Last Updated: Sep 20, 2023

What is CHS?

CHS, or Cannabinoid Hyperemesis Syndrome, is a condition thought to be triggered by heavy and/or long term cannabis use, including CBD. Individuals with CHS may suffer from recurring episodes of nausea, vomiting, dehydration, and abdominal pain, often leading to frequent emergency department visits.

What are the symptoms of CHS?

CHS usually presents in three phases, each with its own set of symptoms, although significant overlap exists:

Prodromal Phase

Timeline: This phase can last for months or even years and it can increase/decrease based on cannabis use - but generally doesn't go away unless cannabis is stopped entirely.

Signs and Symptoms:

⦁ Morning Nausea: Often experienced upon waking.

⦁ Abdominal Pain: Mild discomfort or pain in the abdomen.

⦁ Heavy Indigestion: Digestive issues may begin to occur.

⦁ Lack of Appetite: Decreased desire to eat.

⦁ Increased Anxiety and Irritability: Emotional changes may be noted.

⦁ Fear of Vomiting: Despite nausea, vomiting is rare in this phase.

⦁ Increased Cannabis Use: Some may increase cannabis use to alleviate symptoms.

​

Hyperemetic Phase

Timeline: This phase can last anywhere from 1 to several days.

Signs and Symptoms:

⦁ Cyclical Vomiting: Persistent and severe vomiting, possibly including bile.

⦁ Severe Abdominal Pain: Intense pain in the abdomen.

⦁ Diarrhea or Constipation: Changes in bowel habits.

⦁ Headaches: May occur during this phase.

⦁ Dizziness: Feeling lightheaded or unsteady.

⦁ Dehydration: Leading to thirst, dry mouth, and reduced urination.

⦁ Blurred Vision: Visual disturbances may occur.

⦁ Shakiness: Tremors or shakiness may be noted.

⦁ Elevated Heart Rate: Increased heart rate can occur.

⦁ Night Sweats: Sweating during the night.

⦁ Muscle Weakness: General weakness in muscles.

⦁ Weight Loss: Significant weight loss due to prolonged vomiting.

⦁ Testicle Pain: Pain in the testicles may be reported in males.

⦁ Compulsive Hot Bathing: Frequent hot showers or baths for symptom relief (this occurs in about 90% of CHS patients).

​

Recovery Phase

Timeline: This phase can last days, weeks, or even months, depending on cessation or reduction of cannabis use.

Signs and Symptoms:

⦁ Resolution of Symptoms: Gradual resolution of nausea, vomiting, abdominal pain, and other symptoms.

⦁ Weight Gain: Regaining lost weight.

⦁ Normal Eating Patterns: Return to regular eating habits.

⦁ Reduction of Hot Bathing: Compulsive behavior of hot bathing subsides.

Possible Relapse: Resumption of cannabis use very often leads to symptom recurrence.

What causes CHS:

It is usually associated with a large dose of THC/cannabinoids over a significant length of time. This could be either moderate to heavy use over an extended time (months to years) or very high use over a shorter period of weeks to months. It may also be associated with a sudden increase in use. CHS patients almost always use cannabis multiple times a day, daily or multiple times a week at the very least. However, once CHS has set in - even small amounts of cannabis can make it worse, or bring it back.

There is probably a genetic component; so most people might never get CHS even with heavy use, and some might be more susceptible.

The pathophysiology of CHS is not entirely understood, but it is believed to be related to the complex interaction between cannabinoids and the body's endocannabinoid system. Chronic exposure to cannabinoids may lead to alterations in the functioning of certain receptors, particularly in the gastrointestinal tract, leading to the symptoms of CHS. There are 3 main theories - and all might overlap to some degree:

Gastrointestinal Cannabinoid Receptors (CB1)

⦁ THC Interaction: Tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis, acts on CB1 receptors found in the enteric nervous system.

⦁ Gastric Emptying: By acting on these receptors, THC reduces gastric emptying, which can lead to nausea and vomiting (N/V).

⦁ Chemoreceptor Trigger Zone (CTZ): CB1 receptors are also found in the CTZ, a region in the brain that controls vomiting. THC's activation of enteric CB1 can override the antiemetic response in the CTZ, leading to vomiting.

⦁ Complexity: Proving the emetic and antiemetic effects of cannabinoids is difficult due to overlapping symptoms with other conditions like cyclic vomiting syndrome, viral gastroenteritis, and bulimia nervosa.

Cannabinoid Lipid Buildup

⦁ Lipid Solubility: THC is lipid-soluble, meaning it can accumulate in cerebral fat.

⦁ Release During Stress: During stress or food deprivation, the body breaks down fat, releasing a large store of THC, leading to what's termed the "reintoxication effect."

⦁ CHS Symptoms: This sudden release of THC can cause symptoms associated with CHS, such as nausea and vomiting.

Genetic P450 Polymorphisms

⦁ Cytochrome P450 Enzymes: These enzymes are responsible for metabolizing THC in the liver.

⦁ Genetic Differences: Genetic polymorphisms in the P450 system can change the metabolism rate of THC, leading to either hyper or hyposensitivity.

⦁ Pro-Emetic Effects: Slower THC metabolism in the liver can lead to hypersensitivity and pro-emetic effects, contributing to CHS.

⦁ THC Metabolites: There are over 100 different THC metabolites, ranging in potency, and the P450 isoforms involved include CYP2C9, CYP2C19, and CYP3A4.

^{These theories are discussed in detail here: Senderovich H, Patel P, Jimenez Lopez B, Waicus S. A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options. Med Princ Pract. 2022;31(1:29-38. doi: 10.1159/000520417. Epub 2021 Nov 1. PMID: 34724666; PMCID: PMC8995641.})

Why haven't I heard of CHS?

CHS is relatively new to the medical community, and only in recent years has the diagnosis become more common. Consequently, there has been limited research conducted, leaving many unanswered questions about why cannabis triggers it, its effects on the body, and potential treatments or cures.

CHS seems to be related to THC dose over time - so modern strains of cannabis, and modern cannabis products like carts and dabs are giving today's cannabis consumer a much higher THC dose than before about 2000. This might account for why CHS is increasingly common. (For reference: cannabis in 1995 was usually about 3-5% THC and by about 2017 was usually around 15% and as high as 24%. Carts and dabs can be almost 90% THC.)

Emergence in Medical Literature: CHS is relatively new to the medical community. The number of published studies on CHS has been increasing over the years, but it's still a relatively recent phenomenon. According to PubMed, the number of published studies related to CHS has gradually increased from just one in 2005 to 46 studies in 2021 and 23 in 2023.

Overlap with Other Conditions: CHS symptoms can overlap with other medical conditions like cyclic vomiting syndrome, celiac disease, ulcers, h. pylori infection, etc. making it challenging to diagnose accurately.

Limited Research: There has been limited research conducted on CHS, leaving many unanswered questions about why cannabis triggers it, its effects on the body, and potential treatments or cures.

Increase in Cannabis Use: With the increasing rates of cannabis use and legalization in various jurisdictions, the recognition of CHS may be growing. However, the understanding and awareness of this condition might not have permeated all levels of healthcare or public consciousness.

Social and Cultural Factors: The perception of cannabis as a substance primarily associated with recreational use rather than medical complications may also contribute to the lack of awareness about CHS.

How do I know if I have CHS?

Signs and Symptoms

Look for the characteristic signs and symptoms of CHS, if you have a history of chronic cannabis use:

⦁ Morning Nausea: Regular nausea, especially in the morning.

⦁ Cyclical Vomiting: Frequent vomiting that may include bile - although vomiting might not be present yet in the prodromal phase.

⦁ Abdominal Pain: Persistent abdominal discomfort or pain.

⦁ Compulsive Hot Bathing/Showering: A strong desire to take hot showers or baths to relieve symptoms. This occurs in ~90% of people and is easy to test at home - when you're feeling nauseous take a hot shower, with water over 109 degrees F (but not much hotter - don't get burned). If this makes your nausea feel better - but it comes back shortly after leaving the shower - that is very strong evidence you have CHS. This will work for about 9 of 10 people, but not everybody.

⦁ Other Symptoms: Including indigestion, lack of appetite, diarrhea or constipation, headaches, anxiety, dizziness, dehydration, blurred vision, shakiness, elevated heart rate, night sweats, muscle weakness, weight loss, and possibly testicle pain in males.

Medical Evaluation

If you experience these symptoms, it's essential to consult a healthcare provider:

⦁ Medical History: Your healthcare provider will ask about your symptoms, medical history, and cannabis use.

⦁ Physical Examination: A thorough physical examination may be performed to assess your overall health.

⦁ Diagnostic Tests: Lab tests may be ordered to rule out other conditions, such as blood tests to check for electrolyte imbalances, liver and kidney function, and urine tests to screen for other substances.

⦁ Imaging Studies: Imaging studies like abdominal ultrasound or CT scan may be conducted to rule out other gastrointestinal disorders.

⦁ CHS is often a diagnosis of exclusion, meaning other potential causes of the symptoms must be ruled out. The list of what needs to be ruled out includes Gastroenteritis, Gastroesophageal Reflux Disease (GERD), Gallbladder Disease, Cyclic Vomiting Syndrome (CVS), Pancreatitis, Medication Side Effects, Peptic Ulcer Disease, Kidney Stones and Intestinal Obstruction

⦁ Cessation of Cannabis: If symptoms resolve after stopping cannabis use, it strongly supports the diagnosis of CHS.

⦁ Relapse with Resumption: If symptoms recur with the resumption of cannabis use, it further confirms the diagnosis.

If you suspect you may have CHS, it's crucial to consult with a healthcare provider who is familiar with the condition. They can conduct a thorough evaluation, rule out other potential causes, and guide you in the appropriate management and treatment. Self-diagnosis is not recommended, as CHS shares symptoms with other serious medical conditions that require professional medical evaluation and care.

Is there a way I can figure out if I have CHS without going to the doctor?

The most definitive ways to diagnose CHS is to stop using cannabis* (90 days is recommended) and monitor for symptom resolution. The upside to this approach is that it's a non-invasive, straightforward way to either confirm or rule out CHS. If your symptoms resolve after stopping cannabis use, it would strongly suggest CHS. Most people with CHS have significant improvement within a month. If your symptoms do not go away, it would indicate that another underlying issue may be responsible for your symptoms.

*cannabis = all cannabis products including synthetics and CBD - all cannabinoids can cause CHS, not just THC.

If you're struggling or reluctant to do this simple and effective test, it strongly suggests that you are dealing with the very real and valid effects of dependence. We've been there. It sucks. This post might help you understand that better.

How do I get better if I think I have CHS?

The only known treatment for CHS is to stop using cannabis entirely. Period. If possible, complete abstinence from cannabis is advised.

Side Note: Denial is common among individuals with CHS, as quitting smoking is a difficult decision. It's essential to recognize the seriousness of the condition and understand that merely reducing usage will not aid in recovery. It is natural to want to deny or deflect a CHS diagnoses for some very understandable reasons: Notes on Struggling with a CHS diagnosis. There is even a recent peer reviewed scientific paper examining how hard it is to receive and accept a CHS diagnosis - here.

Are there any treatments for CHS, or at least ways to reduce the symptoms?

Stopping cannabis use is the cure for CHS. For CHS symptoms other than cessation of cannabis and time, several remedies may alleviate symptoms. Note that none of the methods below will work if you are still using cannabis.

See our guide: Hyperemesis Survival Guide - What to do if you're puking right now!

At home: Hot showers or baths above 109F, but not so hot as to burn, relieve nausea while in the shower.

Capsaicin cream applied to the stomach and/or forearms may help with pain and nausea - it feels so hot you might think its burning, but many people get used to it and think it is better than nausea and absominal pain from CHS.

A daily antacid such as Pepcid or Prevacid may combat stomach acid buildup.

Staying hydrated with electrolyte-rich drinks like Pedialyte or Gatorade is critical.

Tylenol (acetaminophen) for abdominal pain according to the package instructions. Do not exceed the recommended dose on the package - the "therapeutic dose" and "toxic dose" of Tylenol are very close to each other. Avoid ibuprofen (Advil), naproxen (Aleve) and other NSAIDs, as they are notoriously hard on your stomach even when healthy.

In the ER or hospital:

IV Rehydration: provides immediate fluids and electrolytes to combat dehydration and kidney problems.

Droperidol: A dopamine antagonist that showed statistically significant differences in reducing N/V.

Benzodiazepines (Clonazepam): Led to rapid cessation of adverse symptoms in a case study with 4 patients.

Haloperidol: Used in severe CHS cases, it relieved N/V in several case studies and an RCT. Relatively safe at low doses, and higher doses do not increase it's ability to treat N/V.

Propranolol: Rapid termination of N/V in a single case study.

Aprepitant: Rapid relief of N/V in case reports where the patient was unresponsive to conventional emetics. This NK1 blocker medication has good theoretical basis to work, and in all case studies has been 100% effective. However there are very few studies to date. It's normally used for chemotherapy patients, so many ER doctors and even gastroenterologists outside oncology are unfamiliar with it.

Note: almost all ER's want to treat nausea and vomiting with a "front line" medication called Zofran (Ondansetron), or a backup called Compazine (Prochlorperazine). These medications seldom work on CHS - and it's one more piece of evidence that CHS might be the cause. Here is a detailed breakdown of what medications are more effective, and those that aren't effective with peer reviewed references: CHS Medications

I'm puking right now, what can I do?

See our guide: Hyperemesis Survival Guide - What to do if you're puking right now!

Can I ever smoke or take edibles again?

Abstaining from cannabis is the 100% cure for CHS - any use at all could cause symptoms to reappear. If for whatever reason, you can not eliminated cannabis, the CHS community generally recommends waiting at least three months before attempting to smoke again, and even then, moderation is key. Some may resume cannabis use without issues, while others may feel symptoms returning after just one exposure.

What is the timeline for recovery? When will I start to feel better after quitting?

Recovery varies among individuals, but some patterns have emerged. The first four days are often the worst, with withdrawal symptoms (more below) exacerbating CHS. Around days 5-7, daily routines may resume, though prodromal symptoms may persist. By the two-week mark, many report feeling better, and a month into sobriety, most symptoms subside. If symptoms remain severe after a month, consult a doctor. Note that you'll probably be experiencing some CHS symptoms, and some cannabis withdrawal symptoms at the same time for a while.

Is withdrawal from cannabis really that bad? How do I differentiate the symptoms from CHS?

Cannabis withdrawal can be intense, especially for chronic users, and may worsen CHS symptoms. Withdrawal symptoms include:

⦁ Increased anxiety and irritability

⦁ Decreased appetite

⦁ Cravings for THC

⦁ Insomnia

⦁ Boredom

⦁ Ultra-realistic dreams

⦁ Flu-like symptoms

Withdrawal peaks around days 3-4 and usually subsides after a week.

Here's our guide: Cannabis Withdrawal Guide for CHS

What are "triggers," and why are they important?

A "trigger" is anything that may cause CHS symptoms to flare up or provoke an episode. Common triggers include certain foods like alcohol, caffeine, chocolate, and greasy items. Stress and intense exercise are also known triggers. Recognizing and avoiding personal triggers is crucial in managing CHS, as they can exacerbate symptoms and hinder recovery.

Foods that might trigger CHS are pinned here: Food Trigger List

At what point should I go to the hospital?

Severe Dehydration: If you experience symptoms like dry mouth, dark urine, dizziness, or weakness, it might indicate dehydration, which requires medical intervention.

Persistent Vomiting: If vomiting continues and you are unable to keep down fluids or food for more than 24 hours, it's essential to seek medical care to prevent complications.

Intense Abdominal Pain: Severe abdominal pain can be a sign of underlying complications and should be evaluated by a healthcare provider.

Electrolyte Imbalance: Symptoms like muscle twitching, spasms, or palpitations might indicate an electrolyte imbalance, which can be life-threatening if not treated.

Failure of Home Remedies: If symptoms persist despite trying home remedies like hot showers or cessation of cannabis use, it may be time to seek professional medical care.

Other Concerning Symptoms: Any other symptoms that are unusual or concerning to you should be evaluated by a healthcare provider. In particular - a loss of more than 5% of body weight in a 7-10 day period should be evaluated.

I've been vomiting for 5 days, I can't keep any food down, and I've lost weight. What do I do?

You should seek medical treatment as soon as possible.

Prolonged vomiting and inability to retain food can lead to serious complications, including a dangerous metabolic state called ketoacidosis. In the context of Cannabinoid Hyperemesis Syndrome (CHS), ketoacidosis can exacerbate your symptoms by releasing stored cannabinoids back into your bloodstream. This creates a self-perpetuating cycle that is difficult to break without medical intervention. Medications like Emend can help manage symptoms in combination with comprehensive medical care.

For a more detailed explanation, you can read this post.

What should I do or say when I go to the hospital?

What do in the ER: Tips for ER (and documents to help your Doctor)

How to get a patient advocate to help you: When you're sick its hard to advocate for yourself - how to get a patient advocate.

Can I still take edibles? What about CBD?

Neither edibles nor CBD are safe options for those with CHS, as the syndrome relates to cannabinoids as a whole, not just THC. Even second-hand smoke can be harmful. Abstaining from cannabis entirely is the best course of action.

What is the "pink cloud"?

"Pink clouding" describes a stage of early addiction recovery marked by euphoria and confidence. This temporary sensation can cloud judgment and lead to relapse. It's vital to remind yourself of the reasons for quitting and the severity of CHS, even long after recovery. A very common story here in r/CHSinfo is a person who was clean for a month or two and is confident they are cured, so they decide to have just one smoke again - and that leads to either 1) an immediate return of CHS symptoms or 2) more and more regular use until CHS returns. Moderation is much more difficult that just quitting - more information below.

I've never felt so anxious and irritable in my life; how do I deal with this?

Managing emotions during CHS recovery is essential. Techniques like meditation, breathing exercises (such as 4-7-8 breathing), and proper sleep may help. Magnesium supplements have been proven to assist with mood swings, anxiety, and depression and may be beneficial.

r/leaves

We're trying to keep r/CHSinfo focused on CHS, including diagnosis, treatment, causes and support. Quitting cannabis use is the 100% cure for CHS - but it is such a complex topic, that it's beyond the scope of this forum.

I'm incredibly bored, and nothing feels enjoyable anymore without weed; what do I do?

This feeling is temporary and usually subsides after a few weeks of sobriety. Engaging in activities like watching a new TV show or committing to a hobby can help distract and entertain. Your brain will adjust, and you'll likely regain enjoyment in activities you loved before.

r/leaves

We're trying to keep r/CHSinfo focused on CHS, including diagnosis, treatment, causes and support. Quitting cannabis use is the 100% cure for CHS - but it is such a complex topic, that it's beyond the scope of this forum.

Is there any scientific research about CHS at all?

Unlike just a few years ago, there are now several excellent peer reviewed scientific articles on CHS. However research is still in its early stages. There are over 200 peer reviewed articles on PubMed that address some aspect of CHS. Here are some of the most influential and comprehensive.

If you only read one - make it this one:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995641/pdf/mpp-0031-0029.pdf

Senderovich H, Patel P, Jimenez Lopez B, Waicus S. A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options. Med Princ Pract. 2022;31(1):29-38. doi: 10.1159/000520417. Epub 2021 Nov 1. PMID: 34724666; PMCID: PMC8995641.

​

Here are others:

Simonetto DA, et al. (2012). Cannabinoid hyperemesis: A case series of 98 patients. Mayo Clinic Proceedings, 87(2), 114-119. [PubMed](https://pubmed.ncbi.nlm.nih.gov/22305029/)

Leu N, Routsolias JC. (2021). Cannabinoid Hyperemesis Syndrome: A Review of the Presentation and Treatment. Journal of Emergency Nursing, 47(3), 483-486. [PubMed](https://pubmed.ncbi.nlm.nih.gov/32943248/)

Richards JR, et al. (2017). Pharmacologic Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review. Pharmacotherapy, 37(6), 725-734. [PubMed](https://pubmed.ncbi.nlm.nih.gov/28467644/)

Richards JR. (2018). Cannabinoid Hyperemesis Syndrome: Pathophysiology and Treatment in the Emergency Department. Journal of Emergency Medicine, 54(3), 354-363. [PubMed](https://pubmed.ncbi.nlm.nih.gov/29102083/)

Razban M, et al. (2022). Cannabinoid Hyperemesis Syndrome and Cannabis Withdrawal Syndrome: A Review of the Management of Cannabis-Related Disorders in the Emergency Department. International Journal of Emergency Medicine, 15(1), 45. [PubMed](https://pubmed.ncbi.nlm.nih.gov/35087964/)

Parvataneni S, Varela L, Vemuri-Reddy SM, Maneval ML. (2019). Emerging Role of Aprepitant in Cannabis Hyperemesis Syndrome. Cureus, 11(6), e4825. doi: [10.7759/cureus.4825](https://doi.org/10.7759/cureus.4825). [PubMed](https://pubmed.ncbi.nlm.nih.gov/31403013/)

Sorensen, C. J., DeSanto, K., Borgelt, L., Phillips, K. T., & Monte, A. A. (2017). Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment—a Systematic Review. Journal of Medical Toxicology, 13(1), 71–87. URL

200+ more are here: https://pubmed.ncbi.nlm.nih.gov/?term=Cannabis+hyperemesis+syndrome&sort=date

How can I find support groups, and how can I support others dealing with CHS as well?

Outside of this subreddit, there are currently two primary means of support groups, which are both linked below. The first of these is a Facebook group, which includes thousands of members. If you do not feel comfortable giving away your identity, feel free to make a throwaway Facebook account and join using that. There is also an excellent discord group, that is active essentially all day and night, and can provide you with not only support, but help with some of the boredom. In any of these groups, it is incredibly important not to shame people for their use or relapse of cannabis. If you see anyone doing this, please report it to the associated moderators immediately. Once you begin to heal, it helps the whole community if you are willing to stay to answer questions for those who are new to this.

Facebook Group Discord Group

How can I find support to completely stop using cannabis?

r/leaves

We're trying to keep r/CHSinfo focused on CHS, including diagnosis, treatment, causes and support. Quitting cannabis use is the 100% cure for CHS - but it is such a complex topic, that it's beyond the scope of this forum.

How can I find support to moderate or control my cannabis use?

r/petioles

Moderating use will not make CHS go away - you need to quit entirely for an extended period of time to allow your body to heal. 90 days clean is often talked about as a minimum. Using again and trying to moderate is much harder for most people than quitting entirely. Trying to moderate cannabis use comes with a very high likelihood of CHS returning.

We're trying to keep r/CHSinfo focused on CHS, including diagnosis, treatment, causes and support. Moderating cannabis use is such a complex topic, that it's beyond the scope of this forum.

​

Disclaimer: This guide is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a healthcare provider if you experience severe symptoms.

Personal Note: For further questions, concerns, or support, feel free to reach out. My inbox and Discord (same username) are always open.

updated: 9/2023

What to Do if You Are Vomiting Repeatedly Right Now

This guide was created by a community of people who have had CHS firsthand. This is the collective community's best advice.

Recognize the Symptoms:

• Frequent Cannabis Use: Either moderate to high dose over long time, or very high dose over a shorter period.
• Cyclical Vomiting: Persistent and severe vomiting, possibly including bile.
• Severe Abdominal Pain: Intense pain in the abdomen.
• Headaches, Dizziness, Dehydration, Blurred Vision, Shakiness, Elevated Heart Rate, Night Sweats, Muscle Weakness, Weight Loss, Testicle Pain (in males),
• Compulsive Hot Bathing/Showering: present in about 90% of cases.

Stop Cannabis Use Immediately:

• CHS is triggered by cannabis use, including CBD. Abstaining from all forms of cannabinoids is essential. Smoking a little, in hopes of getting an anti-nausea effect will not work. It will just make things worse. Nothing else in this guide will really help if you're still using cannabis - we're not trying to be harsh, it's just a hard learned fact.
• We understand addiction. We understand why you might be reluctant to admit you have CHS. We know people use cannabis as a medication for other things. We get it. We sympathize because we've been there. But right now, while you're vomiting, trust us on this and do not use cannabis!

At-Home Remedies:

• Stay Hydrated (this is the most important advice!):
  • Drink electrolyte-rich fluids like Pedialyte or Gatorade -small sips often. Make sure they are not "diet", "zero" or zero calories. You will need those calories! Water is always good.
  • Right after you vomit you'll get a few minutes where your nausea isn't as bad and that is a perfect time to get in a few sips.
  • Experiment with hot or cold drinks - sometimes one extreme or the other will help. Peppermint or Ginger teas might help. (Avoid caffeine, chocolate, ginseng, cinnamon, lemon balm and lavender teas - and all other foods listed here)
  • There is particularly good scientific evidence that Ginger (tea or supplement) can help - but evidence that Gingerol supplements might be effective in treating nausea.
  • Buy or make a popsicle (ideally with electrolytes) or ice cubes - you might be able to use these even if you can't take sips.
  • Some people are able to tolerate salty drinks like broth better than sweet
• Hot Showers or Baths: Above 109°F to relieve nausea, but hotter than that won't help much. Be careful to avoid burns - take care of your skin (but don't use a CBD skin lotion!) Some people use a shower stool or plastic lawn chair and/or chew ice chips while in the shower.
• Heating Pads / Electric Blankets: Above 109°F, applied to stomach. Wrap in a towel first, avoid burns, do not use constantly, only intermittently to avoid skin problems.
• Capsaicin Cream: Start with a pea sized amount or less on your forearm, wait 15 minutes so you know what to expect - if you can tolerate that: Apply to the stomach or forearms a little bit at a time. The "burning" will subside into a "heat" that feels like a heating pad is on your skin. This uncomfortable heat is way better than CHS abdominal pain and nausea. Capsaicin has scientific proof of working - but it's the hardest to use, and some people just can't tolerate the burning sensation.. Other Icy Hot, Tiger Balm, etc. creams might work for you. - and they won't hurt so they are worth a try. Test a small amount on your forearm first.
• Avoid Trigger Foods: Alcohol, caffeine, chocolate, and greasy items may trigger symptoms along with the foods listed here)
• Get Nutrients - Eat: This can be a BRAT (banana, rice, applesauce, toast) diet, or any other foods you think you can keep down. Keep trying even if you don't feel hungry. Rapid weight loss (in a dangerous, unhealthy way) is common, so you need calories however you can get them. Our CHS community lists suggestions for "rescue foods" that worked for them:

watermelon, instant mashed potato flakes, applesauce, apple juice, broth, nutrient shakes like Ensure, toast, yogurt (especially with active cultures like Activa)

At-Home, Over-the-Counter Medications

• Antacids: Some people find "extra strong" or "ultra" antacids like Mylanta or Alka Seltzer help. These help for acid in your stomach right now.
• Acid Reducers: Pepcid, Prevacid and other proton pump inhibitors can help reduce stomach acid. These help prevent future acid in your stomach.
• Anti-Gas: Simethicone based anti-gas pills like Gas-X can help with bloating, burping and a "too full" feeling.
• Chamomile - tea or supplements. Chamomile contains a natural NK1 inhibitor - the kind of substance found in the most powerful prescription medications for nausea and CHS like aprepitant although it may have low bioavailability - nonetheless, chamomile is effective at easing nausea for about 2/3 of people.
• Peppermint pills, or candy: Peppermint is pro-motility - it helps food/drink move from your stomach to your intestines faster - and once it's in your intestines you can't vomit it up, so your body can absorb the nutrients or water. (Peppermint pills are hard to find locally even at big pharmacies, but can be found on Amazon.)
• Ginger chews, candy or supplements: Ginger has lots of scientific evidence that it can reduce nausea and vomiting in morning sickness and for chemotherapy patients. Supplements will provide more of the key ingredient, gingerol. Specific gingerol supplements are also available. The most effective dose in clinical trials was 1500mg/day. This was most effective when split between 3, 500mg doses each day.
  
• Tylenol (acetaminophen): for abdominal pain if you can keep it down. Do not exceed the dose on the package. The dangerous dose of Tylenol is only a little bit more than the recommended dose, so do not use more!
• Do not use Motrin (ibuprofen), Aleve (naproxen) or other NSAIDs: these medications are notoriously hard on your stomach and won't help pain more than Tylenol.
• Sleep Aids: There is some evidence that antihistamines like Benadryl help with nausea, but more importantly they make you drowsy. This can be something to help you sleep at night even if you're nauseous- follow the package directions. Doxylamine (Unisom or generic) can also help according to the package directions. Choose one or the other - don't take both.
• Your prescribed medications: Keep taking anything that your doctor has prescribed for you for other conditions like depression, diabetes, blood pressure, etc. Some of these medications shouldn't be stopped suddenly - or at all. You might be able to keep them down by waiting until those few minutes right after vomiting to take them. If you have a serious medical condition that requires oral medication, but you can't keep the medications down for >24 hours then you should go to the ER.

Don't Do This at Home

Seriously. This is stuff that we've learned will not help, and will usually make things worse.

• Don't use cannabis products like flower or CBD to treat nausea - this makes things worse.
• Don't induce vomiting - Don't make yourself vomit. It won't help the nausea for more than a minute and it creates more irritation/damage to your esophagus, throat, mouth and teeth.
• Don't burn yourself - heat, especially on your stomach, activates TRPV1 receptors which can help with nausea. These activate at 109°F. Shower or heating pad temps above about 112°F won't work any better - so there is no need to turn up the heat so high you get burned.

It's ok to go to the ER -almost all of us have been there. Here's a detailed guide on when someone should go to the ER with CHS and there is a guide to take with you to the ER at the end:

Severe Dehydration:

• Symptoms: Dry mouth, dark urine*,* dizziness, weakness, confusion, rapid heartbeat.
• You can check dehydration by dark urine color and skin turgor/elasticity: pinch the skin on the back of your hand - if you are well hydrated it will snap right back (good turgor). If it "tents" up, or slowly returns to normal that is a sign of dehydration( poor turgor).
• Reason: Persistent vomiting and inability to keep fluids down can lead to dehydration, which can be life-threatening if not treated.

Persistent Vomiting:

• Symptoms: Continuous vomiting for more than 24 hours, including bile, inability to keep down food or fluids. If nothing stays down for 24 hours - go to the ER.
• Reason: This can lead to electrolyte imbalances and further dehydration, requiring medical intervention.

Intense Abdominal Pain:

• Symptoms: Severe, persistent abdominal discomfort or pain.
• Reason: This could be a sign of underlying complications, such as pancreatitis or gallbladder issues, and should be evaluated by a healthcare provider.

Electrolyte Imbalance:

• Symptoms: Muscle twitching, spasms, palpitations, seizures.
• Reason: An electrolyte imbalance can be life-threatening if not treated, as it affects the function of vital organs - most importantly your heart.

Failure of Home Remedies:

• Symptoms: Persistent symptoms despite trying home remedies like hot showers, cessation of cannabis use, hydration, etc.
• Reason: This may indicate a more serious underlying condition or complications that require professional medical care.

Weight Loss and Malnutrition:

• Symptoms: Loss of more than 5% of body weight in a 7-10 day period, signs of malnutrition.
• Reason: Significant weight loss due to prolonged vomiting can lead to malnutrition and other health issues that require medical intervention.

Inability to Manage Pain and Nausea at Home:

• Symptoms: Uncontrolled pain and nausea despite over-the-counter medications and home remedies.
• Reason: Medical intervention may be needed to control symptoms and prevent further complications. Don't suffer. It's ok to go to the ER.

Mental Confusion or Altered Mental Status:

• Symptoms: Confusion, disorientation, altered consciousness.
• Reason: This could be a sign of a serious underlying condition, such as an electrolyte imbalance or dehydration affecting the brain.

Signs of Kidney Problems:

• Symptoms: Decreased urination, swelling in the legs, ankles, or feet, fatigue. If you can't pee for longer than 6-8 hours, go to the ER***.***
• Reason: CHS can lead to kidney problems, which require immediate medical attention.

Other Concerning Symptoms:

• Symptoms: Any other symptoms that are unusual or concerning, such as blurred vision, shakiness, elevated heart rate, muscle weakness.
• Reason: These could be indicative of other underlying health problems or complications related to CHS.

Take this guide with you to the ER. If you have to go alone, ask for a patient advocate.

Join Support Groups:

• Online communities like r/CHSinfo on Reddit, Facebook Group, and Discord Group can provide support and advice. There are folks here who have been where you are right now that you can talk to. They got past CHS, and so will you!

1. Educate Yourself:

• Understanding CHS, its causes, symptoms, and treatments can help in managing the condition. Comprehensive guides like our CHS FAQ can be valuable resources.

Be resilient:

You will get through this. most of the people in this community have been where you are. They got through it, and so will you. Create a post and let us know what you're going through and you'll be surprised at how good the support is.

References:

• A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options. Med Princ Pract. 2022;31(1):29-38. doi: 10.1159/000520417. Epub 2021 Nov 1. PMID: 34724666; PMCID: PMC8995641.