9: Cyclic vomiting syndrome and abdominal migraine

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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
B3b. Cyclic Vomiting Syndrome
H. Childhood Functional GI disorders Child/Adolocent
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
Supportive Remark
History or family history of migraine headaches.
After appropriate evaluation, the symptoms cannot be fully explained by another medical condition.
*Criteria fulfilled for at least 6 months prior to diagnosis.