Cyclic vomiting syndrome

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Summary of Cyclic vomiting syndrome

Cyclic vomiting syndrome is a condition characterized by discrete episodes of intractable vomiting with periods of weeks or months without any symptoms. Attacks may also recur with nausea and abdominal pain, headaches, or migraines. Cyclic vomiting syndrome typically develops during childhood, usually between ages 3 and 7; although it often remits during adolescence, it can persist into adult life. Abortive treatment for cyclic vomiting episodes includes anti-emetics such as ondansetron, and prophylaxis includes anti-migraine drugs such as sumatriptan and amitryptiline.

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Cyclic vomiting syndrome

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Cyclic vomiting syndrome

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A 27-year-old woman comes to the clinic with a 6-year history of intermittent vomiting. She reports that the episodes occur every 2-3 months and last for roughly one day at a time. The episodes are preceded by a typical sequence of generalized abdominal pain, nausea, and a throbbing headache, followed by the onset of vomiting, several times per hour for the next several hours. Physical examination is unremarkable, and she does not seem to be under any apparent distress. She reports that she has visited doctors a handful of times regarding her vomiting, but a diagnosis has never been reached because she is completely symptom-free between episodes. One year ago, she discontinued eating lactose and gluten, but has still experienced several episodes of vomiting since then. Given the most likely diagnosis, which of the following would you prescribe this patient to prevent further episodes of vomiting?

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