classically associated with relief from hot showers resulting in compulsive showers/bathing
cyclical every 2-3weeks
anti-emetics generally do not work well
take care to exclude other important causes before deciding upon this diagnosis and ensure the features do match the syndrome
unfortunately, this may lead to over-investigation with CT scans on multiple visits - the decision to not do a scan should be based on solid clinical reasoning
diagnosis
long term chronic cannabis/marijuana use with current weekly use
cyclic nausea and vomiting
relief of symptoms with hot showers or baths
+/- abdominal pain
+/- mainly in mornings
other diagnoses excluded
Rx
consider iv rehydration and correction of electrolyte disturbances if present
advise cessation of cannabis use
consider trial of promethazine
consider trial of topical 0.075% capsaicin cream to trunk