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Is cyclic vomiting syndrome related to migraine?
B U Li1, R D Murray, L A Heitlinger
1Department of Pediatrics, The Ohio State University, Columbus Children's Hospital, Columbus, Ohio, USA.
Insights
Most children with cyclic vomiting syndrome (CVS) also have migraine. Migraine-associated CVS in children presents with milder vomiting, more migraine symptoms, and better response to migraine treatments.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Genetics
Background:
- Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of intense nausea and vomiting.
- The relationship between CVS and migraine, particularly in pediatric populations, requires further elucidation.
- Understanding this association can inform diagnosis and treatment strategies for children experiencing CVS.
Purpose of the Study:
- To investigate the prevalence and clinical characteristics of migraine-associated CVS in children.
- To compare pediatric patients with migraine-associated CVS to those with non-migraine-associated CVS.
- To determine the impact of migraine association on episode severity and treatment response.
Main Methods:
- A retrospective study of children under 18 diagnosed with CVS between 1986 and 1998.
- Data collection through chart reviews and structured interviews to assess clinical patterns and treatment outcomes.
- Classification of CVS into migraine-associated (based on family history or personal development of migraines) and non-migraine-associated subgroups.
Main Results:
- 82% of 214 pediatric CVS patients had migraine-associated CVS.
- Migraine-associated CVS subgroup experienced milder vomiting episodes (20.7 vs. 39.5 emeses/episode).
- This subgroup also reported more symptoms like abdominal pain, headache, social withdrawal, photophobia, and responded better to anti-migraine therapy (79% vs. 36%).
Conclusions:
- The majority of pediatric CVS cases are associated with migraine.
- Migraine-associated CVS in children exhibits distinct clinical features, including less severe vomiting and migraine-like symptoms.
- These findings reinforce the strong link between migraine and CVS, suggesting shared pathophysiology.
Objective:
To examine the overlap between cyclic vomiting syndrome (CVS) and migraine by comparing 2 subsets of children with migraine-associated and non-migraine-associated CVS.
Methods:
We studied all children <18 years of age who met the consensus criteria for CVS after presentation to our pediatric gastroenterology service from 1986 to 1998. The clinical patterns and responses to treatment were obtained from a combination of chart reviews and structured interviews.
Results:
Among 214 children identified as having CVS, 82% were classified as having migraine-associated CVS based on 1 of 2 criteria either a family history of migraines or subsequent development of migraine headaches. Compared with the non-migraine CVS subgroup, the migraine subset had milder episodes (20.7 27.3 SD vs 39.5 66.5 emeses/episode, P =.006); more symptoms of abdominal pain (83% vs 66%), headache (41% vs 24%), social withdrawal (40% vs 22%), photophobia (36% vs 16%, all P <.05); more frequent triggering events (70% vs 49%, P =.013) including psychologic stress (39% vs 22%), physical exhaustion (23% vs 3%), and motion sickness (10% vs 0%); and a higher positive response rate to anti-migraine therapy (79% vs 36%, P =.002).
Conclusions:
The majority of children with CVS were subclassified as having migraine-associated CVS. The migraine-associated subgroup had less severe vomiting, manifested symptoms typical of migraine headaches, and had higher response rates to anti-migraine therapy. These findings strengthen the relationship between migraine and CVS.