Navigating the New 2025 Guidelines: A Parents Guide to Cyclical Vomiting Syndrome

Text Dr. Lenz any feedback or questions 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 Click here for the YouTube Channel Click here for the YouTube channel Support the show When I started this podcast and YouTube Channel—and the book that came before it—I had my patients in mind. Office visits are short, but understanding complex, often misunderstood conditions like fibromyalgia takes time. That’s why I created this space: to offer education, validation, and hope. If you’ve been told fibromyalgia “isn’t real” or that it’s “all in your head,” know this—I see you. I believe you. This podcast aims to affirm your experience and explain the science behind it. Whether you live with fibromyalgia, care for someone who does, or are a healthcare professional looking to better support patients, you’ll find trusted, evidence-based insights here, drawn from my 29+ years as an MD. Please remember to talk with your doctor about your symptoms and care. This content doesn’t replace per...