1239 Mind Blown: Exploding Head Syndrome as a Side Effect of Marijuana
Christopher Missak, Jenie George, I. Gurubhagavatula
May 27, 2020 DOI: 10.1093/sleep/zsaa056.1233 (opens in new tab)
Study at a glance
AI-extracted from the abstractAbstract
Marijuana use is increasing the United States and has been associated with increased sensory perception, euphoria, and altered cognition. Exploding head syndrome is a parasomnia characterized by loud explosion-like noises occurring prior to or during sleep. This the first report to link marijuana use with the occurrence of EHS. A 45-year-old man with depression, anxiety and multisubstance abuse reported two years of neuropsychiatric symptoms including: “fireworks going off in my brain,” visual hallucinations, and sudden arousals characterized by panic and vertigo. He reported bouts of occupational stress and severe anxiety previously treated with clonazepam for six months, but discontinued it due to poor clinical response. Normal findings were reported on a previous work-up including: MRI, EEG, and head CT Scan. During his visit, he reported that he had been smoking marijuana three times a day for 24 years. One month prior to his visit he discontinued marijuana, stopped clonazepam, and started using mirtazapine with improvement in all aforementioned symptoms. During the same month, he relapsed and smoked marijuana once with a sudden return of all previously described symptoms on the night following its use. These symptoms then resolved and did not recur again until 9 months later, after another episode of weekend marijuana use. An in-lab polysomnogram revealed an apnea-hypopnea index 2.2 per hour, increased alpha intrusion throughout the study, and no epileptiform activity. No parasomnias were observed during rapid-eye-movement (REM) or non-REM sleep. The etiology of EHS remains elusive. A review of the research has proposed five major theories and case reports suggest a complex etiology. Given the temporal correlation with marijuana use and symptom resolution with its cessation, we presume that EHS resulted from a complex interplay between neurons susceptible to cannabinoids and their derivatives.
Comparable studies
Other case reports and case series on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychotic Reactions Following Cannabis Use in East Indians Patients at an Indian drug addiction clinic who developed acute cannabis-related psychosis | 1974 | Descriptive report (case series of clinical observations) | n = 200 |
| Psychiatric effects of cannabis use Swedish cases of cannabis psychosis | 1985 | Case series | n = 70 |
| Forty-Six Cases of Psychosis in Cannabis Abusers Gunila Bernhardson Habitual cannabis users treated for psychosis at Swedish psychiatric clinics and mental... | 1972 | Case series (retrospective survey of psychiatric records) | n = 46 |
| Hallucinogen persisting perception disorder after psilocybin consumption: a case study 18-year-old man with HPPD after mixed psilocybin and cannabis intoxication | 2005 | Case study | n = 1 |
| Cannabis‐induced Koro in Americans American men aged 22-26 with years of cannabis experience who reported negative... | 2001 | Case series | n = 3 |