Cyclic vomiting syndrome (CVS) is a disorder characterized by episodes of
nausea and
vomiting lasting 1 to 5 days, followed by asymptomatic periods. The etiology and pathophysiology of CVS are unknown, but CVS shares similar characteristics to those of
migraine headaches.
Tricyclic antidepressants have the most evidence and are generally effective for prophylaxis of further episodes in patients with CVS. Second-line
pharmacotherapies typically target specific comorbid symptoms or conditions and may include
antiepileptic or antimigraine drugs,
benzodiazepines,
antispasmodics,
proton pump inhibitors,
antiemetics, and
analgesics.
OnabotulinumtoxinA (
ONABoNT-A)
injections have not been studied in the population with CVS but are regarded as a pharmacotherapeutic option for
migraine headaches. We describe a 45-year-old woman with a 5-year history of CVS who had failed previous typical prophylactic
migraine and CVS
pharmacotherapies and was referred to the neurology clinic for management of both of these conditions. On review, the neurologist noted a correlation of the patient's
headaches with her CVS symptoms.
ONABoNT-A injections were started at 155 units intramuscularly every 12 weeks for her
migraine headaches, which also dramatically improved her CVS. The main adverse effect reported by the patient was
numbness and weakness in her left shoulder after the
injections, which are symptoms consistent with
ONABoNT-A injection use; however, these symptoms typically resolved a few days later. Regarded as a pharmacotherapeutic option for
migraine headache prophylaxis,
ONABoNT-A injections have demonstrated modest efficacy in preventing
migraine headaches. Clinicians should be aware that
ONABoNT-A injections may also have a role in the prophylaxis of CVS.