Anti-Migraine Approach to Treat Cyclic Vomiting Syndrome:Response to Anti-Migraine Therapy in Adult Patients
Abstract
To determine the efficacy of anti-migraine therapy in the treatment of cyclic vomiting syndrome in adult patients.
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.
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).
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.
How to Cite This Article
Khalid A, Hamdani M, Rafique R, Arshad M, Batool M. Anti-Migraine Approach to Treat Cyclic Vomiting Syndrome:Response to Anti-Migraine Therapy in Adult Patients. J Pak Soc Intern Med. 2025;6(3):228–232. doi:10.70302/jpsim.v6i3.2542
Conflict of Interest
All authors declare no competing interests.
Funding
No specific funding was received for this research.
Funder information follows the Crossref Funder Registry standard.
References
- Redon S. Episodic syndromes that may be associated with migraine: What adult neurologists need to know. Rev Neurol (Paris). 2021;177(7):773-8.
- 2-Cheema S, Matharu M. Abdominal migraine and cyclical vomiting syndrome. Handb Clin Neurol. 2023;198(1):209-19.
- ROME Foundation. Rome IV Criteria. [Cited March 2025] Available from: [https://theromefoundation.org/rome-iv/rome-iv-criteria]
- Stanghellini V, Talley NJ, Chan FK, Hasler WL, Malagelada JR, Suzuki H. Rome IV ‐ gastroduodenal disorders. Gastroenterol. 2016;150(6):1380‐92.
- Tang C, Dai N. Highlighting the importance of early diagnosis of cyclic vomiting syndrome in adults: A case report. Medicine (Baltimore). 2019;98(51):e18365.
- Li, B.U. Managing cyclic vomiting syndrome in children: beyond the guidelines. Eur J Pediatr. 2018;177(4):1435-42.
- Li BU, Lefevre F, Chelimsky GG, Boles RG, Nelson SP, Lewis DW, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition consensus statement on the diagnosis and management of cyclic vomiting syndrome. J Pediatr Gastroenterol Nutr. 2008;47(2):379-93.
- Venkatesan T, Tarbell S, Adams K, McKanry J, Barribeau T, Beckmann K, et al. A survey of emergency department use in patients with cyclic vomiting syndrome. BMC Emerg Med. 2010;10(1):4.
- Levinthal DJ, Romutis S, Rajalaban A, Kumar VC, Feldman R, Althouse AD, et al. Greater intolerance to uncertainty predicts poorer quality of life in adults with cyclic vomiting syndrome. Neurogastroenterol Motil. 2021;33(12):e14159
- Hayes WJ, VanGilder D, Berendse J, Lemon MD, Kappes JA. Cyclic vomiting syndrome: diagnostic approach and current management strategies. Clin Exp Gastroenterol. 2018;11(1):77-84
- Venkatesan T, Levinthal DJ, Tarbell SE, Jaradeh SS, Hasler WL, Issenman RM, et al. Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association. Neurogastroenterol Motil. 2019;31(Suppl 2):e13604.
- Bhandari S, Venkatesan T. Clinical characteristics, comorbidities and hospital outcomes in hospitalizations with cyclic vomiting syndrome: a nationwide analysis. Dig Dis Sci. 2017;62(8):2035‐44.
- Bagherian Z, Yaghini O, Saneian H, Badihian S. Comparison of the efficacyof amitriptyline and topiramate in prophylaxis of cyclic vomiting syn-drome. Iran J Child Neurol. 2019;13(1):37–44
- Mooers H, Srivastava S, Venkatesan T. topiramate for cyclic vomiting syndrome—for refractory patients only? Authors' reply. Aliment Pharmacol Ther. 2021;54(4): 502-3.
- Rangan V, Lembo AJ. Topiramate for cyclic vomiting syn-drome – for refractory patients only? Aliment Pharmacol Ther. 2021;54(4):500–1
- Mooers H, Srivastava S, Garacci E, Venkatesan T. Retrospective re-view of patients treated for cyclic vomiting syndrome with topira-mate. Aliment Pharmacol Ther. 2021;54(2):153-9
- Frazier R, Li BU, Venkatesan T. Diagnosis and Management of Cyclic Vomiting Syndrome: A Critical Review. Am J Gastroenterol. 2023;118(7):1157-67.
- Haghighat M, Shahrebabak MG, Dehghani SM, Ataollahi M, Farzaneh NA, Hoseinabadi SH, et al. Relapse Rate of Clinical Symptoms After Stopping Treatment in Children with Cyclic Vomiting Syndrome. Middle East J Dig Dis. 2023;15(1):32-6.
Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.