition.

 

*Criteria fulfilled for at least 6 months prior to diagnosis.

Supportive Remark
History or family history of migraine headaches.

What is CVS?

Cyclic vomiting syndrome, or cyclical vomiting syndrome, (CVS) is a chronic functional condition of unknown cause characterized by recurring attacks of intense nausea, vomiting, and sometimes abdominal pain, headaches,

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CVS subgroups

Subcategories of CVS have been identified, including CVS plus, catamenial CVS, and Sato’s variant of CVS. CVS plus is defined by the presence of at

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Treatment of CVS

Although limited data exist on treatment outcomes in children and adults with CVS, a NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition) consensus

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CVS plus

Cyclic vomiting syndrome is characterized by severe discrete episodes of nausea, vomiting, and lethargy. Approximately 25% of cases have coexisting neuromuscular disease manifestations (cyclic vomiting syndrome

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Adult CVS

It has long been thought that CVS was a condition of childhood and adolescence. Now we know that adults also suffer from CVS. There is

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SOURCES

CVSA USA http://cvsaonline.org/what-is-cvs/ CVSA UK http://www.cvsa.org.uk/Whatis.html Cyclic Vomiting Syndrome, National Digestive Diseases Information Clearinghouse, U.S. Department of Health and Human Services, NATIONAL INSTITUTES OF HEALTH UpToDate: CVS: https://drive.google.com/open?id=0B0Jx6ulFbbrsWTRlRUZHQnVSY2s

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