Stage 1: Prodromal Phase

The prodromal phase is the earliest stage of CHS and can last for months or even years. During this phase:

• Patients typically experience early morning nausea, occasional vomiting, and abdominal discomfort.
• There is often a lack of appetite, weight loss, and a growing intolerance to certain foods.
• Despite the symptoms, individuals may increase cannabis use, mistakenly believing it will relieve their nausea.
• Patients are usually still functional and may not seek medical help, often dismissing symptoms as unrelated gastrointestinal issues.

This stage can be easily overlooked, as symptoms are vague and episodic. However, it sets the foundation for the more severe stages of CHS.

Stage 2: Hyperemetic Phase

The hyperemetic phase is when CHS becomes most acute and recognizable. Key features include:

• Persistent, intense vomiting, often in a cyclical or episodic pattern.
• Severe abdominal pain, sometimes described as cramping or burning.
• Relief from hot showers or baths — a hallmark behavior reported by many CHS patients.
• Dehydration and electrolyte imbalances due to excessive vomiting.
• Patients often present to emergency departments, sometimes multiple times, and may undergo extensive testing.

This is the phase when CHS is most likely to be diagnosed, although it can still be mistaken for other gastrointestinal disorders unless cannabis use is disclosed and recognized as a contributing factor.

Stage 3: Recovery Phase

The recovery phase begins once cannabis use is discontinued entirely. This stage is marked by:

• Cessation of vomiting and nausea, usually within a few days to weeks of stopping cannabis.
• Return of normal eating habits and gradual weight gain.
• Improvement in overall health, hydration, and quality of life.
• The recovery can be complete, but symptoms typically return if cannabis is resumed, often bringing the patient back into the hyperemetic phase.

Conclusion

CHS is a serious but treatable condition that follows a recognizable pattern across three stages: prodromal, hyperemetic, and recovery. Awareness among both healthcare providers and cannabis users is essential for early detection and successful management. The key to lasting relief is complete cessation of cannabis use — the only proven treatment for CHS to date.