In this patient, obtaining a drug history is important and particularly asking about marijuana use. Not only can marijuana cause a hyperemesis syndrome, it is also associated with cyclic vomiting syndrome (CVS). CVS is a functional gastrointestinal disorder, which is associated with stress and anxiety, although the exact pathogenesis remains unknown. Similar to symptoms seen in this patient, it is characterized by discreet episodes of nausea and vomiting, often severe. Some patients may intermittently complain of coexisting headache and abdominal pain, also often described as severe. The syndrome is often misdiagnosed as migraine headache, however the primary symptoms are nausea and vomiting and not headache. In between episodes-an interval that may last for several days up to a few months-patients with CVS are without symptoms. Treatment consists of antiemetics, benzodiazepines, and triptans. The parallels found between cannabinoid hyperemesis syndrome and CVS support the notion that the former is a subset of the latter. For those who smoke marijuana, discontinuation is the first course of action. 

Association of marijuana use and cyclic vomiting syndrome. 

 2012;5:719–726. Published online 2012 Jun 29. doi:10.3390/ph5070719.

Gastrointestinal Disorders

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Could repeated episodes of vomiting in this young woman be related to ingestion of a drug? 

Hyperemesis in a Young Woman: Diagnosis