Can chronic heavy cannabis (marijuana) use cause vertigo and what are the other potential negative side effects?

Chronic Heavy Cannabis Use and Vertigo: Side Effects and Risks

Yes, chronic heavy cannabis use can cause vertigo, along with numerous other negative side effects including dizziness, cognitive impairment, cardiovascular complications, and psychiatric symptoms. 1, 2

Vertigo and Dizziness from Cannabis Use

Cannabis use has been clearly linked to vertigo and dizziness through several mechanisms:

• Cannabis contains cannabinoid CB1 receptors that are expressed in the vestibular nucleus complex (VNC), which plays a crucial role in maintaining balance 3
• Clinical guidelines specifically identify vertigo as a common side effect of cannabis use, particularly with heavy chronic consumption 1
• Cannabis can cause orthostatic hypotension (drop in blood pressure upon standing), leading to dizziness and vertigo symptoms 2, 4
• Studies have documented decreased cerebral blood velocity during upright posture after marijuana smoking, with 6 out of 10 subjects reporting moderate to severe dizziness in one study 4

Cardiovascular Side Effects

Heavy cannabis use is associated with significant cardiovascular risks:

• Dose-dependent increased stroke risk, with more frequent than once-weekly use associated with elevated stroke/TIA risk 2
• Tachycardia (increased heart rate) and blood pressure changes 2
• Orthostatic hypotension, particularly with heavy acute and chronic use 2
• Increased risk of myocardial ischemia in vulnerable individuals 2
• Paradoxical effects on cardiac rhythm with chronic use: potential for bradycardia, sinus arrest, and ventricular asystole 5
• Risk of syncope (fainting) related to cannabis-induced hypervagotonia in chronic users 5

Neuropsychiatric Side Effects

Cannabis use is associated with numerous neuropsychiatric effects:

• Sedation and drowsiness 1, 2
• Disorientation and confusion 1, 2
• Hallucinations and mood changes 1, 2
• Exacerbation of psychiatric disorders in vulnerable individuals 2
• Interference with therapeutic effects of psychiatric medications 2
• Increased risk of psychotic symptoms in predisposed individuals 2

Other Documented Side Effects

Additional negative effects of chronic heavy cannabis use include:

• Otolaryngological effects: tinnitus, hearing loss, increased risk of infections, sinusitis, allergic rhinitis, and thyroid dysfunction 6
• Respiratory symptoms: cough, dyspnea 6
• Sleep disturbances: altered normal sleep cycles and poor sleep quality 2
• Cognitive impairment: memory issues, reduced attention, and impaired executive function 2
• Potential for cannabis use disorder and dependence 2

High-Risk Populations

Certain groups face elevated risks from cannabis use:

• Individuals with pre-existing cardiovascular disease 2
• Patients with history of psychosis or bipolar disorder 2
• Older adults and those with liver impairment 2
• Adolescents and young adults (18-25 years) 2
• Patients taking medications that may interact with cannabis (e.g., duloxetine, cariprazine) 2

Clinical Considerations

When evaluating patients who use cannabis heavily:

• Screen for cannabis use patterns and frequency, particularly in patients with cardiovascular risk factors 2
• Monitor for signs of orthostatic hypotension, worsening psychiatric symptoms, and drug-drug interactions 2
• Educate patients about the increasing potency of modern cannabis products and potential withdrawal symptoms 2
• Consider that chronic cannabis users may experience different effects than acute users due to changes in autonomic nervous system function (decreased sympathetic activity and increased parasympathetic activity with chronic use) 5

Heavy cannabis users should be advised that the risk of adverse effects increases with higher doses, higher THC concentrations, and longer duration of use 1, 2.