Adult CVS and Cannabinoid Hyperemesis Syndrome (CHS)

With increasing cannabis use worldwide, a condition known as Cannabinoid Hyperemesis Syndrome (CHS) has become more widely recognized. CHS is characterized by chronic or heavy cannabis use, recurrent episodes of nausea and vomiting, and a tendency toward frequent hot bathing or showering for temporary symptom relief.

Because CHS and Cyclic Vomiting Syndrome (CVS) share several overlapping features, the two conditions are sometimes confused—particularly in adults, where cannabis use is relatively common among individuals with CVS.

What Is Cannabinoid Hyperemesis Syndrome?

CHS is defined by:

• long-term or frequent cannabis use

• recurrent episodes of severe nausea and vomiting

• temporary relief of symptoms with hot baths or showers

The exact mechanism underlying CHS is not fully understood. Although cannabis is well known for its anti-nausea properties, evidence suggests that prolonged exposure may paradoxically disrupt gastrointestinal and central nervous system regulation in some individuals.

CHS typically follows a clinical course with three phases:

• a prodromal phase

• a hyperemetic phase marked by intense vomiting

• a recovery phase, often occurring within days after cessation of cannabis use

Treatment during acute episodes is primarily supportive and includes hydration, symptom control, and avoidance of cannabis.

Why CVS and CHS Are Often Confused

CVS and CHS share several important similarities:

• cyclic episodes of nausea and vomiting

• symptom-free intervals between episodes

• frequent use of hot bathing for symptom relief

In addition, cannabis use is common among adults with CVS. Some individuals report using cannabis to relieve nausea, abdominal pain, or anxiety associated with CVS episodes. This overlap can make it challenging to distinguish between the two conditions in clinical practice.

As a result, patients with CVS may be misdiagnosed as having CHS, and vice versa. Current diagnostic frameworks recognize chronic cannabis-related vomiting as a condition distinct from CVS, even though the symptoms may appear similar.

Key Differences Between CVS and CHS

Despite surface similarities, important differences exist between CVS and CHS:

• Migraine association:
  Individuals with CVS frequently have a personal or family history of migraine, which is less characteristic of CHS.

• Psychological comorbidities:
  Anxiety and depression are commonly reported in adults with CVS and may influence disease course and severity.

• Gastric motility:
  Studies suggest that gastric emptying in CVS is often normal or accelerated, rather than delayed.

• Hot bathing behavior:
  Although hot bathing is often described as characteristic of CHS, it is also observed in individuals with CVS who do not use cannabis. Therefore, hot bathing alone should not be considered diagnostic of cannabis-related vomiting.

Research examining cannabis use among individuals with CVS has shown that while hot bathing behavior is more common among cannabis users, it is not exclusive to them. This finding highlights the importance of careful clinical evaluation rather than reliance on a single symptom.

Clinical Importance of Accurate Diagnosis

Distinguishing between CVS and CHS is essential, as management strategies differ. In individuals with CHS, sustained cessation of cannabis use is central to long-term improvement. In contrast, CVS management focuses on identifying triggers, preventive treatment, early abortive therapy, and supportive care during episodes.

An accurate diagnosis requires a thorough clinical history, including symptom patterns, triggers, migraine history, and substance use, evaluated in the context of established diagnostic criteria.

Summary

Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome are distinct conditions that can present with similar symptoms, particularly in adults. Cannabis use and hot bathing behaviors can complicate diagnosis, but neither alone is sufficient to distinguish between the two disorders. Careful, individualized assessment is essential to ensure appropriate diagnosis, avoid mislabeling, and guide effective treatment.