Cannabis (Marijuana) for dizziness, nausea or headache.
Marijuana is one of the most popular recreational drugs worldwide, and is the #1 illegal drug in the US (followed by cocaine). It is estimated that in the US, about 13.5% of the population uses it every year. (Zhang, 2019) As medical marijuana has become legal in many countries as well as about half of the states in the USA, it is now possible to discuss its use for treatment of common conditions such as dizziness, nausea and headache.
Cannabis is a generic term used for drugs produced from plants belong to the genus Cannabis (i.e. marijuana). Cannabis is not a single substance but rather is a mixture of up to roughly 60 compounds. Some of them, like THC (d-9-tetrahydrocannabinol), are psychoactive, and most others are not.
Prescription forms of cannabinoids include:
|Name||Constituents||FDA approval||Legal under federal/state laws|
|Marijuana||THC, CBD, others||No||No/Yes|
|Dronabinol (Marinol)||THC||Yes||yes/yes, was schedule I in 1971, but FDA indications suggest there i an accepted use.|
|Nabilone (Cesamet)||Synthetic cannabinoid||Yes||Yes/yes|
|Nabiximole (Sativex)||Oral spray mix of THC and CBD||No||No/no — available as of 2015 only in FDA approved clinical trials|
What is in Cannabis ?
According to Fife et al, Marijuana is a plant of the species Cannabis sativa or Cannabis indica, and contains many chemical compounds. THC is the chief psychoactive component, while CBD (cannabidiol) has minimal or no psychoactive effects. Other cannabinoids without psychoactive properties include cannabigerol and cannabinol. THC can be measured in the blood, while carboxy THC is detected only in the urine. Hemp, made from the stem of the plant, contains only traces of THC. There are several strains of cannabis, mainly differentiated by the their psychoactive properties. “sativa’ is more stimulating. “indica” is more calming. “hemp” has low or absent THC.
A single dose of cannabis can be detected in the urine for 12 days. Thus someone who is involved in an auto-accident 10 days after using cannabis, could theoretically be cited for “DUI”.
One would think that it might be possible to use a non-psychoactive cannabinoid for a medical purpose, without running into issues with mental status. Nevertheless, due to the odd status in the US where research on cannabis has been suppressed by the government, we know little about the non-psychoactive components of Marijuana. We do not know, for example, if they cause cancer (just an example).
What does Cannabis do the brain ?
Rather astoundingly, Cannabis appears to activate specific endocannabinoid receptors, mainly in the CNS. There are two main cannabinoid receptors, CB1 and CB2. According to Baron (2018), CB1 is found mainly in the CNS. CB2 is more numerous in the peripheral tissues.
THC (tetrahydrocannabinol) is a partial agonist of CB1 (more so than CB2).
Cannabidiol (CBD) has no psychoactive properties, does not attach to CB1 or CB2, but functions as a noncompetitive antagonist at CB1.
The details of what it does to the brain are being worked out and are presently the subject of considerable controversy. While there are claims that cannabis reduces cognitive function, a recent study published in JAMA psychiatry, analyzing 69 studies, suggested that there is only a very small effect after 72 hours (Scott et al, 2018)
Possible indications for Cannabinoids
As of 2015, Fife et al (2015) summarized their conclusions regarding utility of Cannabis in neurological disorders.
There was evidence for effectiveness in spasticity, central pain in MS. Nabiximols was thought to be “probably effective” in reducing bladder spasms (this drug is also used to treat nausea, see below). In movement disorders such as tremor, Huntington disease, and dopamine related dyskinesias, it was thought either ineffective or unknown. For Epilepsy, as of 2015, it was unknown.
THC (brand name Dronabinol) has been extensively studied with placebo controlled trials for nausea. A similar drug called Nabilone is also available. Both of these have been approved by the FDA for treatment of nausea and vomiting associated with chemotherapy. Another substance called “Nabiximol” is not currently FDA approved for nausea, but it is licensed in other countries and appears to be similar.
McGeeney (2012) suggests that anecdotal evidence suggests that they “are used” by patients for migraine, including as an abortive, and for cluster headache. Baron (2015) also suggests that there is some evidence for a good effect in migraine. As there is some evidence for an effect in chronic pain, one would anticipate a positive effect also in chronic migraine. Thus evidence is currently extremely weak.
According to Baron (2018), a chemical called anandamide inhibits dilation of blood vessels, modulates CGRP, and cortical spreading depression. CB1 also inhibits pain responses. We consider this also anecdotal.
Vertigo and Dizziness
There are presently (in 2015) no studies of cannabis for treatment of dizziness, and dizziness appears to be more of a side effect than a therapeutic target (Grotenhermen et al, 2012). Smith (2006) suggested that there are cannabinoid receptors in the central vestibular system. More studies are needed.
We have had heard from our patients that they have sometimes had a good response to a non-mind altering component of cannabis (CBD). In theory, this might be related to the anti-seizure effects of some components of cannabis. At this date (early 2018), these are just anecdotes.
Products that we have been told were helpful are “Charlotte’s Web”, “Watermelon Pucks”, and “Anandahemp 200”. The first is CBD oil, and can easily be ordered from the internet. The second contains some THC, and is not as readily available. As noted above, THC is approved by the FDA for treatment of nausea and vomiting associated with chemotherapy, and thus it is not surprising that “Watermelon Pucks” might be helpful in some people with dizziness. To be very clear, I am not advocating for these products, but I am simply transmitting what patients are telling me.
Legal status of cannabis in Illinois.
As of 2019, cannabis is scheduled to be available for recreational use by early 2020. Presently, In Illinois, the Illinois Compassionate Use of Medical Cannabis Pilot Program requires physicians to certify the diagnosis of a debilitating condition or terminal illness for a qualifying patient seeking to apply for a medical cannabis registry identification card. Whether or not a physician chooses to provide a written physician certification is up to the health care practitioner. More information is here: https://www.dph.illinois.gov/topics-services/prevention-wellness/medical-cannabis/physician-information
According to Fife et al (2015), the system used in Illinois is the usual one used to handle the odd situation where the Federal government states that licensed physicians cannot legally prescribe herbal marijuana (although they may prescribe nabilone or dronabinol). Physicians can document that the patient has a medical condition that justifies the use of marijuana under that state’s law. Patients then may proceed to acquire the marijuana, under the particulars of the laws of their state. Nevertheless, certain institutions, including the Department of Veteran affairs, may have policies banning physicians from discussing medical marijuana with their patients.
Note that THC can be detected in the urine as long as 12 days after a single “dose”. This means that in Illinois, should one be involved in an auto accident, it is theoretically possible to be cited for DUI, 12 days after ingesting a small amount of medical marijuana.
Qualifying conditions for cannabis in Illinois:
An individual diagnosed with one or more debilitating conditions is eligible to apply for a medical cannabis registry identification card. The qualifying patient must obtain a written certification from a physician specifying their debilitating condition, unless they are a veteran receiving health services at a VA facility. Veterans must submit one year of medical records from the VA facility where they receive services. Effective January 1, 2015, the Act was amended to include eligibility for children under age 18 and to add seizure disorders to the list of debilitating conditions. On June 30, 2016, the Act was amended (Public Act 099-0519) to add Post-Traumatic Stress Disorder (PTSD) as a debilitating condition and to allow persons diagnosed with a terminal illness to apply for a medical cannabis registry identification card. The Act is effective until Jan, 1, 2020.
Qualifying patients must be diagnosed with a debilitating condition, as defined in the Compassionate Use of Medical Cannabis Pilot Program Act, to be eligible for a medical cannabis registry identification card in Illinois.
On this list, conditions that might cause or be associated with dizziness include Arnold-Chiari, Cancer, Hydrocephalus, MS, myoclonus, and TBI. Neither migraine nor intractable nausea are included here.
Here’s What We Know About Using CBD for Vertigo in 2021
While many people have struggled with vertigo, it can also be difficult to find the best solution to treat the symptoms.
In recent years, more research has been able to show promising results when using cannabidiol (CBD) as a treatment for the relief of vertigo symptoms. Now in 2021, we have lots of information to guide us through the use of CBD products for vertigo patients, so let’s get started.
What Is Vertigo?
Many people associate vertigo with dizzy feelings, but the actual meaning of vertigo is slightly more complex. Vertigo occurs when your body experiences a feeling of unbalance.
This can manifest in different ways– including dizziness or spinning feelings. Some people who have vertigo will describe it as their surroundings spinning (even though they aren’t) around them while you aren’t moving, or vice versa.
It’s a common condition that can feel similar to motion sickness in some patients, but it’s more intense than feeling lightheaded.
Multiple factors may lead to vertigo, but problems in the inner ear are a very common cause. One of the main causes of vertigo is called benign paroxysmal positional vertigo (BPPV for short). This condition can lead to short-term sensations of spinning or movement and can be triggered by rapid head movement.
This happens because BPPV appears in the inner ear when tiny particles called canaliths are shifted from their normal location and into the inner ear. When this occurs, your ear sends a signal to the brain to help keep your balance.
Another cause of vertigo can be Meniere’s disease, which research shows can lead to hour-long episodes. This disease affects the inner ear through a buildup of fluids and increased pressure, causing vertigo or tinnitus. People who struggle with this disorder may also experience trouble hearing or hearing loss in addition to symptoms of vertigo.
Other causes can include inner ear infections like vestibular neuritis or labyrinthitis, as well as migraines.
The symptoms of vertigo will vary depending on the cause and case, however, common symptoms include nausea, vomiting, headaches, ringing in the ear, feelings of spinning/unbalance, abnormal eye movements, perspiration, and more. While most symptoms tend to go away within minutes, some sufferers may have symptoms that last up to 24 hours.
How Does CBD Help With Vertigo?
Many people are turning towards CBD products as a treatment for symptoms of vertigo, but is it effective? The effectiveness of CBD treatment for vertigo will ultimately rely on your symptoms and personal case. It does offer a possible solution for patients who would rather try a natural remedy over other medications/methods.
When you look at the symptoms of vertigo, CBD has different benefits that may help treat symptoms in various ways. The most common symptom of vertigo is dizziness, but CBD properties aren’t well known to treat dizziness. However, a 2018 study showed that multiple patients who tried CBD treatment reported relief from dizziness and fatigue.
That being said, there is an abundance of research that shows CBD to possess anti-inflammatory and anti-nausea properties & effects. The anti-inflammatory benefits may help patients who have symptoms caused by pressure or buildup in the inner ear, by providing possible relief to reduce the severity.
It’s also important to note that one of the most inconvenient & uncomfortable symptoms of vertigo is feelings of nausea. Quick relief for nauseousness is hard to find, but studies show that cannabidiol can work effectively to reduce or even eliminate nausea.
While CBD has helpful properties that can help alleviate symptoms of vertigo, it is not a one-size-fits-all treatment. For patients interested in natural remedies to relieve nausea, pressure, or dizziness related to vertigo, CBD may be worth trying. However, patients should consult their doctor before starting CBD treatment, for further safety.
Is CBD Safe?
CBD has been considered as a possible treatment method for vertigo symptoms, as well as many other conditions. That being said, if you haven’t used CBD products like oils, tinctures, edibles, or inhalers , it may leave you wondering about safety.
For more context, CBD refers to cannabidiol, which is one of the most notable active ingredients found in marijuana (aka cannabis) plants. While CBD does derive from the hemp plant (the cousin of the marijuana plant), it does not provide the psychoactive effects or “high” feeling that cannabis products containing tetrahydrocannabinol, or THC, will produce.
CBD is not a cure; however, it has been shown to provide relief for many symptoms that result from health conditions. CBD can help relieve an extensive range of health symptoms without the risk of developing a dependency.
CBD does not provide any psychoactive effects. Therefore, it will likely not impair your ability to drive safely. However, it’s important to check with your local laws and restrictions, as they differ among regions. That being said, you are most likely safe to drive after taking CBD oil. The only exception might be if the CBD product you’ve taken contains THC, it can impair your driving.
As for possible side effects, the research available on CBD suggests that there are some rare cases. The potential side effects are not common & typically mild but include dry mouth, nausea, or fatigue. In order to prevent adverse side effects, make sure your CBD dosage is reasonable concerning the recommended amount.
Overall, CBD is a safe treatment method, but if you have specific concerns related to your health– check with your doctor beforehand.
Other Treatment Options For Vertigo
Vertigo cases vary in symptoms and causes, so treatment options will depend on the patient and their specific case. For many cases, vertigo symptoms will fade without any treatment, as most episodes are short– ranging from 2 minutes to a few hours.
There are treatment options that can help to prevent vertigo symptoms/episodes from occurring in the future, depending on the case. Here are some of the common treatments for vertigo patients.
If an underlying cause of a patient’s vertigo is an infection of the inner ear or elsewhere, doctors may prescribe antibiotics to reduce inflammation. This can open up the passageways, reduce buildup in the ear, and minimize swelling to eliminate vertigo triggers.
This form of treatment is more common with patients who experience vertigo very often and want to prevent/reduce symptoms such as dizziness and loss of balance. This treatment is a form of physical therapy that works to train your vestibular system.
The vestibular system is a sensory-based system that influences balance and spatial orientation. It works by training your system to send signals to the brain that relate to movement and gravity, making it easier to control balance and disorientation. Overall, this treatment helps to strengthen your senses in order to prevent common triggers or symptoms of vertigo long-term.
For patients with severe cases, especially caused by Meniere’s disease, certain medications are prescribed to alleviate dizziness. These medications can include diuretics, antihistamines, lorazepam, and more. This is a preferred treatment only when recommended by a medical professional after a thorough diagnosis.
Canalith Repositioning Procedure
This procedure is used to treat patients with benign paroxysmal positional vertigo (BPPV) in order to prevent dizziness using simple head maneuvers. This treatment is focused on the inner ear calcium deposits, using movement to reposition the particles to prevent dizziness. It is not a total cure, but it can be effective after 1-2 treatments. Although uncommon vertigo may reoccur after treatments, but less frequently.
Some patients may feel relief from vertigo symptoms by practicing lifestyle habits/home remedies. These practices include walking with a cane, squatting instead of bending, sleeping with a raised head, and other daily changes.
There isn’t much research out on this method of treatment, however, a 2015 study showed some promising results. This research found that 30 minutes of acupuncture treatment was able to reduce vertigo symptoms in 60 patients who were seeking emergency medical attention for dizziness/vertigo.