Cyclic Vomiting Syndrome (CVS) - Management Algorithm
General Approach:
- Identify and avoid triggers
- Good sleep hygiene
- Healthy diet (avoid fasting)
- Stress management
Treat Comorbidities (psychiatric disorders, heavy cannabis use, autonomic dysfunction, migraine, etc):
- Seek consultation as needed
- Counseling for cannabis cessation
Mild (<4 episodes / year, Brief episodes (≤2 days), Quick recovery from episodes, No ED visits or hospitalizations):
- Triptans (intranasal or SQ)
- Ondansetron
- Phenothiazines
- Antihistamine
- Consider CoQ10
Moderate/Severe (≥4 episodes / year, Longer episodes (>2 days), Long recovery from episodes, ED visits and/or hospitalizations):
• Provide Abortive Tx
- Triptans (intranasal or SQ)
- Ondansetron
- Phenothiazines
- Antihistamines
- Benzodiazepines
• Give Prophylactic Tx: TCA or Topiramate and CoQ10
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