Symptoms & Causes of Cyclic Vomiting Syndrome

What are the main symptoms of cyclic vomiting syndrome?

The main symptoms of cyclic vomiting syndrome are sudden, repeated attacks—called episodes—of severe nausea and vomiting. You may vomit several times an hour. Episodes can last from a few hours to several days. Episodes may make you feel very tired and drowsy.

Each episode of cyclic vomiting syndrome tends to start at the same time of day, last the same length of time, and happen with the same symptoms and intensity as previous episodes. Episodes may begin at any time but often start during the early morning hours.

Young woman feeling nauseated.
The main symptoms of cyclic vomiting syndrome are sudden, repeated attacks—called episodes—of severe nausea and vomiting.

What are some other symptoms of cyclic vomiting syndrome?

Other symptoms of cyclic vomiting syndrome may include one or more of the following:

  • retching—trying to vomit but having nothing come out of your mouth, also called dry vomiting
  • pain in the abdomen
  • abnormal drowsiness
  • pale skin
  • headaches
  • lack of appetite
  • not wanting to talk
  • drooling or spitting
  • extreme thirst
  • sensitivity to light or sound
  • dizziness
  • diarrhea
  • fever

What are the phases of cyclic vomiting syndrome?

Cyclic vomiting syndrome has four phases:

  • prodrome phase
  • vomiting phase
  • recovery phase
  • well phase

How do the symptoms vary in the phases of cyclic vomiting syndrome?

The symptoms will vary as you go through the four phases of cyclic vomiting syndrome:

  • Prodrome phase. During the prodrome phase, you feel an episode coming on. Often marked by intense sweating and nausea—with or without pain in your abdomen—this phase can last from a few minutes to several hours. Your skin may look unusually pale.
  • Vomiting phase. The main symptoms of this phase are severe nausea, vomiting, and retching. At the peak of this phase, you may vomit several times an hour. You may be
    • quiet and able to respond to people around you
    • unable to move and unable to respond to people around you
    • twisting and moaning with intense pain in your abdomen
  • Nausea and vomiting can last from a few hours to several days.

  • Recovery phase. Recovery begins when you stop vomiting and retching and you feel less nauseated. You may feel better gradually or quickly. The recovery phase ends when your nausea stops and your healthy skin color, appetite, and energy return.
  • Well phase. The well phase happens between episodes. You have no symptoms during this phase.

When should I seek medical help?

You should seek medical help if

You should seek medical help right away if you have any signs or symptoms of dehydration during the vomiting phase. These signs and symptoms may include

  • extreme thirst and dry mouth
  • urinating less than usual
  • dark-colored urine
  • dry mouth
  • decreased skin turgor, meaning that when your skin is pinched and released, the skin does not flatten back to normal right away
  • sunken eyes or cheeks
  • light-headedness or fainting

If you are a parent or caregiver of an infant or child, you should seek medical care for them right away if they have any signs and symptoms of dehydration during the vomiting phase. These signs and symptoms may include

  • thirst
  • urinating less than usual, or no wet diapers for 3 hours or more
  • lack of energy
  • dry mouth
  • no tears when crying
  • decreased skin turgor
  • sunken eyes or cheeks
  • unusually cranky or drowsy behavior

What causes cyclic vomiting syndrome?

Experts aren’t sure what causes cyclic vomiting syndrome. However, some experts believe the following conditions may play a role:

  • problems with nerve signals between the brain and digestive tract
  • problems with the way the brain and endocrine system react to stress
  • mutations in certain genes that are associated with an increased chance of getting CVS

What may trigger an episode of cyclic vomiting?

Triggers for an episode of cyclic vomiting may include:

  • emotional stress
  • anxiety or panic attacks, especially in adults
  • infections, such as colds, flu, or chronic sinusitis
  • intense excitement before events such as birthdays, holidays, vacations, and school outings, especially in children
  • lack of sleep
  • physical exhaustion
  • allergies
  • temperature extremes of hot or cold
  • drinking alcohol
  • menstrual periods
  • motion sickness
  • periods without eating (fasting)

Eating certain foods, such as chocolate, cheese, and foods with monosodium glutamate (MSG) may play a role in triggering episodes.

December 2017
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Thangam Venkatesan, M.D., Medical College of Wisconsin