CHS Diagnosis & Misdiagnosis

Do I Have Cannabinoid Hyperemesis Syndrome?

If you’re experiencing severe nausea, vomiting, and stomach pain-especially if you use cannabis regularly-you might be wondering: do I have CHS? This page will help you understand how CHS is diagnosed, what doctors look for, and why it’s often misdiagnosed as other conditions.

The Challenge: CHS Looks Like Many Other Conditions

One of the biggest problems with CHS is that its symptoms overlap with many other medical conditions. This means people often go through months or even years of being misdiagnosed before someone figures out what’s actually wrong.

If you’ve been told you have “cyclic vomiting syndrome,” “gastroenteritis,” or “anxiety-related nausea,” but the treatments aren’t working, you might actually have CHS. Many people end up in the emergency room multiple times before getting the right diagnosis.

How Doctors Diagnose CHS

There’s no single test that definitively diagnoses CHS. Instead, doctors use a combination of:

Your medical history (especially your cannabis use)
Your symptom pattern (how often, when, what helps)
Ruling out other conditions (tests to exclude other causes)
Response to treatment (whether stopping cannabis helps)

The most important thing for getting an accurate diagnosis is being honest with your doctor about your cannabis use. Many people are reluctant to mention it, but this information is crucial for diagnosis.

The Rome IV Diagnostic Criteria

Medical professionals often use the Rome IV criteria to diagnose CHS. These criteria require:

1. Episodic Vomiting Pattern

You need to have stereotypical episodes of vomiting that happen at least three times per year. These episodes should be similar to each other-meaning they follow a similar pattern each time.

What this looks like:

Episodes that come on suddenly
Severe nausea and vomiting that lasts for hours or days
Episodes that are separated by periods where you feel relatively normal
A pattern that repeats over time

2. Cannabis Use History

You need a history of prolonged and excessive cannabis use. This typically means:

Using cannabis more than four times per week
Using cannabis for over a year (often much longer)
Regular, frequent use rather than occasional use

Important note: Not everyone with CHS uses cannabis daily, but most do. The key is regular, frequent use over an extended period.

3. Symptom Resolution with Abstinence

Your symptoms should improve or completely resolve after you stop using cannabis. This is one of the most important diagnostic clues.

What to expect:

Symptoms may start improving within days of stopping
Complete resolution typically happens within weeks to months
Some people need to be completely abstinent for at least six months to see full resolution
If you start using again, symptoms often return

4. Compulsive Hot Bathing

This is one of the most distinctive features of CHS. You should experience temporary relief from hot showers or baths, and you may find yourself taking multiple hot showers per day during episodes.

What this looks like:

Relief that’s immediate when you get in hot water
Needing the water to be very hot (sometimes almost scalding)
Relief that disappears as soon as you cool down
Taking multiple showers per day during episodes
Spending hours in the shower just to feel better

Self-Assessment: Could I Have CHS?

Ask yourself these questions:

Cannabis Use

Do I use cannabis regularly (more than 4 times per week)?
Have I been using cannabis for over a year?
Do I use cannabis daily or near-daily?
Have I been using cannabis for several years?

Symptoms

Do I have recurrent episodes of severe nausea and vomiting?
Do these episodes happen at least a few times per year?
Do I experience abdominal pain or cramping during episodes?
Are my episodes separated by periods where I feel relatively normal?
Do my symptoms come in cycles or waves?

Hot Water Relief

Do hot showers or baths temporarily relieve my symptoms?
Do I need the water to be very hot to get relief?
Do my symptoms come back when I cool down?
Have I found myself taking multiple hot showers per day?
Is hot water one of the only things that helps?

Response to Stopping Cannabis

Have I noticed my symptoms improve when I’ve stopped using cannabis?
Do my symptoms get worse when I use cannabis more?
Have I tried stopping cannabis and seen improvement?

Other Clues

Have I been to the emergency room multiple times for vomiting?
Have doctors ruled out other causes (like infections, ulcers, etc.)?
Do standard anti-nausea medications not work well for me?
Have I been misdiagnosed with other conditions (cyclic vomiting, anxiety, etc.)?

If you answered “yes” to most of these questions, especially the cannabis use and hot water relief questions, you should talk to a healthcare provider about CHS.

Common Misdiagnoses: Why CHS Gets Missed

CHS is frequently misdiagnosed because its symptoms overlap with many other conditions. Here are the most common misdiagnoses:

Cyclic Vomiting Syndrome (CVS)

Why it’s confused: CVS and CHS have almost identical symptoms-recurrent episodes of severe vomiting, nausea, and abdominal pain that come in cycles.