title: [An adult case of cyclic vomiting syndrome in which tricyclic antidepressant was effective].
abstract: 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.
authors.affiliation: Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Sciences.
authors.forename: Manabu
authors.initials: M
authors.lastname: Hattori
authors.forename: Norihiko
authors.initials: N
authors.lastname: Uematsu
authors.forename: Hideka
authors.initials: H
authors.lastname: Nakazawa
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Matsukawa
authors.forename: Takemori
authors.initials: T
authors.lastname: Yamawaki
authors.forename: Kosei
authors.initials: K
authors.lastname: Ojika
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008881:Migraine Disorders; D010507:Periodicity; D013577:Syndrome; D016896:Treatment Outcome; D014839:Vomiting / Q000188:drug therapy*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline