What are the causes and treatment options for Irritable Bowel Syndrome (IBS) and headaches in a patient who is a chronic Cannabis (marijuana) smoker and has recently stopped?

From the Guidelines

Irritable Bowel Syndrome (IBS) and headaches following cannabis cessation can be managed with dietary modifications, over-the-counter medications, and lifestyle changes, with cannabis withdrawal symptoms typically peaking within the first week and resolving within 2-4 weeks. The patient's symptoms may be related to withdrawal symptoms, and it is essential to address both conditions simultaneously. For IBS management, start with dietary modifications like the low-FODMAP diet, avoiding trigger foods such as caffeine, alcohol, and spicy foods, as recommended by the AGA clinical practice update on the role of diet in irritable bowel syndrome 1.

Some key considerations for IBS management include:

• Taking fiber supplements like psyllium husk (3-4g daily) to help manage global symptoms and abdominal pain, as suggested by the British Society of Gastroenterology guidelines on the management of irritable bowel syndrome 1
• Considering over-the-counter medications like loperamide (Imodium) 2mg for diarrhea or docusate sodium (Colace) 100mg for constipation, as recommended by the British Society of Gastroenterology guidelines on the management of irritable bowel syndrome 1
• Avoiding insoluble fiber, such as wheat bran, as it may exacerbate symptoms, as noted in the British Society of Gastroenterology guidelines on the management of irritable bowel syndrome 1

For headaches, use acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil) 400-600mg every 6-8 hours with food, staying within maximum daily doses. It is also essential to stay hydrated, exercise regularly, practice stress management techniques like meditation, and maintain regular sleep patterns to help manage both conditions. If symptoms persist beyond 4 weeks or worsen, consult a healthcare provider as prescription medications like antispasmodics for IBS or preventive headache medications may be needed, as suggested by the AGA clinical practice update on diagnosis and management of cannabinoid hyperemesis syndrome 1.

The connection between these symptoms and cannabis cessation relates to the endocannabinoid system's role in gut function and pain regulation, which undergoes adjustment during withdrawal, as noted in the AGA clinical practice update on diagnosis and management of cannabinoid hyperemesis syndrome 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Causes of Irritable Bowel Syndrome (IBS) and Headaches in a Chronic Cannabis Smoker

• The exact causes of IBS are not fully understood, but it is believed to be related to a combination of factors, including gut motility, hypersensitivity, and psychological factors 2
• Cannabis use disorder (CUD) has been linked to an increased risk of IBS hospitalizations, with a 40.7% higher odds of IBS hospitalization in patients with CUD 3
• Headaches are a common symptom of cannabis withdrawal, which can occur after abrupt cessation or significant reduction in cannabis use 4
• Other symptoms of cannabis withdrawal include anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood, and loss of appetite 4

Treatment Options for IBS

• Dietary modifications, such as increasing soluble fiber intake and reducing caffeine and alcohol intake, may help improve symptoms 5
• Over-the-counter medications like loperamide may improve stool frequency and rectal urgency, but may have mixed results for abdominal pain 5
• Prescription medications like tricyclic antidepressants, bile acid sequestrants, and antispasmodics may be useful in managing IBS-D 5
• FDA-approved medications for IBS-D include alosetron, eluxadoline, and rifaximin 5
• Eluxadoline has been shown to improve work productivity and health-related quality of life in patients with IBS-D who have had an inadequate response to loperamide 6

Treatment Options for Headaches and Cannabis Withdrawal

• Supportive counseling and psychoeducation are the first-line approaches in managing cannabis withdrawal 4
• Medications like antidepressants and anti-anxiety medications may be used to manage short-term symptoms of cannabis withdrawal, but there are no medications currently approved specifically for medically assisted withdrawal (MAW) 4
• Inpatient admission for MAW may be clinically indicated for patients with significant comorbid mental health disorders and polysubstance use 4