Many of my patients smoke or vape cannabis and tell me that they find it very helpful for their anxiety. One of them told me that she had been having repeated bouts of vomiting and abdominal pain, that she was undergoing various tests for it, and that she had been diagnosed with cyclic vomiting syndrome. I had no idea what that was and my only response was to make my usual joke about how doctors use jargon to impress their patients. The patient tells the doctor that s/he has a headache and doesn’t know what is causing it and the doctor diagnoses the patient as having “idiopathic cephalgia”! The patient tells the doctor that she has cycles of intermittent vomiting and the doctor diagnoses her with “cyclic vomiting syndrome”.
But, a few weeks later, her primary care physician called me to discuss the case and told me that she thought that the patient’s cycles of vomiting and abdominal pain were being caused by the cannabis. I had never heard of such a thing! But, I started to read about it and learned that there is a whole literature on Cannabinoid Hyperemesis Syndrome (CHS), which I will summarize for you on this website.
It is a condition that is associated with excessive use of cannabinoids (cannabis or substances derived from cannabis). Its typical symptoms are intermittent (“cyclical”) nausea and vomiting. Most of these patients also have abdominal pain that is diffuse; that is, the pain is all over the abdomen. Cannabis has antiemetic effects and is sometimes used in patients on cancer chemotherapy. The reason why cannabis can paradoxically cause nausea and vomiting is not clear but may have to do with desensitization of cannabinoid receptors.
After learning about Cannabinoid Hyperemesis Syndrome (CHS), it struck me that I have another two patients who use cannabis and have longstanding problems with unexplained intermittent abdominal pain, nausea, and vomiting! Maybe you too might have a patient with this condition? Even if you don’t have such a patient at this time, as cannabis use is rising, mental health clinicians are likely to encounter more such patients in the future. So, we should learn at least the basics about it. A word of caution: we cannot count on the non-mental-health clinicians who are evaluating the patient to know about CHS. Often, the mental health clinician may have to be the one who brings up the possibility of this diagnosis.
On another page on this website, we’ll learn more about the clinical features of CHS including an unusual one that helps to diagnose it. See Related Pages below.
This page has been peer-reviewed by Kevin Hill, MD, in March 2019. Dr. Hill is the Director of Addiction Psychiatry, at Beth Israel Deaconess Medical Center in Boston, Massachusetts and an Assistant Professor of Psychiatry at Harvard Medical School.
Related Pages
Cannabinoid Hyperemesis Syndrome (CHS): Clinical features
Cannabinoid Hyperemesis Syndrome (CHS): Management
References
Bajgoric S, Samra K, Chandrapalan S, Gautam N. Cannabinoid hyperemesis syndrome: a guide for the
Blumentrath CG, Dohrmann B, Ewald N. Cannabinoid hyperemesis and the cyclic vomiting syndrome in adults: recognition, diagnosis, acute and long-term treatment. Ger Med Sci. 2017 Mar 21;15
King C, Holmes A. Cannabinoid hyperemesis syndrome. CMAJ. 2015 Mar 17;187(5):355.
Lu ML, Agito MD. Cannabinoid hyperemesis syndrome: Marijuana is both antiemetic and proemetic. Cleve Clin J Med. 2015 Jul;82(7):429-34. doi: 10.3949/ccjm.82a.14023. Review. PubMed PMID: 26185942.
Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review. J Med Toxicol. 2017 Mar;13(1):71-87. doi: 10.1007/s13181-016-0595-z. Epub 2016 Dec 20. Review. PubMed PMID: 28000146; PubMed Central PMCID: PMC5330965.
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Disclaimer: The content on this website is provided as general education for medical professionals. It is not intended or recommended for patients or other lay persons or as a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified health care professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most recently updated information.
Concur with diagnostic utility of asking regarding hot showers.
Topical capsaicin provides some relief and tentative mechanisms have related the two
Clinical pearl: Patients with hyperemsis syndrome (HES) feel better from long hot showers. A new patient was referred for psychiatric evaluation of why she was having cyclic vomiting. She smoked several mj joints each day. She tolerated these until going off them during pregnancy, and when she resumed post-partum, she began having these vomiting cycles. Knowing that patients with HES feel better when they take LONG HOT showers, I asked her, and in fact she was taking piping hot showers for half an hour every day, having learned empirically that she felt better. She would not discontinue MJ completely, but she got the dose down to where she no longer experienced any nausea, vomiting, or pain. When you suspect HES, always ask if they feel better from long hot showers.
Colorado of course has seen a huge increase since in these cases presenting to ERs
Treatment: stop the cannabis