A Comparison of Dysautonomias Comorbid with Cyclic Vomiting Syndrome and with Migraine

Abstract

Cyclic vomiting syndrome (CVS) shares many features with migraine headache, including auras, photophobia, and antimigrainous treatment response being traditionally viewed as a migraine variant. Aims. To determine whether CVS is associated with the same disorders as migraine headache, and compare these associations to those in healthy control subjects. Methods. Cross-sectional study of patients utilizing the ODYSA instrument, evaluating the probability of 12 functional/autonomic diagnoses, CVS, migraine, orthostatic intolerance (OI), reflex syncope, interstitial cystitis, Raynaud's syndrome, complex regional pain syndrome (CRPS), irritable bowel syndrome, functional dyspepsia, functional abdominal pain, fibromyalgia, and chronic fatigue syndrome. Control subjects were age-matched gender-matched friends. Patients had to fulfill criteria for CVS or migraine, while control subjects could not. Results. 103 subjects were studied, 21 with CVS, 46 with migraine and 36 healthy controls. CVS and migraine did not differ in the relative frequencies of fibromyalgia, OI, syncope, and functional dyspepsia. However, CVS patients did demonstrate a significantly elevated frequency of CRPS. Conclusions. Although CVS and migraine clearly share many of the same comorbidities, they do differ in one important association, suggesting that they may not be identical in pathophysiology. Since OI is common in CVS, treatment strategies could also target this abnormality.

Syncopal migraine

“…Additionally, the syncopal migraine group also has a significantly higher rate of QSART abnormalities. This finding was also reported in a prior study of another form of atypical migraine, cyclic vomiting syndrome [9].…”

Nausea and Vomiting

“…The refl ex appears to be absent in Rodentia (e.g., laboratory rats and mice) and Lagomorpha (e.g., rabbits and hares) [ 12 ]. In Horn Cisplatin [ 54 , 55 ] Nicotine [ 109 ] Apomorphine [ 110 ] Morphine [ 111 ] Motion [ 112 ] 5-HT 1A CuSO4 [ 114 ] Cisplatin [ 114 ] Nicotine [ 114 ] Motion [ 113 ] H 1 histamine 1, M (3/5) et al, we tested representative members of the three main groups of rodents (mouse-related, Ctenohystrica, and squirrel-related) and none were found to have emetic responses to apomorphine, CuSO 4 , or veratrine (a plant alkaloid) [ 34 ]. Using an isolated perfused brainstem preparation, we also showed that laboratory rats and mice lack any coordinated neural efferent activity that would indicate emesis, compared to musk shrew controls [ 34 ].…”

“…Altered serotonergic (5-HT) signaling has been postulated as a factor in IBS with increased circulating levels of 5-HT demonstrated in diarrheal-predominant IBS and decreased 5-HT levels in constipation-predominant IBS [ 109 ]. The importance of 5-HT in IBS is highlighted by the use of selective serotonergic agonists and antagonists in the treatment of different IBS phenotypes [ 110 ]. Alterations of the gut microbiome is also proposed to be an important factor in the pathophysiology of IBS with studies suggesting that IBS patients show an abundance of fi rmicutes and/or decrease in bacteroidetes bacteria [ 111 ].…”

“…A study of 21 patients with CVS, 40 patients with migraines, and 36 healthy controls explored the association of CVS and migraines with other disorders thought to have autonomic abnormalities as their pathogenic basis-orthostatic intolerance, reflex syncope, interstitial cystitis, Raynaud's syndrome, chronic regional pain syndrome (CRPS), irritable bowel syndrome, functional dyspepsia, functional abdominal pain, fibromyalgia, and chronic fatigue syndrome [110]. Adult CVS was significantly associated with orthostatic intolerance and fibromyalgia as compared to controls.…”

NextGen nuclear DNA sequencing in cyclic vomiting syndrome reveals a significant association with the stress‐induced calcium channel (RYR2)

“…Comorbid symptoms commonly experienced by patients with CVS include migraine headaches, anxiety, gut dysmotility (e.g., constipation), and postural orthostatic tachycardia syndrome, all of which are conditions associated with aberrant autonomic control. The autonomic nervous system plays an essential role in the responses to emetic activators.…”