Injectable sumatriptan for cyclic vomiting syndrome in adults: a case series

Objective: To better familiarize the reader with a migraine-related disorder, cyclic vomiting syndrome (CVS) in adults, and to discuss its diagnosis and treatment.

Background: CVS is a profoundly disabling disorder characterized by recurrent, stereotypic episodes of incapacitating nausea and vomiting, separated by completely asymptomatic intervals. CVS episodes tend to start at the same time of day, persist for the same duration, and present with the same intensity and associated symptoms. Most patients experience prodromal symptoms and can identify triggers that precipitate attacks, such as menstruation, lack of sleep, certain foods, physical exertion, and stress. The prevalence of CVS in adults is unknown, but since its occurrence in this age group has been little recognized, patients typically experience lengthy delay in diagnosis or misdiagnosis.

Method: Literature review, case reports, and discussion.

Results: Given genetic links of CVS to migraine, as well as its comorbidity, typical migraine triggers, and response to similar acute and preventive medications, CVS likely represents a disorder on the migraine spectrum.

Conclusion: Adult CVS is not only highly comorbid with migraine, but it responds to migraine preventives, and in some cases to injectable sumatriptan even in the absence of headache.