Concussions and Traumatic Brain Injuries- Can Cannabis Help Recovery?

Concussions, Traumatic Brain Injuries and the Role of Cannabis in Recovery

I happened to be watching NFL Thursday Night Football (something I almost never do), but the Buffalo Bills were here in Miami and despite my gripes with how the NFL treats players into retirement, I root for the Bills. After all, they were the ones that gave me my shot in the league. As many of you may know, during that game, Miami Dolphins quarterback Tua Tagovailoa suffered a head injury resulting in him being removed from the game and diagnosed with a concussion. 

What makes this concussion of greater significance than the many other head injuries that football players suffered that week was not only the gruesome nature of it, but the context. Tua had suffered several concussions prior to this that were also disturbing to watch. I personally don't like to see the players on the ground injured - it doesn't make me feel good. I’ve laid on the ground injured twice playing football: the first was when I got kicked in the pearls in college 😖. The second time was during training camp with the Bills was my last time (torn ACL, MCL, PCL, meniscus).

As the years went along and I learned more about the dangers of head injuries (especially as it related to playing football), I began to be somewhat appreciative that it was “just” my knee that ended my career. I’ve written about some of the struggles I’ve had with the effects of my concussions and the headaches I suffered with as a result. 

I can't tell you how many I’ve had because I was never officially diagnosed with one. When I played, they didn't really call it a concussion unless you lost consciousness. Back then, you “got your bell rang” and needed to “clear out the cobwebs”. Both those terms are actually very descriptive of some of the sensation you have when you suffer a concussion. Visual disturbances (seeing double), short term memory loss (what happened?) nausea, vomiting, photophobia (aversion to bright lights) and loss of motor control (staggering, spasticity) are some of the common signs of brain injuries and concussions. 

What Is a Concussion?

A concussion is a type of traumatic brain injury (TBI) caused by a sudden blow or jolt to the head that disrupts normal brain function. During a concussion, the brain may shake inside the skull, leading to chemical changes and potential damage to brain cells. While concussions are often considered mild TBIs, their effects can range from temporary disruptions in brain function to long-term cognitive and emotional impairments. Symptoms include headaches, dizziness, confusion, memory loss, and sensitivity to light or noise.

The risk of sustaining a second concussion after an initial one is significantly increased. Statistics show that once someone has had a concussion, they are 3 to 6 times more likely to suffer another compared to someone who has never had one. This is why so many people have shown concern/ distress over the visuals of Tua Tagovailoa suffering yet another concussion. This increased susceptibility is often due to the brain’s vulnerability during the recovery period after the first concussion, especially if there isn’t sufficient time for full healing.

This is particularly evident in sports related concussions:

• High school athletes who have experienced one concussion are more than twice as likely to suffer a second concussion within the same season, according to a study published in Pediatrics.

• In football, studies have found that athletes who have had a concussion are two to five times more likely to experience another compared to their non-concussed counterparts.

Additionally, repetitive concussions can lead to Second Impact Syndrome (SIS), where a second concussion occurs before the brain has fully recovered from the first, potentially leading to rapid brain swelling and even fatal outcomes.

Pearls:

• Concussions are a type of traumatic brain injury that can cause both immediate and long-term effects.

• Repeated concussions, even minor ones, increase the risk of long-term brain damage, including conditions like chronic traumatic encephalopathy (CTE).

Demographic Data on Concussions

Concussions affect people of all ages, but data shows that certain groups are more vulnerable. According to the CDC, adolescents aged 5-18 account for the majority of sports- and recreation-related concussions, with nearly 70% of reported cases occurring in this age group. Older adults, particularly those over 65, are also at higher risk due to falls. Socioeconomic status influences how concussions are reported and treated, as individuals from lower-income families may have limited access to healthcare, leading to potential underreporting or undertreatment.

Gender also plays a role. Males tend to sustain more concussions due to participation in high-contact sports, but females often report more severe symptoms and longer recovery times, particularly in sports like soccer and basketball. Research suggests that physiological factors like neck strength and hormonal differences contribute to these gender-based variations.

Pearls:

• Children and adolescents account for nearly 70% of sports-related concussions, with older adults also at high risk due to falls.

• Females often experience more severe concussion symptoms and have longer recovery times, likely due to physiological differences.

Gender Differences in Sports-Related Concussions

While males generally experience more concussions in contact sports, female athletes, particularly in sports like soccer and volleyball, are more likely to experience concussions in non-contact sports. A study focusing on collegiate women’s volleyball found the concussion rate to be 3.57 per 10,000 athlete exposures, a significant number for a non-contact sport. Researchers attribute this to the high velocity of the ball, frequent head impacts, and collisions with other players.

In terms of recovery, females tend to report more severe symptoms and may take longer to recover, which is thought to be due to differences in neck strength and hormonal fluctuations. In sports like volleyball, where players are frequently exposed to high-speed ball impacts, concussions remain a significant concern.

Pearls:

• Female athletes in non-contact sports like volleyball experience concussions at a rate of 3.57 per 10,000 athlete exposures.

• Hormonal differences and neck strength disparities may explain why female athletes often experience more severe symptoms and slower recovery times.

Chronic Traumatic Encephalopathy (CTE)

Chronic traumatic encephalopathy (CTE) is a progressive, degenerative brain disease associated with repeated head injuries and concussions. CTE is marked by the buildup of abnormal tau protein in the brain, which can lead to cognitive decline, memory loss, mood swings, and, in severe cases, dementia. CTE is most commonly seen in athletes from contact sports like football and boxing, as well as military personnel exposed to repetitive head trauma.

A study published in JAMA found that 99% of NFL players whose brains were studied posthumously exhibited signs of CTE. The exact number of concussions or head impacts required to develop CTE is still unknown, but the risk increases with the frequency and severity of head injuries. Currently, CTE can only be diagnosed definitively through an autopsy, but researchers are exploring ways to detect it earlier.

Pearls:

• CTE is linked to repeated head trauma and leads to the buildup of tau protein, causing cognitive and emotional decline.

• In a study of deceased NFL players, 99% showed signs of CTE, highlighting the dangers of repeated concussions.

Traditional Treatments for Concussions: Pros and Cons

Concussion treatment traditionally involves rest, both physical and cognitive, to allow the brain to recover. Most physicians recommend limiting activities that strain the brain, such as screen time, reading, or intense physical exercise, for at least 24-48 hours following the injury. Over-the-counter pain medications like acetaminophen may help manage symptoms like headaches, though NSAIDs (e.g., ibuprofen) are generally avoided early on due to the risk of bleeding.

Pros:

• Rest allows the brain to recover naturally without additional strain.

• Gradual reintroduction of activities can prevent further injury.

Cons:

• Some studies suggest that extended rest can delay recovery, especially in young athletes.

• There is no one-size-fits-all treatment plan, and recovery timelines vary widely.

Pearls:

• Rest is the cornerstone of concussion treatment, though prolonged rest may delay recovery in some cases.

• Research suggests that reintroducing light physical activity after the initial rest period may promote faster recovery.

Holistic Treatments: Pros, Cons, and Novel Approaches

Many concussion patients turn to holistic treatments to complement traditional care. Dietary supplements like omega-3 fatty acids, alpha-lipoic acid, and other antioxidants are popular choices, as they are believed to support brain health and reduce inflammation.

Alpha-Lipoic Acid (ALA)

Alpha-lipoic acid (ALA) is an antioxidant that helps neutralize free radicals, which are harmful molecules that contribute to oxidative stress and inflammation in the brain after an injury. ALA also regenerates other antioxidants like vitamin C and E, providing additional protection. Some studies suggest that ALA can reduce neuroinflammation following a concussion, potentially aiding in recovery, though more research is needed in humans .

Omega-3 Fatty Acids

Omega-3s, particularly DHA, are essential for maintaining the structure and function of brain cells. They play a key role in reducing inflammation and promoting the repair of damaged cells after a concussion. Research suggests that omega-3 supplementation can help restore brain function by reducing the inflammatory response and aiding in neuroprotection .

Pearls:

• Alpha-lipoic acid acts as a powerful antioxidant that may reduce brain inflammation following a concussion.

• Omega-3 fatty acids, particularly DHA, have shown promise in reducing brain inflammation and promoting recovery from concussions.

Cannabis and CBD for Managing Concussion Symptoms

Cannabis, particularly its compounds cannabidiol (CBD) and tetrahydrocannabinol (THC), has been explored for its neuroprotective properties in concussion management. Both cannabinoids interact with the body’s endocannabinoid system, which helps regulate mood, pain, and inflammation. The U.S. government holds a patent (Patent No. 6630507) on cannabinoids as antioxidants and neuroprotectants, which underscores their potential in treating neurodegenerative diseases and traumatic brain injuries like concussions.

CBD's Neuroprotective Properties

CBD is known for its anti-inflammatory and neuroprotective effects, which are especially useful in managing concussions. It works by reducing brain inflammation, limiting oxidative stress, and promoting neurogenesis (the growth of new brain cells). Research that I personally conducted shows promising results on the ability of CBD to manage symptoms such as headaches, cognitive issues, and sleep disturbances following concussions.

THC's Role in Brain Recovery

THC, the psychoactive compound in cannabis, also has neuroprotective properties, though it works differently from CBD. THC can help reduce inflammation and promote relaxation, which can be beneficial for managing the anxiety and mood disturbances that often accompany concussions. THC also increases cerebral blood flow, which could potentially aid in brain recovery after injury. However, its psychoactive effects may not be suitable for all patients, particularly those who experience altered cognition after a concussion.

Israeli Army Research

Significant research on cannabinoids and their neuroprotective properties has been conducted with the Israeli military, under the leadership of Professor Raphael Mechoulam, who is often credited with discovering THC. The study explored how cannabinoids could mitigate the effects of head trauma and improve recovery outcomes for soldiers, highlighting cannabis’ potential as a neuroprotectant.

Routes of Administration:

1. Oral (Capsules, Gummies, Oils): Delayed onset (30-90 minutes), but provides consistent and prolonged relief.

   • Benefit: Ideal for long-lasting symptom relief, such as managing headaches or sleep disturbances.

2. Inhalation (Smoking, Vaping): Rapid onset, with effects felt within minutes.

   • Benefit: Useful for immediate symptom relief, particularly for acute headaches or nausea.

3. Topical (Lotions, Balms): Applied directly to the skin, effective for localized pain and inflammation.

   • Benefit: Targets specific areas without systemic effects, useful for neck or head pain.

4. Sublingual (Tinctures): Absorbed under the tongue, with effects felt in 15-30 minutes.

   • Benefit: Provides fast relief without the need for inhalation.

Pearls:

• The U.S. government holds a patent on cannabinoids for their antioxidant and neuroprotective properties, highlighting their potential in concussion treatment.

• Research by Dr. Herve Damas shows that CBD may help manage symptoms like headaches and cognitive impairment following concussions.

Wrapping It All Up

This is probably one of the longest posts I’ve written on any subject. The headaches I suffered many years after I stopped playing football are one of the reasons I went to cannabis as medicine. After finding that it helped me more than any other thing I tried, I knew I’d have to tell others. As a result, since I’ve been working in the field, I’ve had the opportunity to help a lot of my fellow NFL retired players, military veterans, boxers, mma fighters, and people from all walks who’ve suffered head injuries from falls, motor vehicle crashes and other accidents. 

Concussions are serious brain injuries that require individualized care. Traditional rest-based treatments remain essential, but emerging therapies such as CBD, THC, alpha-lipoic acid, and omega-3 fatty acids offer new avenues for managing symptoms and promoting brain recovery. Understanding gender differences and the risks of repeated concussions, especially in sports, is key to improving outcomes and preventing long-term issues like CTE. If you’re considering using cannabis, CBD or any supplements to help with your concussion symptoms please make sure you consult with a healthcare provider first and make sure you only buy them from the most reputable source that provides only the best results. 

Pearls:

• Early intervention and tailored treatment are critical to preventing long-term consequences like CTE.

• Cannabinoids, including CBD and THC, have shown promise as neuroprotective agents, offering new treatment options for concussions.