Differential diagnosis of cyclic vomiting syndrome

Medications and toxic etiologies	Disorders of the gut and peritoneum	Neurologic causes	Endocrinologic and metabolic causes	Gynecologic or urologic disorders	Miscellaneous causes
Cancer chemotherapy Analgesics (eg, aspirin, NSAIDs, narcotics) Cardiovascular medications and diuretics Hormonal therapies (oral antidiabetic agents, contraceptives) Antibiotics/antivirals Erythromycin Tetracycline Sulfonamides Antituberculous drugs Acyclovir CNS-active drugs (eg, antiparkinsonian drugs, antiseizure medications) Antiasthmatics Radiation therapy Jamaican vomiting sickness (unripe ackee fruit) Drug misuse and abuse Cannabinoid hyperemesis syndrome Ethanol abuse Nicotine use Hypervitaminosis A Apomorphine poisoning (medical child abuse)	Mechanical obstruction Gastric outlet obstruction Malrotation with intermittent volvulus* Superior mesenteric artery syndrome Median arcuate ligament syndrome Duodenal atresia, web, or diverticulum Other causes of small bowel obstruction Functional gastrointestinal disorders Nonulcer dyspepsia Functional vomiting* Dysmotility Gastroparesis* Chronic intestinal pseudo-obstruction Peptic and inflammatory Peptic ulcer disease* Eosinophilic esophagitis* Crohn disease Recurrent subacute appendicitis Inflammatory intraperitoneal disease Visceral Cholecystitis/ cholelithiasis/ biliary dyskinesia Choledochal cysts Pancreatitis Hepatitis Gastrointestinal infections* Pinworms, Blastocystis hominis, Entamoeba histolytica, Giardia, Gastrospirillum Miscellaneous Mesenteric ischemia Retroperitoneal fibrosis	Migraine and variants* Migraine headache* Abdominal migraine* Increased intracranial pressure Hydrocephalus (primarily infants and toddlers)* Chiari type I malformation* Malignancy (eg, brainstem tumors) Stroke Infection Congenital malformation Pseudotumor cerebri Seizure disorder^¶ Demyelinating disorders Emotional responses (eg, pain) Psychiatric disease Functional vomiting Anxiety disorders Depression Anorexia nervosa Bulimia nervosa Labyrinthine disorders Benign paroxysmal positional vertigo Motion sickness Labyrinthitis Menière disease Iatrogenic Fluorescein angiography Chronic sinusitis*	Inborn errors of metabolism (primarily infants and toddlers)* Organic acidemias, urea cycle defects, fatty acid oxidation disorders Uremia Diabetic ketoacidosis* Hyperparathyroidism, hypoparathyroidism Hyperthyroidism Adrenal insufficiency Acute intermittent porphyria	Pregnancy Urolithiasis Ovarian cyst Premenstrual syndrome Uteropelvic junction obstruction*	Postoperative nausea and vomiting* Cardiac disease Myocardial infarction Heart failure Radiofrequency ablation^Δ Postural orthostatic tachycardia syndrome (POTS)* Starvation

NSAIDs: nonsteroidal antiinflammatory drugs; CNS: central nervous system.

* Indicates disorders that are more common considerations for children^[1].

¶ Seizure disorders that may mimic cyclic vomiting syndrome include early-onset childhood occipital epilepsy (Panayiotopoulos syndrome) or temporal lobe epilepsy^[2].

Δ Vomiting after radiofrequency ablation is very common but may be anesthesia related^[3,4].

References:

Li BU, Murray RD, Heitlinger LA, et al. Heterogeneity of diagnoses presenting as cyclic vomiting. Pediatrics 1998; 102:583.
Carbonari G, Tonti G, Di Pisa V, et al. Pediatric epilepsies misdiagnosed as gastrointestinal disorders. Epilepsy Behav 2018; 83:137.
Tyndall A, Nyström KV, Funk M. Nausea and vomiting in patients undergoing radiofrequency catheter ablation. Am J Crit Care 1997; 6:437.
Erb TO, Hall JM, Ing RJ, et al. Postoperative nausea and vomiting in children and adolescents undergoing radiofrequency catheter ablation: a randomized comparison of propofol- and isoflurane-based anesthetics. Anesth Analg 2002; 95:1577.

Original table modified for this publication. From: Quigley EMM, Hasler WL, Parkman HP. AGA technical review on nausea and vomiting. Gastroenterology 2001; 120:263. Table used with the permission of Elsevier Inc. All rights reserved.

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Differential diagnosis of cyclic vomiting syndrome