Cyclic
vomiting of
childhood is characterized by
recurrent attacks of violent or
prolonged vomiting without
headache, which may last for hours. Attacks may be
precipitated by infection, menstruation, or physical or emotional stress.
During the attacks, patients characteristically show other symptoms of
migraine such as nausea, lethargy, yawning, and drowsiness.
Cyclic vomiting is thought
to result from abnormal activity in the area postrema. Additionally,
gastroparesis, which occurs during migraine, has been implicated as an
etiologic factor for cyclic vomiting and abdominal migraine. Cyclic vomiting should be
suspected in children presenting with recurrent attacks of vomiting without
headache, especially when a family history of migraine is present. In children with cyclic
vomiting, a serum lactate level is helpful in excluding mitochondrial
disorders. Other tests including, upper and lower gastrointestinal series and
vagal autonomic function testing, are rarely indicated. In childhood periodic
vomiting syndrome, early use of intravenous fluids containing adequate glucose
(to prevent a catabolic state) and analgesics may abort the attack. Some
patients respond to the triptans or ergotamine classes of medication.
Antiemetic drugs are usually not effective, but ondansetron may be more
efficacious given its central mechanism of action. Preventive medications such
as cyproheptadine and tricyclic antidepressants are preferred in children.
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