CBD May Protect Against and Relieve Brain Injury Symptoms
During the past several years, public awareness about brain injuries has increased — thanks in part to several former professional athletes, military veterans, and accident survivors who are speaking out about effects of brain injuries, as well as a variety of brain injury awareness campaigns conducted by athletic and government organizations. 
Researchers also have been conducting studies to learn more about brain injuries, so they can understand the causes and develop new, more effective treatments. One brain injury treatment that is showing promise is cannabidiol, or CBD, which is a non-intoxicating cannabinoid molecule produced by cannabis.
What is a brain injury?
Traumatic brain injury (TBI) is a condition that occurs when a head injury, such as a bump, blow, or jolt, causes your brain to slam into the inside of your skull, which results in brain damage.
When your brain is injured, it releases neurotransmitters and chemicals that cause inflammation, blood vessel injury, chemical imbalances, tissue damage, and cell death. These brain responses are called a “secondary injury cascade” and are responsible for many of the neurological problems associated with TBI.
Although a severe TBI can be deadly or cause lifelong complications, even a mild TBI — which is commonly called a concussion — can cause symptoms that can last for days or weeks.
Repeated TBIs can cause a buildup of Tau protein, which can lead to a degenerative neurological condition called chronic traumatic encephalopathy (CTE). CTE can have a devastating impact on individuals and their families because it can cause a variety of symptoms that affect memory, emotions, behavior, movement, and mental functioning.
CBD May Offer Neuroprotective Benefits
In 1998, researchers published the results of a study on rats that demonstrated the neuroprotective benefits of CBD and tetrahydrocannabinol (THC), which are two of the cannabinoids found in cannabis.  Although more research is required to fully understand the neuroprotective effects of CBD, recent studies have shown that CBD activates the cannabinoid receptors in your brain that are part of your body’s natural endocannabinoid system.
A 2011 study of mice found that endocannabinoid levels are elevated during and after a TBI, which suggests that the endocannabinoid system plays an important neuroprotective role. 
Other animal studies also have shown that activating the cannabinoid receptors in your brain may help to limit nerve cell damage and promote healing by enhancing blood flow to the brain.  In a 2002 study, researchers found that mice that were genetically engineered to lack CB1, a cannabinoid receptor found in the brain, had more severe brain damage and cognitive deficits after a TBI when compared to mice that had the CB1 receptor.
Activating another cannabinoid receptor in the brain, called CB2, has been shown to promote the creation of new brain cells, as well as regulate inflammation after brain injury. A 2014 animal study found that mice that were genetically engineered to lack a CB2 receptor had worse outcomes after TBI when compared to mice that had a CB2 receptor. The study also found that the lack of a CB2 receptor impaired the creation of new brain cells.
And, CBD may also affect your glial cells, which insulate your neurons and facilitate your brain’s immune response after injury. Research shows that CBD seems to have the strongest effect on two types of glial cells: astrocytes and microglia. A 2017 animal study showed that CBD suppressed the activity and swelling caused by astrocytes;  another 2017 study showed that stimulating cannabinoid receptors in the brain suppressed inflammation caused by microglia in rats.
The Benefits of the “Entourage Effect”
Because full-spectrum CBD contains a variety of phytocannabinoids, it produces an “entourage effect” that engages both the CB1 and CB2 receptors in the brain — as well as other cannabinoid and non-cannabinoid receptors throughout your body — for maximum neuroprotective and overall health benefits.
Although further research is needed, some studies suggest that when CBD is used shortly before or within 12 hours of a brain injury, it may help to prevent or limit the damage that occurs after a TBI during the secondary injury cascade.
Anecdotal Evidence and Research Support CBD Use for TBI and CTE
Although CBD has shown promise for brain injury treatment in the research lab, anecdotal evidence also is strong — especially among some former professional athletes in sports with a high risk of head injuries, such as boxing and football.
Many professional athletes have spoken out about the benefits of CBD for the treatment of TBI and CTE symptoms, saying that it helped to regulate their mood, improve physical function, and reduce or eliminate their use of prescription painkillers and other medications.
Unlike many prescription pain medications, CBD is non-addictive and will not lead to overdose. CBD does not cause side effects and will not result in increased tolerance that requires higher doses to achieve the same effect. CBD also can be used to treat other health conditions that are common in athletes, such as chronic pain, anxiety, and insomnia.
But although anecdotal evidence suggests that CBD may be safe and effective for professional athletes, it also may show promise for the treatment of TBIs caused by youth sports, falls, car accidents and military combat injuries. And, researchers are investigating CBD as a potential treatment for other conditions that affect the brain, including Alzheimer’s disease, Parkinson’s disease, stroke, and HIV-associated dementia.
Researchers are hoping to conduct further studies on CBD and how it can be used to treat TBI and CTE, as well as develop dosing and safety recommendations for CBD use. But in the meantime, many people who have experienced TBI or have been diagnosed with CTE are using CBD to treat the symptoms of their condition — often with life-changing results.During the past several years, public awareness about brain injuries has increased — thanks in part to several former professional athletes, military veterans, and accident survivors who are speaking out about effects of brain injuries, as well as a variety of brain injury awareness campaigns conducted by athletic and
CBD and Cannabis Research
Current research is pointing towards CBD serving as a neuroprotectant, possibly helping the brain heal from concussions. Findings also indicate that CBD and/or medical cannabis (marijuana) can be effective for pain management, anxiety, and insomnia, all of which are common symptoms of concussions and Post-concussion Syndrome.
Some research focuses specifically on CBD (cannabidiol), which is the nonpsychoactive element of cannabis, and other research focuses on medical cannabis, with various ratios of CBD and THC (tetrahydrocannabinol). CBD is a nonpsychoactive cannabinoid, and THC is the psychoactive cannabinoid.
CBD products are extracted from hemp or marijuana, which are essentially the same cannabis plant but are cultivated differently, hemp plants being grown to contain less than 0.3% THC.
Concussion patients are using CBD oil from hemp, which has virtually no THC, or marijuana products (vape, tincture, etc.) with various ratios of CBD and THC.
We use the term medical cannabis (or medical marijuana) because that is what is being used in research studies. The critical point is that where marijuana is legal, either as medical marijuana or recreational marijuana, the products are regulated and you can purchase marijuana with specific ratios of CBD to THC.
Study indicates medical cannabis improves concussion symptoms
A December 2018 study in the journal Neurology indicates that medical cannabis (marijuana) helps concussion patients with concussion symptoms, especially pain, mood, sleep, and quality of life. The study also specifies the optimal forms of medical cannabis for the patients in the study, in terms of rations of CBD to THC, and methods of intake, such as a tincture (oral) or a vapor pen (inhaling). Read more in our blog post Study finds medical marijuana improves concussion symptoms.
In the United States, the first big study on cannabinoid treatment for concussion is being done by the University of Miami which received a $16 million grant for the research. The study is a five-year, three-stage study that will “assess the effectiveness of a new cannabinoid-based pill to treat concussion injuries. This partnership aims to propel this research and potential treatment forward by using two classes of drugs in a combination that scientists believe will reduce brain inflammation and the immune response.” See also the Miami Herald article.
As reported in UHealth in July 2018, the “findings of a pre-clinical pilot study were recently released, and they show that the combination therapy improved the cognitive functions of animals, compared with those treated with a single vehicle. In addition, there were no adverse effects from either the combination therapy or the individual components.”
The cannabinoid combination therapy is made up of CBD (Cannabidiol, an element of cannabis) and Dexanabinol (HU-211) which is synthetic cannabinoid which is an “anticonvulsant and neuroprotective, and is widely used in scientific research as well as currently being studied for applications such as treating head injury, stroke, or cancer.”
The next phase of the University of Miami study will be a small pilot study with people; the cannabinoid-based pill will be “to a control group and two groups of TBI patients, acute and chronic.”
For additional information, see our blog post: Clinical Trial for a CBD pill for concussions.
In Canada, a new study led by NEEKA Health Canada will “test if CBD-based therapies can reduce the severity of post-concussion brain disorders in former NHL players.” The National Hockey League Alumni Association and Canopy Growth Corp. (a cannabis and hemp company) are partnering with NEEKA for the clinical research; approximately 100 former players will be enrolled in the randomized, double-blind study.
The World Health Organization (WHO) in a November 2017 report concluded that “CBD is generally well tolerated with a good safety profile. For further information, see our blog page WHO report.
CBD and/or THC as a protectant for the brain
In a 2017 study, “a team at the Hebrew University of Jerusalem has found that rats and mice subjected to traumatic brain injury (TBI) showed significantly better recovery when treated with cannabinoid compounds, possibly opening the way for clinical trials in the near future.”
A November 2017 report by the World Health Organization (WHO), in its “Overview of diseases for which CBD may have therapeutic benefits” discusses the neuroprotectant effects of CBD. It does not specifically list concussions or traumatic brain injury, but the neuroprotectant effects of CBD are listed for Alzheimer’s and Inflammatory Diseases. “Alzheimer’s disease: Antiinflammatory, antioxidant, antiapoptotic in in vitro and in vivo models of AB-evoked neuroinflammatory and neurodegenerative responses.” “Inflammatory Diseases: Antinflammatory properties in several in vitro and in vivo models; inhibition of inflammatory cytokines and pathways.”
A February 2017 study, “Endocannabinoids: A Promising Impact for Traumatic Brain Injury”, by authors Lesley D. Schurman et al., was published in Frontiers in Pharmacology.
A 2014 study, Effect of Marijuana Use on Outcomes in Traumatic Brain Injury, reviewed the records of all trauma patients admitted to the surgical intensive care unit at Harbor-UCLA Medical center over a period of 2 years. All patients sustaining a traumatic brain injury and who had been given a urine test for drugs were selected for the study. After accounting for variables, “A positive THC screen is associated with decreased mortality in adult patients sustaining TBI.” “The THC(+) group had a significantly lower mortality rate than the THC(-) group.” The THC positive group had a 2.4% mortality rate compared to the THC negative group which had an 11.5% mortality rate.
In a 2012 study, researchers took newborn rats and restricted blood flow/oxygen levels to their brains, created a hypoxia-ischemia (HI) brain injury. They found that “CBD administration after (injury)..led to long-lasting neuroprotection.” They found that dosing with CBD after the brain injury reduced the volume and extent of brain damage, reduced inflammation in the brain, and prevented the impairment of neurological behavior. The researchers observed that overall, rats given the HI brain injury had long-lasting functional impairments, but the rats that were given CBD after the injury had functional results similar to the group of control rats who were not given brain injuries.
CBD for treatment of pain, including headaches and migraines
In a 2019 study published in Neurology, researchers found that 88.3% of patients with chronic migraines who were given medical cannabis reported a reduction in headache frequency, along with improvements in sleep, anxiety, and mood. Headaches are the most common symptom after a concussion, with the most common type of headache resembling a migraine, according to the American Migraine Foundation. Researchers Laszlo Mechtler et al. found that significantly more patients taking the 20:1 (THC to CBD) ratio reported headache reduction than those taking the 1:1 (THC to CBD) ratio.
A 2018 survey of oncology doctors regarding medical marijuana found that “sixty-seven percent viewed it as a helpful adjunct to standard pain management strategies”. “In the new study, cancer doctors said their conversations about marijuana were almost always started by patients and their families, not by the doctors themselves. Overall, nearly eight in 10 cancer doctors reported having discussed marijuana with patients or their families, with 46 percent recommending it for pain and other cancer-related problems to at least one patient in the past year.”
In April, 2018 a new was introduced to the Veteran’s Affairs Committee that would “encourage the U.S. Department of Veterans Affairs (VA) to ‘conduct and support research relating to the efficacy and safety of medical cannabis on the health outcomes of covered veterans diagnosed with chronic pain, post-traumatic stress disorder, and other conditions.'”
A November 2017 report by the World Health Organization (WHO), in its “Overview of diseases for which CBD may have therapeutic benefits” lists “Pain: Analgesic effect in patients with neuropathic pain resistant to other treatments.”
In 2016 researchers in the Johns Hopkins University School of Medicine (Baltimore, Maryland) began recruiting football players on the active roster in the NFL for a study of cannabis versus opioid consumption and “Evaluate how general health (e.g. mood, sleep, stress) relates to cannabinoid and opioid use.” Players supporting the study are Derrick Morgan, Jake Plummer, and Eugene Monroe, who donated $80,000 toward the research. From the Player Research Invitation: “With emerging evidence about both the harms associated with opioid use and potential benefits of cannabinoids for pain and inflammation, some players have called for the NFL to re-evaluate its policy regarding cannabinoid use and the current practices surrounding opioid use. “
A 2014 study reviewed research since a 2004 “landmark” investigation that concluded that “cannabinoids can block spinal, peripheral and gastrointestinal mechanisms that promote pain in headache, fibromyalgia, irritable bowel syndrome and muscle spasm.” The 2014 study is a review of ten years of subsequent research, confirming that “underlying endocannabinoid deficiencies indeed play a role in migraine, fibromyalgia, irritable bowel syndrome and a growing list of other medical conditions. Further research and especially, clinical trials will further demonstrate the usefulness of medical cannabis. As legal barriers fall and scientific bias fades this will become more apparent.”
CBD treatment to reduce insomnia and anxiety
A 2017 study states that “Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia.”
A 2016 Colorado-based study found that CBD oil “can be an effective compound to reduce anxiety and insomnia secondary to PTSD.” The case-study patient was given 12 mg to 25 mg once daily, which “appears to provide relief of key symptoms with minimal side effects.” “Her scores on the sleep scale and the anxiety scale consistently and steadily decreased during a period of 5 months. she was ultimately able to sleep through the night most nights in her own room, was less anxious at school and home, and displayed appropriate behaviors.”
A 2013 study investigating CBD effects on sleep in rats, found that “CBD appears to increase total sleep time.”
A 2007 study treated people with Sativex, a pharmacological medicine (a combination of CBD and THC,15 mg of each) which has regulatory approval from 30 countries outside the United States, as of 2018. The researchers found “marked improvement in subjective sleep parameters in patients with a wide variety of pain conditions including multiple sclerosis, peripheral neuropathic pain, intractable cancer pain, and rheumatoid arthritis” with no need for dosage increases over time. The researchers note that lack of good sleep quality is a “key source of disability in chronic pain syndromes.”
Resources For Information On CBD
We’ve several times quoted articles from PROJECT CBD, which is a highly respected resource. Project CBD is “California-based nonprofit dedicated to promoting and publicizing research into the medical uses of cannabidiol (CBD)”.Highlighting research and clinical trials around the world for use of CBD for concussion and post-concussion syndrome treatment, neuroprotection, and pain, insomnia, & anxiety management. ]]>