Treatment options for cyclic vomiting syndrome

Since its initial description nearly two centuries ago, treatment of idiopathic cyclic vomiting syndrome (CVS) remains largely empiric because of its obscure pathogenesis and the paucity of controlled therapeutic trials. Despite these challenges, this report reviews open-label trials, retrospective case series, and upcoming consensus guidelines to update the treatment. The treatment approach to a patient with CVS should include consideration of lifestyle changes including avoidance of potential triggers, prophylactic drug therapy to prevent subsequent episodes, abortive and/or supportive care treatment during acute episodes, and support of the family. The mainstays of drug therapy include antimigraine, anti-emetic, and anticonvulsive medications used for prophylactic, abortive, and supportive therapy, with reported efficacies of between 40% and 90%. Prophylactic antimigraine and anticonvulsive agents are used to prevent episodes. Antimigraine triptans are used to abort episodes. Antiemetic agents can reduce the severity of episodes and are best used in conjunction with sedatives.