A 30-year-old man presented with a 10-year history of recurrent, stereotypic episodes of incapacitating
nausea and
vomiting. Initially, he had been diagnosed as having
superior mesenteric artery syndrome, and had undergone abdominal surgery at age 20. The patient was in good health between episodes. During each episode, oral intake was impossible and
total parenteral nutrition and sedation were necessary. Conventional
antiemetics such as
metoclopramide were not effective, and the
5-HT3 antagonist ondansetron hydrochloride was only partially effective. Investigations into gastrointestinal, hormonal, and metabolic function were unremarkable, as was psychiatric evaluation. Diagnosing this to be an adult case of
cyclic vomiting syndrome, we administered
amitriptyline hydrochloride; a prophylactic agent for
migraine. This resulted in rapid resolution of the episodes, which have not recurred over several years' follow up. Recently,
cyclic vomiting syndrome has been considered a subtype of
migraine. In the present case, effectiveness of the
tricyclic antidepressant amitriptyline hydrochloride indicated that
migraine and
cyclic vomiting syndrome have a common pathology. Clinicians should be aware that
cyclic vomiting syndrome can affect adults as well as children, and that treatment for
migraine may be effective.