Cyclic vomiting syndrome.

Cyclic vomiting syndrome (CVS) is characterized by recurrent vomiting episodes. In this study, the mean ages at the onset of symptoms and at the diagnosis of children with cyclic vomiting pattern were 5.7 and 8.0 years, respectively. On average 2.3 years elapsed between the onset and diagnosis, suggesting the difficulty of diagnosing CVS. However, the prevalence of CVS ranges from approximately 0.3% to 2%. Its pathophysiology, prognosis, and natural history need to be further investigated. Various abortive and prophylactic therapies that have been applied in CVS cases were reported. To date, no randomized control study on abortive therapy (i.e., treatment intended to stop a migraine once it starts) for CVS has yet been conducted. Current treatment recommendations are detailed in the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) 2025 guidelines for the management of CVS in children. The NASPGHAN 2025 guidelines for the management of CVS in children recommend non-steroidal anti-inflammatory drugs, triptans, ondansetron, aprepitant, and fosaprepitant for acute medicine. The NASPGHAN 2025 guidelines for the management of CVS in children recommend coenzyme Q10, riboflavin, and magnesium as preventive treatments. The recommended medications include propranolol, cyproheptadine, aprepitant, and amitriptyline. The guidelines also recommend not using the antiseizure medications topiramate and valproic acid. However, antiseizure medications are recommended only for patients who are unresponsive to the aforementioned preventive medications and who have frequent vomiting and severe symptoms.