Cyclical Vomiting Syndrome

Diagnosis and Characteristics

The American Gastroenterological Association emphasizes that cyclical vomiting occurs when a person is actively smoking marijuana, not when they stop, which is known as Cannabinoid Hyperemesis Syndrome (CHS), and resolves with cannabis cessation 1
Stereotypical episodic vomiting occurs 3 or more times annually in patients using cannabis more than 4 times per week for over 1 year before symptom onset, and resolution of symptoms after abstaining from cannabis for at least 6 months 1
Compulsive hot water bathing for symptom relief is reported in 71% of cases 2

The 2024 AGA guidelines emphasize that cannabis cessation is the only definitive treatment to prevent recurrent episodes 1
The American Gastroenterological Association recommends that patients with CHS should stop using cannabis to prevent recurrent episodes 1

Cannabinoid Withdrawal Syndrome (CWS) affects approximately 47% of regular cannabis users and includes anxiety, irritability, and gastrointestinal symptoms, but does not cause the severe cyclical vomiting pattern seen in CHS 3
Nausea and stomach pain begin after 48 hours of abstinence in patients with CWS 2

Patients and clinicians often misattribute CHS symptoms to other factors like food, alcohol, stress, or pre-existing GI disorders, leading to continued cannabis use and worsening of the underlying condition 2
The syndrome is frequently underdiagnosed due to limited awareness, and the prevalence of CHS is rising with legalization and higher THC concentrations in modern cannabis products 3