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Cyclic Vomiting Syndrome
R11.15 · Cyclical vomiting
Cyclic Vomiting Syndrome
Episodes of intense nausea and vomiting that come in cycles, with full recovery between attacks. Long delay to diagnosis is the rule.
8 yrs
average delay from first symptoms to a CVS diagnosis
Quick answer
Cyclic Vomiting Syndrome is a real, named pattern, not 'stomach flu' coming back. It runs in four phases: a calm baseline, a warning phase, a vomiting phase, and recovery. The right plan can shrink episodes from days to hours and stretch the time between them.
Cyclic vomiting syndrome (CVS, ICD-10 R11.15) is a disorder of gut-brain interaction defined by stereotypic episodes of intense nausea and vomiting separated by symptom-free intervals, with no structural cause. Rome V (2026) formalized adult diagnostic criteria for the first time and reports adult prevalence of approximately 2%. The episodes are predictable in shape; the triggers are usually neurologic and circadian, not infectious or dietary.
Patterns and subtypes
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Prodrome
The warning phase
Symptoms
- Pale, sweaty, 'off'
- Cold extremities
- Loss of appetite
- Anxiety
Triggers
- Sleep loss
- Migraine triggers
- Period of high stress
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Emetic
The vomiting phase
Symptoms
- Nausea and vomiting in waves
- 5+ episodes/hour at peak
- Lasts hours to days
Triggers
- Once started, hard to stop
- Dehydration spirals it
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Recovery
Returning to baseline
Symptoms
- Slow eating
- Fatigue
- Catching up on sleep
Triggers
- Pushing too soon
- Skipping prophylaxis
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Interictal
Between episodes
Symptoms
- Feels normal
- Window for prevention
- Build the routine
Triggers
- Drift from sleep, hydration, B1
What your doctor might miss
It's not 'just food poisoning.'
Repeated ER visits for 'viral gastroenteritis' with full recovery between is the classic CVS pattern. The clue is the recovery in between, not the episode itself.
Migraine link is real.
CVS sits on the migraine spectrum. People with CVS often have a personal or family history of migraine. The same prevention drugs help both.
Cannabis use changes the diagnosis.
Heavy cannabis use can drive a CVS-like pattern that resolves with stopping. That's cannabinoid hyperemesis (CHS), a separate Rome V diagnosis.
Red flags
Urgent — ER now
- Vomiting blood or coffee-ground material
- Severe belly pain different from your usual
- Fever > 101°F
- Confusion or trouble waking
- No urination for 12+ hours
Needs evaluation
- New CVS-like pattern after age 50
- Headache with focal neurological signs
- Pregnancy
- Severe weight loss across episodes
- Episodes lasting longer than usual
Mimics
- Cannabinoid hyperemesis (CHS) — heavy cannabis + hot shower relief.
- Migraine — headache-prominent. Same prevention drugs help both.
- Bowel obstruction — imaging during the episode.
- Diabetic ketoacidosis — glucose, ketones.
The treatment ladder
01 · Track
Track.
Log every episode in MeNome: trigger, prodrome length, peak, recovery. Patterns emerge in 6 to 8 weeks.
02 · Adjust
Adjust.
Sleep first. Then food triggers (chocolate, aged cheese, MSG for some). Stop cannabis if heavy use is in the picture.
03 · Stabilize
Stabilize.
Daily prevention is the win. Most patients get tricyclic prophylaxis or topiramate. CoQ10 + B1 + magnesium support the same circuits.
04 · Support
Support.
MGB+ Calm pairs calming magnesium with benfotiamine and brain-cell support. Built for the prevention window.
See MGB+ Calm → →
CVS questions
Frequently asked
How is CVS different from 'I just throw up sometimes'?
CVS is a stereotyped pattern: episodes look the same each time, with full recovery between. Most adults have 4 or more episodes a year, with episodes lasting at least an hour. Random one-off vomiting from food or virus is not CVS. The pattern is the diagnosis.
Why does it take 8 years to get diagnosed?
Each episode looks like a stomach virus on its own. The pattern only shows up over time. Many patients hit 5+ ER visits before someone names the pattern. That's why we built our Visit Prep tool. Walking in with a printed history of episodes shortens the diagnostic loop.
Is CVS related to migraine?
Yes. Most adults with CVS have a personal or family history of migraine. The same nerve circuits and the same prevention drugs (tricyclic antidepressants, topiramate, magnesium, B2) help both. CVS is sometimes called 'abdominal migraine' in kids.
Can I prevent an episode once the prodrome starts?
Sometimes. The 'abort' plan involves rest, hydration, ondansetron, sumatriptan in some patients, and a quiet, dark room. The earlier you act, the better. Most people work out their personal abort kit with their neurologist or GI.
Will MGB+ Calm replace my prevention medication?
No. Calm is built to support the same circuits with magnesium, benfotiamine, CoQ10, and riboflavin (the same B2 dose used in migraine prevention guidelines). It layers on top of your prescription plan. Talk to your prescriber before changing any medication.
Is cannabis a trigger?
For some, yes. Heavy daily cannabis use can drive a CVS-like pattern that only resolves with stopping. That's cannabinoid hyperemesis (CHS), a separate Rome V diagnosis. If you use cannabis daily and have this pattern, please read our CHS page.
Should I see a neurologist or a gastroenterologist?
Both, ideally. A GI rules out other causes (gastroparesis, obstruction, ulcer). A neurologist with migraine experience often runs the prevention plan. Some major centers have CVS-specific clinics now.