In patients suffering from cvs there is consensus

In patients suffering from CVS, there is consensus that
application of preventive medication and medication
capable of aborting an episode reduces the intensity and
frequency of cycles [1], [3], [4]. Amitriptyline, propranolol,
sumatriptane are recommended preventive medications
[1], [3], [4]. Metoclopramide, ondansetron, lorazepam or
oxycodone, ideally with application at the onset of pro-
dromal symptoms, can abort an episode [1], [3], [4].
Psychosocial care is of additional benefit [1], [3], [4].
In patients who refuse cessation of cannabis use and
especially in patients who do not sufficiently respond to
cannabis use cessation alone, adopting the therapeutic
regime of CVS might be beneficial. But there is no data
supporting a potential benefit of applying the therapeutic
strategy of CVS to CHS in these patients.
Follow-up of CVS and CHS
Reliable long-term follow up data (minimum follow up
time: 12 months) of patients suffering from CVS or CHS
is sparse [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11],
[13], [14], [15]. Differentiation between CVS and CHS is
simple in patients who do not practise chronic marijuana
abuse [1], [2]. Distinguishing between CVS from CHS in
patients who practise chronic marijuana abuse can be
extremely difficult [1], [3], [5], [9], [11].
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Table 1: Criteria for the diagnosis of CVS and CHS
Table 2: Differential diagnoses of CVS and CHS
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Table 3: Treatment
Follow-up involving these patients pursues five main ob-
jectives:
1. Evaluation of complete and permanent resolution of
symptoms due to cannabis cessation alone.
2. Evaluation of the effectiveness of therapeutic
strategies for CVS when applied to CHS patients who
refuse cannabis cessation.
3. Evaluation of the efficacy of therapeutic strategies for
CVS patients in patients who do not fully respond to
cannabis cessation.
4. Providing access to physicians familiar with CVS and
CHS to patients suffering from either syndrome.
5. Collection of data helpful to evaluate therapeutic
strategies in CVS and CHS patients [1], [2], [3], [4],
[5], [6], [7], [8], [9], [10], [11], [13], [14], [15].
Patients who fully respond to cannabis cessation alone
for a minimum period of 12 months after complete resol-
ution of symptoms are likely to suffer from CHS [2], [5],
[6], [8]. Diagnosis in patients who cease cannabis abuse
and continue to have symptoms is probably CVS. Patients
who continue cannabis abuse but benefit from therapeut-
ic regimes available for CVS patients may be diagnosed
CVS [1], [2]. The occurence of patients who do not cease
cannabis abuse and continue to have symptoms despite
treatment alike CVS patients support the hypothesis that
cannabis cessation is the only available treatment for
CHS [2].
Discussion
From a practitioner’s point of view, the major issue of
CVS and/or CHS is the limited awareness among physi-
cians which consequently results in diagnostic failure and
inadequate treatment [1], [2]. Displaying educational
material in poster format in departments of emergency