P5090 - Prolonged Prophylactic Migraine Therapy Associated With Reduction in Frequency and Severity of Cyclic Vomiting Syndrome Episodes: A Retrospective Review

Jason C. Truong, DO, MS¹, Amruth A. Alluri, BA²
1HCA Medical City Healthcare UNT-TCU GME (Arlington), Arlington, TX; 2American University of the Caribbean School of Medicine, Miami, FL

Introduction: Cyclic Vomiting Syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of severe nausea and vomiting, often with periods of normal health in between. Increasing evidence supports a shared pathophysiology between CVS and migraine, with overlapping triggers and familial associations. This study evaluates whether long-term use of migraine prophylactic medications correlates with reduced frequency and severity of CVS episodes.

Methods: We conducted a retrospective chart review of adult patients diagnosed with CVS between 2014 and 2023 at two academic medical centers. Patients with coexisting migraine diagnoses who were treated with prophylactic medications for ≥6 months were included. Prophylactic therapies included amitriptyline, propranolol, topiramate, and candesartan. Frequency, duration, and severity of CVS episodes were compared before and after initiation of prophylaxis. Secondary outcomes included ER visits and hospital admissions for CVS.

Results: Of 54 patients with CVS, 16 met inclusion criteria. Mean episode frequency declined from 5.2 episodes/year pre-treatment to 1.6 episodes/year post-treatment (p< 0.001). Average episode duration also decreased from 3.4 days to 1.7 days (p=0.002). Eleven patients (68.8%) reported significant improvement in nausea severity. Emergency department visits declined by 58%, and hospitalization rates were reduced by 45%. Amitriptyline was the most commonly prescribed agent (52%), followed by propranolol (28%). Patients on combination therapy (n=11) demonstrated the greatest overall reduction in symptoms.

Discussion: These findings lend credence to the hypothesis that CVS may be on the migraine spectrum and that migraine prophylaxis may offer substantial benefit in reducing both the frequency and severity of CVS episodes. While data are retrospective and observational, the improvements seen across multiple outcome measures are compelling. Prospective trials are warranted to further evaluate the role of migraine-directed therapies in CVS management, particularly in adult populations.

Disclosures:
Jason Truong indicated no relevant financial relationships.
Amruth Alluri indicated no relevant financial relationships.

Jason C. Truong, DO, MS¹, Amruth A. Alluri, BA². P5090 - Prolonged Prophylactic Migraine Therapy Associated With Reduction in Frequency and Severity of Cyclic Vomiting Syndrome Episodes: A Retrospective Review, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.