The Role of CBD in the Treatment of Traumatic Brain Injuries
How Can CBD Help with Traumatic Brain Injuries?
WHAT DO WE MEAN BY TRAUMATIC BRAIN INJURY?
Traumatic brain injury (TBI) refers to any damage to the brain caused typically by an external force or impact. These injuries cover a broad spectrum, ranging from mild, short-term effects to severe, long-lasting consequences.
Many people don’t realize that even mild TBI can have long-term mental health effects, including depression and impulsivity, as well as a decline in judgment and memory. The severity of the impact influences the severity of TBI symptoms and may cause brain changes underlying lasting neurological deficits and seizures. Forty-three percent of TBI patients require further hospital care within the first year after injury, and many experience a complete or partial loss of work capacity, which places a heavy burden on both the individual and the healthcare system. (In the United States alone, TBI-related direct and indirect costs were estimated at $76.5 billion in 2010.)
MECHANISMS OF INJURY
The appearance of TBI symptoms results from a series of physiological, molecular, and chemical changes that occur either directly after the injury or later—even months or years afterward. Accordingly, TBI is described in terms of primary and secondary injuries.
PRIMARY INJURY
Primary TBI refers to the direct structural damage to nervous tissue and blood vessels caused specifically by the impact event. During the collision, the brain’s compression and expansion produce shock waves that generate significant mechanical forces inside the skull. This shock wave causes immediate bruising at the impact site, damages glial cells*, triggers localized bleeding, severs axons, and damages blood vessels. Currently, helmets and headgear are the only known protective measures against primary TBI from occupational hazards, motorsports, combat sports, or military activities. These protective gears effectively reduce the severity of TBIs but cannot prevent injury if a sufficiently strong blow hits the head. Unfortunately, many everyday injuries—often from falls—occur without any protection, especially in childhood and older age.
*Glial cells are found in the brain and spinal cord and are responsible for supporting, protecting, and maintaining the function of the central nervous system. They are not neurons but are vital for normal nervous system function and neuron health.
SECONDARY INJURY
Secondary injury involves additional system damage that results from mechanisms triggered by the primary injury. It is characterized by widespread cascades of cellular, molecular, and biochemical changes, including uncontrolled ion and neurotransmitter release, dysregulation of glial cells, neuronal hyperexcitability, and pervasive neuroinflammation. During secondary injury, uncontrolled glutamate release leads to cell death, increases reactive oxygen species (ROS), and induces oxidative stress. This sustains and prolongs post-traumatic inflammation indefinitely. Prolonged inflammatory responses contribute to further tissue damage and neurodegeneration. The resulting immune response and simultaneous neuroinflammation create a toxic cellular environment that hinders neuron repair, perpetuates neuronal loss and degeneration, and leads to white matter degradation. Symptoms that arise include personality changes and disturbances in emotional and mood regulation.
CLINICAL PRACTICES AND THE ROLE OF CBD
In clinical practice, the severity of traumatic brain injury is assessed using the Glasgow Coma Scale (GCS), which classifies TBI based on consciousness levels following the injury.
It categorizes TBI into three main groups: mild (GCS 13–15), moderate (GCS 9–12), and severe (GCS 3–8).
Estimates suggest that mild TBI accounts for 70-90% of all traumatic brain injuries. Even mild TBI can cause serious and debilitating symptoms, such as post-traumatic headaches, nausea/vomiting, dizziness or balance problems, light or noise sensitivity, blurred or double vision, fatigue, memory problems, poor concentration, increased anxiety, irritability, emotional instability, depressed mood, and sleep disturbances. Patients suspected of TBI should be evaluated by specialists to determine if emergency referral and a head CT scan are necessary!
Current recommendations for mild TBI treatment include 24-hour observation in the hospital or at home to monitor for any neurological deterioration. After a head injury, patients are advised to avoid strenuous physical activity and contact sports until symptoms fully resolve, which can take up to four weeks.
Patients with moderate and severe TBI may have primary injuries requiring immediate medical care to prevent secondary injury.
Current treatment for moderate and severe TBI includes medical and surgical measures to mitigate secondary brain injury effects, such as: (1) maintaining blood pressure to ensure adequate cerebral blood flow, (2) providing sufficient oxygen and maintaining normal partial CO2 pressure, (3) regulating intracranial pressure (ICP), (4) preventing and treating seizures, (5) preventing fever, (6) maintaining normal glucose levels, (7) managing intravenous fluids to maintain normal serum osmolality, (8) elevating and positioning the head to enhance venous drainage, and (9) providing nutritional support. Patients are at high risk of progression to brain death if brain edema and increased ICP remain uncontrolled. Surgical decompression via a dural incision is an option for those with elevated ICP who do not respond to treatment. This life-saving procedure effectively reduces ICP but generally results in severe disability among survivors.
THE ROLE OF CBD
Cannabidiol (CBD) is a natural compound characteristic of the cannabis plant, known as a phytocannabinoid, which targets more than 65 known sites in the brain and other parts of the body. Among these targets, several directly reduce inflammation, which has sparked interest in CBD’s potential to alleviate secondary injury effects in TBI.
Preclinical evidence shows that CBD promotes neurogenesis, which is the formation of new nerve cells. This suggests that in TBI patients, CBD could enhance neurogenesis, reduce symptoms of brain injury, speed recovery, and improve neurological function restoration.
The neuroprotective effects of CBD in secondary brain injuries have been demonstrated in numerous preclinical studies where molecular, chemical, and physiological mechanisms impaired by TBI were restored under the influence of CBD. CBD acts through multiple pathways, including:
- enhancing signaling of the endocannabinoid system
- reducing glutamate excitotoxicity
- promoting neurogenesis
- easing neuroinflammation
- removing reactive oxygen species
- decreasing blood-brain barrier permeability induced by TBI and regulating cerebral blood flow, which helps protect against negative cognitive, mood, and motor changes and assists recovery of functions impaired by TBI.
Nate Diaz, a cage fighter, vaporizes CBD at a post-fight press conference after a tough bout.
THE FUTURE OF CBD IN TBI TREATMENT?
Determining safe and effective dosing strategies remains a challenge in preclinical and clinical research on CBD and other cannabinoids. Given the complex and sometimes competing mechanisms involved in TBI, finding the right and consistent CBD dose continues to present a major research obstacle. Current studies on CBD’s effects in TBI suggest that timing of administration relative to the injury, duration of use, and CBD dosage are critical for treatment success.
Understanding the time course of CBD’s effectiveness is a key research area going forward. This will hopefully clarify when and how much CBD a patient with traumatic brain injury needs. Available data suggest that CBD use not only after but also before the injury might reduce mortality rates and improve sensorimotor functions. Current evidence also indicates that administering CBD within 15 minutes after injury can offer significant neuroprotective benefits.
One promising property of CBD in terms of treatment potential is its good tolerance even at high doses. Adults can take doses in the thousands of milligrams* without significant harmful effects. (In a clinical trial for an epilepsy medication, participants tolerated single doses of 6000 mg well, as well as multiple doses up to 1150 mg twice daily over 6 days.)
*This data applies to pure CBD isolates or synthetic CBD. Full-spectrum and broad-spectrum CBD Oil also contain other cannabinoids—typically CBG, CBDA, CBN, CBC, THC—which enhance each other’s effects and have been shown to be more effective than CBD alone. Read our relevant article: 
Based on available study results, it can be concluded that CBD may be an effective tool in treating TBIs; however, it is important to note that much of the current research is based mainly on animal studies. Encouraged by preclinical research findings, human trials will soon begin, partly sponsored by the National Hockey League (NHL) and the National Football League (NFL). These upcoming clinical trials will be especially informative in determining CBD’s effectiveness, and their data will benefit not only professional athletes but also other groups exposed to traumatic brain injuries, particularly the elderly and children.
It is important to mention that CBD Oil is not a miracle cure! The foundations of maintaining our health are regular exercise, a balanced diet, and a stress-free lifestyle. CBD does not replace any of these! In Hungary and most EU countries, CBD is classified as a “novel food” because its widespread use before 1997 is not documented; therefore, no claims can be made regarding prevention or treatment of diseases with CBD-containing products.
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