Treatment for Cyclic Vomiting Syndrome

Episodes of cyclic vomiting syndrome may be prevented to some extent by taking the following steps:

• Triggers of vomiting episodes should be avoided to reduce attacks. Some patients suffer from the episodes after eating certain foods like chocolates; these patients should avoid such foods.
• People who suffer from episodes when stressed should undergo counseling during the well-interval phase so that they can deal with the stress better.
• Medications may be taken daily to prevent attacks. Commonly used medications include cyproheptadine in children less than 5 years of age, amitriptyline in children over the age of 5 years, and propranolol. Drugs used in adults include amitriptyline, levetiracetam and zonisamide.

Anti-migraine medications like sumatriptan and zolmitriptan are used to treat the attacks. These drugs may be given intranasally, so that they are not vomited out.

Supportive treatment includes -

• The patient should be treated in a quiet, dark room

The following may be administered to the patient -

• IV fluids and electrolytes to prevent dehydration
• Anti-emetics like ondansetron in high dose to reduce vomiting
• Sedative like lorazepam to reduce the number of times the patient vomits
• Ketolorac or narcotics for pain

Children with cyclic vomiting syndrome usually recover once they reach puberty. Majority of them go on to develop migraine by the age of 18 years. However, adults tend to deteriorate with time, and may even become completely disabled.