This is a phase 2 randomized controlled trial testing the effect of topical capsaicin for the relieve of nausea and vomiting.

Inclusion Criteria:

• suspected cyclical vomiting syndrome / cannabinoid hyperemesis
• active severe nausea or vomiting in the emergency department

Exclusion Criteria:

• pregnant women, children < 18 years, no prior history of similar symptoms, suspected surgical or infectious cause of symptoms, suspected hepatitis or pancreatitis, allergy to capsaicin or hot peppers, chronic use of prescription antiemetic in prior 24 hours, abdominal pain alone (without nausea or vomiting)

4 hours

Identical appearing placebo cream used for control