JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v6i3.2542 jpsim.v6i3.2542 Original Research Anti-Migraine Approach to Treat Cyclic Vomiting Syndrome: Response to Anti-Migraine Therapy in Adult Patients Khalid Abdul abdulkhalid301@gmail.com * Hamdani Mazhar Rafique Rubina Arshad Muhammad Batool Marium Abbass Institute of Medical Sciences Muzaffarabad, Azad Jammu & Kashmir Medical College Muzaffarabad *Correspondence: Abdul Khalid (abdulkhalid301@gmail.com) 23 08 2025 2025 6 3 228 232 13 09 2024 03 02 2025 24 07 2025 Copyright © 2025 The Author(s) 2025 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives

To determine the efficacy of anti-migraine therapy in the treatment of cyclic vomiting syndrome in adult patients.

 Methodology

A prospective study was conducted at the Abbas Institute of Medical Sciences (AIMS), between March 2021 and February 2024. All adult patients with the diagnosis of Cyclic Vomiting Syndrome (CVS) as per ROME-IV criteria, were included in the study from outpatient departments of neurology and internal medicine. These patients were treated with anti-migraine therapies. The efficacy of individual drugs was assessed, and then the anti-migraine treatment as a composite group was also evaluated.

 Results

A total of 21 patient were included in the study, 62% (13) were female and 38% (8) were male patients. The mean age was 31.3 years, with a range of 14 to 51 years. The mean duration of symptoms was 18.7 months and ranged from 12 to 60 months. The mean duration of treatment after diagnosis with anti-migraine therapy was 2.14 months with a minimum of 1 month and a maximum of 4 months (SD ± 0.9). The mean frequency of symptoms was 4 (SD ± 2.4) episodes and varied from 2 to 8 episodes per year. There was a complete response to treatment with resolution of symptoms in 57% (12), 28% (6) had a partial response, and 14% (3) had no response to treatment. The most effective treatment intervention was found to be topiramate, with a complete response and resolution of symptoms in 43% of the study population. Propranolol was effective in 29%, cinnarizine and amitriptyline were effective each in 14% of patients. As a composite group, the efficacy of anti-migraine treatment was statistically significant (p-0.03).

 Conclusion

The diagnosis of cyclic vomiting syndrome is clinical, as there are no available specific diagnostic tests or biomarkers. An anti-migraine treatment approach during the inter-episode phase of CVS was effective.

 Keywords Cyclic Vomiting Syndrome anti-migraine therapy Ethics Statement

Ethics committee: Ethics Committee, Abbas Institute of Medical Sciences, Muzaffarabad, Azad Jammu & Kashmir, Pakistan. Approval number: 5476/AIMS/2021, dated February 9, 2021.

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