1.6.1.1 Cyclic vomiting syndrome

A 52-year-old accountant reports that she has now experienced nine of these vomiting attacks. Each emesis episode is preceded by a short prodrome of profound nausea. She is clear that every attack follows an almost identical script for her personally, recurring at intervals she has described as uncannily regular. Once an attack starts, she can be sick up to eight times an hour, and she has never known two attacks to fall less than a week apart. The longest attack, several months ago, ran for six and a half days before it broke. Between attacks, by her own account and her husband's, she is entirely back to normal, working full days with no nausea or fatigue at all. She has a history of well-controlled hypothyroidism and has never smoked. She reports that no other cause has been identified despite this extensive assessment.