Cannabis and Migraine
Migraine is a class of severe headache with two primary
variants: common migraine headache occurring with nausea, vomiting, and
sensitivity to sensory stimuli; and classical migraine headache preceded by an
aura of warning symptoms – for example, visual disturbances. Less common
migraines are ocular, abdominal, and chronic migraines.
The many causes of tension headaches include lake of sleep,
dehydration, poor posture, and emotional stress. Tension headaches affect up to
80% of the population.
Cannabis is effective as a prophylaxis for reducing the
frequency of migraine in many patients. A 2016 chart review of Colorado
patients with migraine noted that 39.7% of these patients reported positive
benefits for their migraines, with nearly 20% successfully reducing the
frequency or preventing headaches, and over 11% crediting cannabis with
aborting headaches. Cannabis is also successful in treating the symptoms of
many common tension headaches.
Cannabis has been used for the prevention and relief of
migraine headaches for over a thousand years in Chinese, Indian, Egyptian,
Greek, Roman, and Islamic medicine.
While the mechanism of headaches is not completely
understood, it appears to involve the hypothalamus. The hypothalamus has a high
density of cannabinoid receptors, which could explain why cannabinoids can be
effective in treating cluster headache. In his 2015 review of medical cannabis
and headache, Dr. Eric Baron of the Cleveland Clinic cites several cases that
support his opinion that cluster headache can be helped by cannabis. In one
case report, a 19 year-old who did not respond to any medications for his headache,
said that smoking marijuana at the onset of a cluster headache would abort the
headache completely within five minutes.
Italian researchers, Greco and Tassorelli, published an
excellent review of cannabinoids and migraine in their book, Cannabinoids in Neurologic and Mental
Disease. Migraines may form as a series of steps. The patient encounters a
migraine generator or trigger: bright light, hunger, chemicals in a certain
food, sudden anxiety, hormonal change, and so on. This trigger indicates a
chemical reaction within the brain – one that may normally stimulate the
release of endocannabinoids to restore equilibrium. For some unknown reason,
migraineurs don’t always release these endocannabinoids and this absence may be
indicative of an endocannabinoid deficiency.
Without endocannabinoids to normalize communication, the
trigger causes pain-sensing cells in the brain stem to release neuropeptides,
which sensitize other pain-sensing cells into releasing more neuropeptides,
starting a cascade. This flood of chemicals causes abnormal dilation of blood
vessels on the brain’s surface. This jump in pressure increases swelling in the
surrounding tissue, causing pain levels to skyrocket.
Dosing with Cannabis
for Migraine
There are two approaches to cannabis dosage for migraine:
prophylactic and symptomatic. Prophylaxis is intended to reduce the frequency
and intensity of the headaches. The symptomatic approach relieves pain and
nausea associated with migraine after it’s onset.
With Prophylaxis dosing, patients take a small daily dose of
cannabis, often below 2.5 mg of THC or it’s equivalent, which produces little
to no intoxication. This prophylactic dose appears to be most effective if
taken upon rising, or mid-afternoon, depending on whether the patient has noted
a pattern for the occurrence of headaches. Many cannabinoids, including THC,
are biphasic, so while a small THC dose may relieve anxiety and reduce headache
frequency, a large dose may trigger anxiety and precipitate a headache. Symptomatic
relief is most effective taken early in the migraine’s progression.
Sublingual administration, smoking, or vaporizing of up to 12.5
mg of THC can be helpful if the migraine patient is already vomiting.
The addition of CBD to the THC dose can reduce the intensity
of THC psychoactivity. It helps patients to find a cannabis medicine that has
both cannabinoids; CBD and THC together.
For tension headaches, 2.5 to 5 mg of THC should be
effective. An addition of CBD with THC can help. However, CBD alone may result
in mild headache.
Patients report that small doses of oral cannabis can be
quite effective in reducing migraine occurrence. If using an edible from a
cannabis dispensary, initially choose a product that contains less than 5 mg of
THC and start by eating half of the product. Start with small doses, only
increasing if necessary.
Both vaped and smoked cannabis can be effective at the onset
of a headache. Patients have noticed a halt in the migraines development if
they smoked or vaped at the onset.
Cannabis dosage has a “sweet spot” for pain relief, so avoid
overmedication.
Cannabis Strains to
Look for Headaches
High THC cultivars seems effective for anti-inflammatory,
sedative, and analgesic effects. Strains such as Gorilla Glue and Purple Haze are
nice because of their terpenes caryophyllene, limonene and myrcene. For
low-dose migraine prophylaxis, a very small dose of myrcene-ocimene Skunk or a
myrcene-pinene Purps or Blue Dream. For acute pain and nausea, myrcene-dominant
Purps.
This information and more, is found in the book Cannabis Pharmacy – The Practical Guide
to Medical Marijuana by Michael Backes, fwd by Andrew Weil, M.D. and
Jack McCue, M.D., Medical Editor
Scientific Research
on Cannabis and Migraines
Migraine Headaches
“There is no question that THC-rich cannabis can help abort
or lessen the severity of a migraine, especially if taken at the onset of the
pain. Some patients report that low-dose, regular use of THC-rich medicine
significantly reduces frequency and severity of the headaches. Other patients
report that daily CBD-rich cannabis prevents migraine from occurring. Once the
headache begins, a rapid delivery method such as inhalation or sublingual
tincture is preferred by most. Specific strain choice results from trial and
error for most patients.”
Clinical Endocannabinoid Deficiency Reconsidered
“Statistically significant differences in cerebrospinal
fluid anandamide levels have been documented in migraineurs, and advanced
imaging studies have demonstrated ECS hypofunction in post-traumatic stress
disorder. Additional studies have provided a firmer foundation for the theory,
while clinical data have also produced evidence for decreased pain, improved
sleep, and other benefits to cannabinoid treatment and adjunctive lifestyle approaches
affecting the ECS.”
The Endocannabinoid System and Migraine
“Several studies have suggested that ECS is centrally and
peripherally involved in the processing of pain signals. This finding is
corroborated by the evidence that endocannabinoids inhibit, through a
cannabinoid type-1 receptor (CB1R)-dependent retrograde mechanism, the release
of neurotransmitters controlling nociceptive inputs and that the levels of
these lipids are high in those regions (such as sensory terminals, skin, dorsal
root ganglia) known to be involved in transmission and modulation of pain signals.”
Cannabinoids Suitable for Migraine Prevention
“The results after three months of treatment and follow-up
after a further four weeks produced various insights. While the TCH-CBD
combination yielded slightly better results than amitriptyline (40.1%) with a
40.4% reduction in attacks, the severity and number of cluster headache attacks
only fell slightly. When analysing use in the treatment of acute pain, the
researchers came across an interesting phenomenon: cannabinoids reduced pain
intensity among migraine patients by 43.5%. The same results were seen in
cluster headache patients, but only in those that had experienced migraine in
childhood. In patients without previous history, THC-CBD had no effect
whatsoever as an acute treatment.”
These research findings were collectively from the most
amazing site for cannabis education; ProjectCBD.org, fid more information on
cannabis and migraines here
https://www.projectcbd.org/condition/31/Migraine