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The expert committee included the President of the <jats:styled-content style=\"fixed-case\">CVSA<\/jats:styled-content> who brought a patient perspective into the deliberations. The committee makes recommendations for the prophylaxis of <jats:styled-content style=\"fixed-case\">CVS<\/jats:styled-content>, treatment of acute attacks, diagnosis, and overall management of <jats:styled-content style=\"fixed-case\">CVS<\/jats:styled-content>. The committee strongly\u00a0 recommends that adults with moderate\u2010to\u2010severe <jats:styled-content style=\"fixed-case\">CVS<\/jats:styled-content> receive a tricyclic antidepressant (<jats:styled-content style=\"fixed-case\">TCA<\/jats:styled-content>), such as amitriptyline, as a first\u2010line prophylactic medication and receive topiramate or aprepitant as alternate prophylactic medications. Zonisamide or levetiracetam and mitochondrial supplements (Coenzyme Q10, L\u2010carnitine, and riboflavin) are conditionally recommended as alternate prophylactic medications, either alone or concurrently with other prophylactic medications. For acute attacks, the committee conditionally recommends using serotonin antagonists, such as ondansetron, and\/or triptans, such as sumatriptan or aprepitant to abort symptoms<jats:bold>.<\/jats:bold> Emergency department treatment is best achieved with the use of an individualized treatment protocol and shared with the care team (example provided). The committee recommended screening and treatment for comorbid conditions such as anxiety, depression, migraine headache, autonomic dysfunction, sleep disorders, and substance use with referral to appropriate allied health services as indicated. Techniques like meditation, relaxation, and biofeedback may be offered as complementary therapy to improve overall well\u2010being and patient care outcomes.<\/jats:p>","DOI":"10.1111\/nmo.13604","type":"journal-article","created":{"date-parts":[[2019,6,26]],"date-time":"2019-06-26T14:06:43Z","timestamp":1561558003000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":119,"title":["Guidelines on management of cyclic vomiting syndrome in adults by the American Neurogastroenterology and Motility Society and the Cyclic Vomiting Syndrome Association"],"prefix":"10.1111","volume":"31","author":[{"given":"Thangam","family":"Venkatesan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Medical College of Wisconsin Milwaukee Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Levinthal","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition University of Pittsburgh Medical Center Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally E.","family":"Tarbell","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Northwestern Feinberg School of Medicine Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safwan S.","family":"Jaradeh","sequence":"additional","affiliation":[{"name":"Stanford University Medical School Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William L.","family":"Hasler","sequence":"additional","affiliation":[{"name":"University of Michigan Health System Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Issenman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology McMaster University Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen A.","family":"Adams","sequence":"additional","affiliation":[{"name":"Cyclic Vomiting Syndrome Association Milwaukee Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Sarosiek","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Texas Tech University Health Sciences Center El Paso Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Stave","sequence":"additional","affiliation":[{"name":"Stanford University Medical School Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi N.","family":"Sharaf","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Department of Healthcare Policy and Research Weill Cornell Medical Center New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahnaz","family":"Sultan","sequence":"additional","affiliation":[{"name":"Minneapolis VA Health Care System Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B U. 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