Is cyclic vomiting syndrome related to migraine?,☆☆,,★★

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Abstract

Objective: To examine the overlap between cyclic vomiting syndrome (CVS) and migraine by comparing 2 subsets of children with migraine-associated and non-migraine-associated CVS. Methods: We studied all children <18 years of age who met the consensus criteria for CVS after presentation to our pediatric gastroenterology service from 1986 to 1998. The clinical patterns and responses to treatment were obtained from a combination of chart reviews and structured interviews. Results: Among 214 children identified as having CVS, 82% were classified as having migraine-associated CVS based on 1 of 2 criteria—either a family history of migraines or subsequent development of migraine headaches. Compared with the non-migraine CVS subgroup, the migraine subset had milder episodes (20.7 ± 27.3 SD vs 39.5 ± 66.5 emeses/episode, P = .006); more symptoms of abdominal pain (83% vs 66%), headache (41% vs 24%), social withdrawal (40% vs 22%), photophobia (36% vs 16%, all P < .05); more frequent triggering events (70% vs 49%, P = .013) including psychologic stress (39% vs 22%), physical exhaustion (23% vs 3%), and motion sickness (10% vs 0%); and a higher positive response rate to anti-migraine therapy (79% vs 36%, P = .002). Conclusions: The majority of children with CVS were subclassified as having migraine-associated CVS. The migraine-associated subgroup had less severe vomiting, manifested symptoms typical of migraine headaches, and had higher response rates to anti-migraine therapy. These findings strengthen the relationship between migraine and CVS. (J Pediatr 1999;134:567-72)

Section snippets

Study Population

From 1986 to 1998, 277 children <18 years of age presented to the Gastroenterology Service at Columbus Children’s Hospital with at least 3 discrete episodes of vomiting. Of those children, 9 had incomplete information and could not be contacted, 27 had a non-gastrointestinal disorder (eg, brainstem glioma), and 27 had a gastrointestinal disorder (eg, malrotation) identified that was thought, based on its response to treatment, to cause or contribute to the vomiting as previously described.14

RESULTS

Of the 214 children with CVS, 176 (82%) met the criteria for migraine-related CVS and 38 (18%) did not. Among those in the migraine subset, 170 had a positive family history of migraine headaches (55 of whom later experienced migraine headaches), and the 6 who did not have a positive family history subsequently experienced headaches that met the International Headache Criteria for migraines.19 Among those with a family history of migraine, 107 (63%) had it identified on the maternal side alone,

DISCUSSION

Our study of a large cohort of children with CVS indicates that the vast majority of cases may be related to migraines. This conclusion is based on the use of 1 of 2 key criteria to classify affected patients into migraine-associated and non-migraine CVS subgroups—either a positive family history of migraines or subsequent development of migraines in the patient. Our findings support the schema that migraine may present in different patterns during childhood: cyclic vomiting in toddlers and

Acknowledgements

We thank Jan Brickman for assistance of with the references and Brad Pfau, MD, Kim-Ahn Vu, MD, Sam Chiao, Nirav Rana, Allison Robbins, and Ankur Rana for their work on the CVS database.

References (33)

  • T Sato et al.

    Periodic ACTH discharge

    J Pediatr

    (1980)
  • S Gee

    On fitful or recurrent vomiting

    St Bart Hosp Rep

    (1882)
  • Diagnostic criteria for cyclic vomiting syndrome

    J Pediatr Gastroenterol Nutr

    (1995)
  • BK Rachford

    Recurrent vomiting

    Arch Pediatr

    (1904)
  • F Langmead

    On recurrent vomiting of childhood (cyclical vomiting), with the reports of two cases

    BMJ

    (1905)
  • PS Smith

    Cyclic vomiting and migraine in children

    Virginia Med Mon

    (1934)
  • CS Hoyt et al.

    A study of 44 children with the syndrome of recurrent vomiting

    Pediatrics

    (1960)
  • GD Withers et al.

    Precipitants and aetiology of cyclic vomiting syndrome

    Acta Paediatr

    (1998)
  • PO Lundberg

    Abdominal migraine—diagnosis and therapy

    Headache

    (1975)
  • DNK Symon et al.

    Abdominal migraine: a childhood syndrome defined

    Cephalalgia

    (1986)
  • I Abu-Arafeh et al.

    Current controversies—abdominal migraine

    Cephalalgia

    (1993)
  • BT Pfau et al.

    Differentiating cyclic vomiting from chronic vomiting patterns in children: quantitative criteria and diagnostic implications

    Pediatrics

    (1996)
  • J Anderson et al.

    Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriptyline or cyproheptadine

    Pediatrics

    (1997)
  • J Benson et al.

    Sumatriptan [Imitrex] in the treatment of cyclic vomiting

    Ann Pharmacol

    (1995)
  • BUK Li et al.

    Heterogeneity of diagnoses in cyclic vomiting

    Pediatrics

    (1998)
  • I Abu-Arafeh et al.

    Prevalence and clinical features of abdominal migraine compared with those of migraine headache

    Arch Dis Child

    (1995)
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    Supported by Glaxo-Wellcome Inc, the Cyclic Vomiting Syndrome Association, and the Roessler Fund at the Ohio State University.

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    Conflict of interest: Dr Li receives research support from Glaxo Wellcome, Inc.

    Reprint requests: B U. K. Li, MD, Division of Gastroenterology, Columbus Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205-2696.

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