Cannabis hyperemesis syndrome: the rare case of a valid diagnosis plus hypersensitization hypothesis for development and chronification of this severe somatic cannabis use disorder

Abstract

Cannabis hyperemesis syndrome (CHS) is a serious physical consequence of long-term, high-dose cannabis use, and a regional increase in incidence appears to be an indicator of an increase in cannabis use there. In addition to gradually increasing nausea, which escalates into cyclical vomiting attacks, and resistance to classic antiemetics, relief by hot showers is one of the diagnostic criteria. However, the same symptoms are also found in cyclic vomiting syndrome (CVS), which in turn can also be associated with cannabis use, but unlike CHS, cannabis is not causal for CVS. The only diagnostic criterion that can distinguish CHS from CVS is the persistent disappearance of nausea/hyperemesis during cannabis abstinence. Observation periods of 12 months are diagnostically reliable. Most CHS cases described in the literature have a significantly shorter observation period and can therefore only be considered as suspected CHS cases. Since diagnostically safe (i.e. verified by long periods of abstinence) CHS cases have rarely been documented, this case report of an adult cannabis user should be added. Even after 3 weeks of abstinence, blood cannabinoid-levels (tetrahydrocannabinol and tetrahydrocannabinol-carboxylic acid) were relevantly elevated, indicating previous prolonged and higher dose cannabis use. Remarkably, each CHS episode was stronger than the previous one, indicating ongoing sensitization, even in cannabis relapse after prolonged abstinence. The pathophysiology of CHS is still largely unclear. This case history and other previously observed cases provided the impetus for the hypersensitization hypothesis of CHS development and maintenance presented here, which also takes into account the recently published reports of possible relief of severe nausea and vomiting by haloperidol (or droperidol) or by topical capsaicin.

Zusammenfassung

Das Cannabis-Hyperemesis-Syndrom (CHS) ist eine schwerwiegende körperliche Folge des langfristigen, hochdosierten Cannabiskonsums, und ein regionaler Anstieg der CHS-Inzidenz scheint ein Indikator für eine Zunahme des dortigen Cannabiskonsums zu sein. Neben allmählich zunehmender Übelkeit, die sich zu zyklischen Brechattacken steigert, und der Resistenz gegenüber klassischen Antiemetika ist die Linderung durch heiße Duschen eines der Diagnosekriterien. Die gleichen Symptome finden sich jedoch auch beim Zyklischen Erbrechen (cyclic vomiting syndrome; CVS), das ebenfalls im Zusammmemhang mit Cannabiskonsum auftreten kann; aber im Gegensatz zum CHS ist Cannabis für das CVS nicht kausal. Das einzige diagnostische Kriterium, das CHS zuverlässig von CVS unterscheiden kann, ist das anhaltende Verschwinden von Übelkeit/Hyperemesis während der Cannabisabstinenz. Beobachtungszeiträume von 12 Monaten sind diagnostisch zuverlässig. Die meisten in der Literatur beschriebenen CHS-Fälle haben einen deutlich kürzeren Beobachtungszeitraum und können daher nur als CHS-Verdachtsfälle angesehen werden. Da diagnostisch sichere (d. h. durch lange Abstinenzzeiten verifizierte) CHS-Fälle in der Literatur selten dokumentiert wurden, sollte dieser Fallbericht eines erwachsenen Cannabiskonsumenten hinzugefügt werden. Selbst nach dreiwöchiger Abstinenz waren die Cannabinoid-Spiegel (Tetrahydrocannabinol und Tetrahydrocannabinol-Carbonsäure) im Blut deutlich erhöht, was auf einen vorangegangenen längeren und höher dosierten Cannabiskonsum hinweist. Bemerkenswerterweise war jede CHS-Episode stärker als die vorherige, was auf eine fortschreitende Sensitisierung hinweist, selbst bei einem Cannabis-Rückfall nach längerer Abstinenz. Die Pathophysiologie des CHS ist noch nicht geklärt. Diese Fallgeschichte und andere zuvor beobachtete Fälle gaben den Anstoß für die hier vorgestellte Hypersensitisierungs-Hypothese zur Entstehung und Aufrechterhaltung von CHS, die auch die neuen Befunde über eine mögliche Linderung von schwerer Übelkeit und Erbrechen durch Haloperidol (oder Droperidol) oder durch topisches Capsaicin berücksichtigt.

Keywords

Cannabis use disorder - THC - cannabis hyperemesis - autoimmune disease - aquaporin 4 antibody - autonomous nervous system

Schlüsselwörter

Cannabisabhängigkeit - THC - Cannabis Hyperemesis - Autonomes Nervensystem - Autoimmunerkrankung - Aquaporin 4 Antikörper

Publication History

Received: 13 August 2024

Accepted after revision: 17 October 2025

Article published online:
28 January 2026

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