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2025 Pediatric Cyclic Vomiting Syndrome (CVS) Guidelines: A Brain–Gut, Migraine-Based Action Plan

The script explains updated 2025 guidelines for pediatric cyclic vomiting syndrome (CVS), framing CVS as a disorder of gut–brain interaction and a “migraine equivalent,” with up to 82% of affected children having personal or family migraine history, shifting treatment focus to the central nervous system. It highlights links to nociplastic pain/central sensitization and higher rates of neurodivergence (ADHD, autism), supporting a holistic biopsychosocial approach and trigger management, especially consistent sleep. Key terminology (abortive vs prophylactic therapy, strong vs conditional recommendations) is clarified. The only strong recommendation is early abortive anti-migraine therapy (triptans like sumatriptan or high-dose NSAIDs like ibuprofen) during prodrome; conditional options include aprepitant, ondansetron, and early IV rehydration. Prevention starts with lifestyle and supplements (riboflavin, CoQ10), then escalates to propranolol, cyproheptadine, or amitriptyline; topiramate is generally avoided unless others fail. The guidelines address catamenial and “calendar time” CVS, distinguish CVS from cannabinoid hyperemesis syndrome via six months of cannabis cessation, and emphasize creating a written green/yellow/red CVS action plan for home, school, and emergency care.

00:00 Lost in the Fog
01:56 CVS as Brain Gut Disorder
04:19 Migraine Link Explained
06:13 Nociplastic Pain and Sensitization
08:48 Neurodivergence Connection
10:50 Guideline Terms Decoded
13:26 Abortive Rescue Plan
17:18 Preventing Future Episodes
22:05 Special Subtypes and CHS
24:08 Action Plan Zones
26:04 Holistic Approach and Wrap Up

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