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Can Cannabis Help With Cluster Headaches?

by Gleb Oleinik

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Cluster headaches can be extremely difficult to treat with standard therapy. As a result, some sufferers have turned to cannabis to relieve these and other types of refractory headaches. 

Although medical research is scarce and inconclusive, some studies have found that cannabis can relieve cluster headaches. This suggests that the body’s endocannabinoid system (ECS) may be involved.

So far, researchers have found that the ECS may affect three processes believed to underlie cluster headaches. However, much of this evidence is indirect or comes from studies of migraines, so more research looking specifically at ECS function in cluster headaches is essential.

Read on for a detailed look at what research has uncovered about the endocannabinoid system, cluster headaches, and cannabis treatment.

Research on cluster headaches and cannabis

Only a few studies have looked at the use of cannabis for relieving cluster headaches, but their findings are promising.

Most notably, a 2014 study looked at 18 chronic cluster headaches sufferers who tried cannabis after failing to find sufficient relief from standard treatment. Most of them chose to smoke cannabis with an average daily dose of 1 gram. The researchers contacted the participants 2 months to 3 years after they started taking cannabis. 

They found that 15 people (83%) experienced a 50% or greater reduction in headache severity, while 11 (61%) saw a 90%–100% reduction. Also, nine people (50%) noted an 80-100% decrease in headache frequency. Additionally, 11 of the participants (61%) reported high satisfaction from using cannabis, highlighted by reduced usage of prescription medication and improvement of sleep and quality of life. 

Meanwhile, a 2009 report discussed the case of a 19-year-old student whose cluster headaches ceased through the use of cannabis, after failing to find relief with standard medications. He saw benefits from smoking whole-plant cannabis and later on from taking dronabinol, a synthetic drug form of tetrahydrocannabinol (THC). 

However, some studies have reported less promising results. For example, a 2016 study of 139 French cluster headache patients looked at 27 (19.4%) of them who used cannabis to relieve headaches. Of these individuals, 26% reported some benefits, such as stopping the headache or promoting relaxation, while 52% noted variable or uncertain effects, and the remaining 22% reported negative effects (headaches/pain getting worse).

Several studies have shown that cannabis helps with migraines, which are similar to cluster headaches. One 2016 study reported a reduction from an average of 10.4 to 4.6 migraines per month in 85% of the 121 study participants. Similar results were reported by a 2019 study of 316 migraine sufferers, including the finding that high-THC cannabis was most effective.

Aside from this, numerous studies have shown that cannabis is effective at relieving pain, which is the main symptom of cluster headaches. The evidence is so strong that the National Academies of Sciences, Engineering, and Medicine concluded in their 2017 report that “There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults.”

Given that relaxation is one of the most common effects of cannabis use, it may also help with restlessness: another symptom of cluster headaches.

Existing evidence shows that cannabis may help people reduce the severity and frequency of their cluster headaches, as well as pain and other symptoms. However, it may also worsen headaches in some people, so more high-quality research is needed to provide conclusive recommendations.

CBD and cluster headaches

There’s virtually no research looking at the benefits of CBD in cluster headaches. Although some researchers hypothesize that CBD could be helpful, available data shows that it is cannabis preparations high in THC—rather than CBD—that are more effective at relieving headaches. 

For example, the 2019 study mentioned earlier found that cannabis with a 20:1 ratio of THC to CBD provided greater migraine relief than 1:1 preparations. 

This may be because unlike CBD, THC works primarily through the cannabinoid receptors that are abundant in parts of the brain associated with headaches. Also, THC closely resembles anandamide, the endocannabinoid that seems to be most involved in headaches. 

Nonetheless, it’s too early to say anything conclusive. Even if CBD is less effective at alleviating cluster headaches than THC-rich cannabis, it may still provide pain-relieving effects and help with anxiety.

How cannabis works on cluster headaches

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.

Recent research has shown that a malfunctioning ECS may be involved in headache disorders. In fact, there’s a good deal of evidence to support the theory of clinical endocannabinoid deficiency (CED), which states that insufficient endocannabinoid levels may be one of the causes of several difficult-to-treat disorders, including migraines.

Since the triggers, treatment, and biological markers of migraines are similar to cluster headaches, a dysfunctional ECS may be involved with them too. 

There is evidence that this system affects three key processes considered responsible for cluster headaches.

First and foremost, researchers believe that a part of the brain called the trigeminovascular system plays a central role in causing both migraine and cluster headaches. 

Endocannabinoids are known to regulate this system. For example, a 2004 study found that the endocannabinoid anandamide reduced the activity of trigeminovascular neurons. Similarly, a follow-up 2011 study reported that anandamide reduced migraine pain in rats by suppressing these specific neurons. 

Second, the malfunction of the key neurotransmitter (brain chemical) serotonin is believed to be another process involved in both cluster and migraine headaches. There’s evidence that the ECS and serotonin dysfunction are related. 

For example, a 2008 study found that migraine and medication-overuse headache sufferers had reduced endocannabinoid and serotonin levels in their platelets, a type of cell that may be involved in headaches.

Lastly, neuroimaging studies have consistently shown that cluster headaches originate in the hypothalamus, a part of the brain known to contain cannabinoid receptors.

More studies looking specifically at the endocannabinoid system in cluster headaches (rather than migraines) are needed. Still, current findings suggest that a malfunctioning ECS could be involved in cluster headaches, which may explain why cannabis is effective for some people.

Side effects

Although cannabis is an increasingly popular alternative to standard cluster headache treatment, it does have some unwanted side effects.

These are mostly attributed to THC, which can cause impaired memory and reaction time, increased heart rate, red eyes, dry mouth, sleepiness, and dizziness. Some people may also experience feelings of paranoia and anxiety. These side effects were noted in a 2014 study, with sleepiness and dizziness being the most common.

Cannabis Side Effects

More importantly, six participants (22%) of a 2016 study reported that cannabis triggered or worsened their cluster headaches. It’s not clear why, but it could be related to differences in the cannabinoid content of cannabis preparations or biological differences of the users.

Another possibility is the biphasic effect: the tendency of cannabis to have opposing effects at low vs higher doses. In that sense, using a small amount might provide relief, while higher doses could make the headaches worse. 

On the other hand, CBD-rich preparations lack the intoxicating side effects of regular cannabis but can cause minor issues such as diarrhea, low blood pressure (hypotension), dry mouth, lightheadedness, sleepiness, and changes in appetite. The likelihood of these effects is low unless high dosages are used.

Disclaimer

The Cannigma content is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with an experienced medical professional with a background in cannabis before beginning treatment.

About Cluster Headaches

Overview

Cluster headaches are considered the most painful type of headache, often waking people up from pain in the middle of the night. As a matter of fact, it is considered by many to be the most noxious type of pain known to man. It is often referred to as a “suicide headache,” because people have taken their own life during an attack. Cluster headaches occur in bouts or clusters, which is how they got their name. Cluster headache attacks, called cluster periods, can last for weeks or even months of short but intensely painful headaches that can occur multiple times a day. There are even chronic cluster headache sufferers who have these headaches every day, all year.  

In between cluster periods, you’re said to be in remission, without cluster attacks. This can last for months or years. Nonetheless, cluster headache can come back again without any warning. Many people have seasonal cluster headache, which occur at the same time of year each year.

Cluster headaches can affect anyone, but typically affect men more than women. Attacks usually start at a younger age, often beginning in their 20s to 40s. Fewer than 1 in 1,000 people have cluster headache, and sometimes an effective treatment can make cluster periods both shorter and less severe. 

Symptoms

Cluster headache has very specific symptoms that don’t occur with regular headaches or migraines:

  • A severe, piercing pain that is practically always described as completely disabling.
  • Pain on just one side of the face, the same side every time. It’s centered around, in, or behind the eye, and can radiate out to other parts of the head, face, and neck. 
  • Unlike with migraines, people who have cluster headaches usually feel restless, pacing up and down or rocking back and forth. Some may even want to bang their heads against the wall.  
  • The headache reaches full force very fast, within 5 or 10 minutes at the most, and lasts for an average of 30-90 minutes, although it can continue for as little as 15 minutes or as long as 3 hours.

Cluster headache is accompanied by:

  • A red, watery eye on the affected side
  • The affected eyelid droops, swells, and/or the pupil gets smaller
  • Sweaty, flushed, or pale face on the affected side
  • A blocked or runny nostril on the affected side

Most people who get cluster headaches have what’s called episodic cluster headache. This means that they have cluster headaches for a period of anything between 1 week up until 1 year, and then are headache-free for as long as 12 months. A lot of people have seasonal cluster headache, where their cluster periods occur at more or less the same time of year each year, like every spring and fall.

During a cluster period, the person can get an intense headache as often as 5 times a day or as seldom as once every other day, usually at the same time every day. Many people get cluster headache at night, a couple of hours after going to bed, or in the morning around when they wake up  

Twenty percent of people with cluster headaches have chronic cluster headaches. This is a more severe form of cluster headache where there’s no headache-free remission between cluster periods.

Diagnosis

Although cluster headaches are not life-threatening, you should consult a doctor if you experience severe head pain. Your doctor will need to rule out other possible causes of the pain, some of which could be serious, like a tumor or aneurysm. 

There’s no test to diagnose cluster headache. Instead, your doctor will listen carefully to your description of the headache pain, looking out for the characteristics of cluster headache. It’s likely that your doctor will order an MRI and/or CT scan to check for other causes of sudden head pain. 

If you have cluster headache, your brain scans will likely come back normal and you’ll probably be referred to a neurologist or headache specialist to confirm the diagnosis and come up with a treatment plan. Cluster headache can be difficult to manage, and treatment is usually provided by a headache expert.

Causes

Scientists and doctors are still not sure about the cause of cluster headache. More men get it than women, and it is more common among smokers than non-smokers, although quitting smoking doesn’t seem to reduce your chances of getting them. It’s also thought that having a close relative with cluster headache raises the risk of developing it. People tend to first get cluster headaches during their 20s to 40s, but it is possible to develop symptoms at any age. 

The current theory is that someone who gets cluster headaches has some kind of irregularity in the hypothalamus. This is the area near the base of your brain that governs your internal clock, which controls sleeping and waking cycles. 

The trigeminal nerve rests in this part of the brain, and it controls sensations of pain, heat, and cold in your facial area. The trigeminal nerve runs down near the eye, across the cheek towards the forehead, down the jaw line, and above the ear — all the areas which hurt during a cluster headache attack. 

Although scientists don’t know what triggers a cluster period, there are certain triggers that can bring on a cluster headache during the cluster period. Some of the most common triggers include:

  • Drinking alcohol
  • Taking certain medications, like nitroglycerin
  • Strong smells like petrol, strong perfume, paint fumes, and solvents
  • Smoking 
  • Exercise or getting overheated

It’s worth noting that unlike migraines and tension headaches, cluster headaches aren’t usually triggered by stress, hormonal changes, or certain foods.

Treatment 

While there’s no cure for cluster headaches, there are ways to reduce the pain of a cluster headache, and to lower the duration and severity of attacks during a cluster period. 

Acute treatment

Acute treatment aims to stop or reduce the pain of a cluster headache once it has already begun. It’s difficult to find effective acute treatment because the pain becomes severe so quickly. 

  • Oxygen. Inhaling pure oxygen through a mask is low-cost and highly effective, relieving the pain within 15 minutes. The trouble is that most people don’t have access to an oxygen tank and regulator at all time. 
  • Injectable medications. Triptans are a type of medication that includes sumatriptan, which comes as an injection. Medication is most effective when injected subcutaneously (under the skin), because oral medication takes too long to work. Zolmitriptan is another triptan, that is available as a nasal spray. Rizatriptan, which disintegrates under the tongue and also works relatively quickly, can also be given.  
  • Local anesthetics. Some people find that lidocaine nasal spray works to numb the affected area. 

Preventive treatment

This treatment is aimed at reducing the frequency, severity, and length of headaches during a cluster period. Once you think that you’ve reached the end of a cluster period, you can taper off the medication. 

  • Corticosteroids like prednisone can be a good option for short periods, but the side effects mean that it’s not safe or preferable to take them for an extended period of time.
  • Calcium channel blockers like verapamil can be effective for preventing cluster headaches. These medications are usually given to lower blood pressure.
  • Lithium carbonate is typically used to treat bipolar disorder, but it can also work against cluster headache. 
  • Lamotrigine, gabapentin, and topiramate are also prescribed for cluster headache.  They are normally given for seizures, pain, migraine or bipolar disorder.

Other preventive treatment options include:

  • Nerve blocks. This involves having a local anesthetic agent injected into the area around the occipital nerve, which lies at the back of your head. It’s used only as a temporary treatment to allow longer term medications time to take effect. 
  • Nerve stimulation. Some people who have no success with medication find that occipital nerve stimulation can help. The doctor surgically implants a device to send electrical impulses to a group of nerves at the base of your skull. 
  • Neuromodulation. This is a non-invasive device that uses electrodes to send signals to the supraorbital nerve (Cefaly), or the vagus nerve (nVNS).

Lifestyle changes

Although lifestyle changes can’t prevent cluster periods from occurring, some people find that sticking to a regular sleep cycle and avoiding alcohol can help them avoid headaches during a cluster period. 

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