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EspañolCannabis hyperemesis syndrome (CHS) symptoms: What are the early signs of cannabis hyperemesis syndrome?
Overview: What does cannabis hyperemesis syndrome (CHS) feel like?
Cannabinoid hyperemesis syndrome (CHS) is an increasingly common gastrointestinal disorder involving recurrent bouts of vomiting in chronic marijuana users. The pathophysiology is not fully understood but is considered a nervous system disorder. Long-term exposure to THC inactivates cannabinoid receptors in the part of the brain responsible for controlling gastric motility. Early signs of CHS are similar to morning sickness: nausea and stomach pain in the morning. Later repeated bouts of overwhelming vomiting, maybe four times in an hour or over a dozen a day, are known to occur. The abdomen often feels crampy and painful. One of the hallmark features of CHS is the resolution of symptoms by taking a hot shower or hot bath. The most defining sign of CHS is that recurrent vomiting clears up when people quit marijuana or THC.
Key takeaways:
Cannabis hyperemesis syndrome is an increasingly common condition that affects longtime regular users of marijuana products.
Early signs of cannabis hyperemesis syndrome are morning nausea and abdominal cramps.
Serious symptoms of cannabis hyperemesis syndrome, such as severe vomiting or dehydration, may require immediate medical attention.
Cannabis hyperemesis syndrome is caused by long-term regular cannabis or THC (tetrahydrocannabinol) use. It does not seem to be related to the use of cannabidiol (CBD). You may be at risk for developing cannabis hyperemesis syndrome symptoms if you use cannabis products containing THC at least once weekly or have been using cannabis products since adolescence.
Cannabis hyperemesis syndrome requires a medical diagnosis.
Cannabis hyperemesis syndrome generally requires treatment. Cannabis hyperemesis syndrome symptoms typically resolve with cessation of cannabis use within weeks. Hot water (baths or showers) can help relieve vomiting during a vomiting episode. Intravenous fluids administered in a hospital or emergency room may be necessary during a vomiting episode to resolve severe dehydration but do not treat the cause of the vomiting.
The only successful treatment of cannabis hyperemesis syndrome is cessation of cannabis use. Acute treatment of severe vomiting episodes may include hot water, supportive care, oral rehydration, IV fluids, capsaicin cream, or prescription drugs, but these drugs may not be effective.
Untreated cannabis hyperemesis syndrome can result in complications like dehydration, nutrition deficiencies, electrolyte imbalances, weight loss, kidney damage, esophageal damage, aspiration, and pneumonia.
Save on prescriptions for cannabis hyperemesis syndrome with a SingleCare prescription discount card.
What are the early signs of cannabis hyperemesis syndrome?
The early signs of cannabis hyperemesis syndrome include:
Nausea (usually in the morning)
Abdominal cramps
Fear of vomiting
These early symptoms can last for months or years and are more commonly experienced by people who have been using marijuana since their teen years.
Other cannabis hyperemesis syndrome symptoms
The distinguishing symptoms of cannabis hyperemesis syndrome are recurrent vomiting episodes that stop with the sustained discontinuation of cannabis use. Symptoms include:
Extreme vomiting (several times per day)
Severe nausea
Stomach pain
Loss of appetite
Symptoms of dehydration
Since CHS involves recurrent vomiting, the symptom picture is a bit more complex than just a list of episodic symptoms. Other details are important in its diagnosis and treatment:
Vomiting episodes can last from 12 hours to over a week, but most episodes last one or two days
These vomiting episodes can be relieved by hot showers or hot baths, so though abnormal bathing is not a symptom, it is a distinctive sign of CHS
These vomiting episodes are preceded by years of regular use of cannabis products
These vomiting episodes stop happening when cannabis use is discontinued in a sustained way
Cannabis hyperemesis syndrome vs. cyclic vomiting syndrome (CVS) symptoms
The diagnostic criteria for CHS include repeated episodes of vomiting “resembling cyclical vomiting syndrome.” That means the symptoms of CHS and CVS are identical. So much so that CHS is easily misdiagnosed as CVS. However, cannabis hyperemesis differs from CVS not because of symptoms, but because of its links to marijuana use, the age of onset, and its treatment:
People are diagnosed with CVS when doctors can find no reason for the episodes of vomiting. However, CHS is always linked to long-term cannabis use.
Both children and adults are equally likely to experience CVS, but CHS is a disease of adult cannabis users and sometimes older teens who use cannabis routinely.
Traditional antiemetic drugs, antihistamines, proton-pump inhibitors, and other drugs may help relieve or abort the symptoms of CVS. They usually don’t help during CHS attacks, but heat does.
Although CVS episodes may stop recurring on their own, there is no cure. CHS episodes always stop recurring when cannabis use is discontinued. That is one of the criteria necessary for a diagnosis.
Stages of cannabis hyperemesis syndrome: How can I tell which one I have?
Healthcare professionals distinguish between three phases of CHS, but they usually only encounter the illness in its worst stage.
The prodromal phase of CHS involves mild symptoms of nausea and abdominal cramping, usually in the morning. People may also develop a fear of vomiting as a result of these symptoms. This early phase may last a few months to a few years.
The hyperemetic phase (“extreme vomiting” phase) is an episode of extreme vomiting, abdominal pain, and other symptoms. This is the phase in which most people seek treatment by seeing a doctor or going to an emergency room.
The recovery phase begins after marijuana use has stopped. Most people have a complete remission of cyclical vomiting. In some, the remission may take a few days or weeks. If marijuana is resumed, the cyclical vomiting usually returns, as well.
When to see a doctor for cannabis hyperemesis syndrome symptoms
Most people see a doctor or go to an emergency department during an episode of prolonged vomiting. As a general rule, severe vomiting that lasts for two days or longer requires medical care. Vomiting that involves the inability to drink fluids, symptoms of dehydration, or severe pain requires medical care.
A CHS diagnosis is not easy to make. An expensive work-up may be needed, especially if the clinician does not know of the chronic marijuana use. The clinicians will automatically assume there is a potentially serious problem, such as an infection. At the minimum, diagnosis of acute vomiting will involve:
A medical history
A physical examination
Blood tests
Urine tests
Other tests might include:
A drug screen
An EKG to make sure heart rhythms are normal
A pregnancy test for women
X-rays or CAT scans
Traditional potentially serious causes, as well as identify any problems with dehydration, kidney dysfunction, or electrolyte imbalances.
CHS is uncommon to be misdiagnosed, especially if the patient does not alert the clinician about chronic marijuana use. They will use traditional treatments such as antinausea drugs. If these don’t work, that’s one sign of CHS.
A definitive CHS diagnosis is made based on a medical history of chronic cannabis use, repeated bouts of vomiting, and relief of symptoms after stopping marijuana use or when in a hot shower. Rarely, the clinician may use blood tests to monitor cannabis use during follow-up treatment.
Complications of cannabis hyperemesis syndrome
Complications of unresolved CHS are directly caused by persistent vomiting:
Dehydration
Electrolyte imbalances
Kidney damage
Nutritional deficiencies
Heart rhythm problems
Weight loss
Aspiration (stomach contents entering the lungs after vomiting)
Aspiration pneumonia (vomit is inhaled into the lungs and can cause pneumonia)
How to treat cannabis hyperemesis syndrome symptoms
The only proven treatment for CHS is to discontinue marijuana or cannabinoid use.
During an attack, some people find symptom relief through prolonged showers or baths with hot water.
For people who visit a doctor or urgent care, healthcare professionals are limited in their treatment options. If dehydration is a problem, healthcare providers will administer oral or intravenous fluids. They may need to administer electrolytes as well if lab work shows abnormalities.
Traditional antiemetic drugs like ondansetron often don’t work for vomiting and abdominal pain. Clinicians may try unproven treatments that may or may not succeed. These include topical capsaicin cream, benzodiazepines, or haloperidol (an antipsychotic medication).
Marijuana cessation is the only proven cure. Treatment options to stop marijuana use include counseling, therapy, group therapy, and medications to manage cannabis withdrawal symptoms.
Signs cannabis hyperemesis syndrome is getting better
CHS symptoms will resolve within a few days or weeks after the cessation of cannabinoid products. Symptoms will return if cannabis use resumes. The most reliable sign that CHS is getting better is sustained cessation of TCH or marijuana use.
Most importantly, get help quitting marijuana
CHS is a disease that afflicts long-term chronic cannabis users. As with any substance use disorder, quitting chronic marijuana use is not easy. People who succeed follow a few basic principles:
Make a plan—talk to a substance abuse counselor to ensure success
While quitting cold turkey is one of the best ways to succeed, that may not be possible for long-term users because of withdrawal symptoms
If quitting cold turkey isn’t an option, talk to a healthcare professional or a substance abuse counselor on how to taper use
Get rid of all marijuana paraphernalia
Talk to mental health professionals or counselors about treatment options for anxiety, depression, worry, or stress that may be trigger marijuana use
Make a list of things or events that trigger your use of marijuana—avoid those things after quitting
Find a substitute for marijuana use, like exercise or walking
Ask friends and family to help
Join a support group or talk to counselors
FAQs about cannabis hyperemesis syndrome symptoms
How do you stop an episode of CHS?
Most people find that prolonged hot showers or baths relieve some or all the symptoms of a CHS episode. Healthcare professionals can help, but drug treatment isn’t always effective. In the final analysis, the only way to stop vomiting episodes of CHS for good is to quit marijuana.
What does CHS do to your body?
Persistent vomiting is a health threat because it depletes the body of water. This can lead to dehydration and electrolyte imbalances. If either gets severe enough, vomiting could lead to kidney damage or heart rhythm abnormalities. Persistent vomiting also depletes the body of food, which can lead to malnutrition and weight loss. Repeated episodes of vomiting may affect social interactions and employment situations.
Is CHS a permanent condition?
CHS is not a permanent condition. It can be resolved by quitting marijuana use.
What’s next? Additional resources for people with cannabis hyperemesis syndrome symptoms
Test and diagnostics
Cannabinoid hyperemesis syndrome, StatPearls
Diagnosis and treatment of cannabinoid hyperemesis syndrome, Contemporary PEDS Journal
Treatments
Cannabinoid hyperemesis syndrome, U.S. Pharmacist
Pharmacological treatment of cannabis dependence, Current Pharmaceutical Design
Scientific studies and clinical trials
More information on related health conditions
Cyclic vomiting syndrome, NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Drug abuse, SingleCare
Health effects of marijuana, Centers for Disease Control and Prevention (CDC)