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Can Cannabis Help Migraines?
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Gleb Oleinik by Gleb Oleinik

Overview

People have been using cannabis to relieve migraine headaches throughout history. This remains a popular practice today as standard medications don’t always offer relief and come with significant side effects.

Recent medical research is beginning to provide evidence for the beneficial effects of cannabis and the involvement of the endocannabinoid system in migraines.

In fact, groundbreaking findings suggest that a deficient endocannabinoid system may be the underlying cause of migraines and some other difficult-to-treat conditions.

As such, using cannabis preparations to alleviate this deficiency provides a natural way to prevent migraines instead of only treating their symptoms. More importantly, cannabis can achieve this without many of the significant side effects of standard prescriptions drugs.

Although more clinical research exploring the efficacy of medical cannabis in treating migraines is sorely needed, the current evidence is strong enough to support its use.

The Endocannabinoid System

The endocannabinoid system is an important biological system involved in maintaining a healthy state of balance in the body called homeostasis. 

Consisting of cannabinoid receptors, endocannabinoids, and the enzymes that synthesize and break down endocannabinoids, this system helps regulate many critical processes, such as cognitive function, mood, metabolism, immunity, and pain. 

So far, researchers have identified two cannabinoid receptors—CB1 and CB2. Although they are spread throughout the whole body, CB1 is particularly abundant in the central nervous system, whereas CB2 is commonly found in immune cells. These receptors are activated by two endocannabinoids made by the human body: anandamide and 2-AG. 

Similarly, phytocannabinoids (plant-derived cannabinoids) such as THC and CBD are also able to interact with cannabinoid receptors.

Research studies indicate that the endocannabinoid system may interact with several processes involved in migraines. 

One such process is the release of the brain chemical serotonin by platelets, small cell fragments found in the blood. Studies suggest that endocannabinoids can prevent this release and that individuals with chronic migraines have reduced levels of anandamide and 2-AG in their platelets.

More importantly, endocannabinoids have been linked to a part of the brain called the trigeminovascular system, which is widely considered to play a central role in causing migraine attacks. Research suggests that endocannabinoids regulate this system through the CB1 receptor.

For example, one 2004 study found that anandamide inhibits trigeminal neurons, suggesting a mechanism for how endocannabinoids can prevent migraines.

More importantly, a follow-up 2011 study reported that administering anandamide to rats with migraine-like headaches reduced both neuron activation in the trigeminovascular system and the associated pain. 

Similar findings were reported by a 2015 study of the FAAH enzyme, which is responsible for breaking down anandamide. The researchers almost completely relieved migraine-like pain in mice when they deleted this enzyme or administered compounds that prevented it from working.

Findings such as these led researchers to suggest that a dysfunctional endocannabinoid system may even be responsible for migraines.

This idea was first proposed Dr. Ethan B. Russo, the Director of Research and Development for the International Cannabis and Cannabinoids Institute (ICCI) and one of the leading medical cannabis experts, when he unveiled his theory of clinical endocannabinoid deficiency (CED) in 2001.

According to this theory, insufficient endocannabinoid levels might be the cause of a wide variety of difficult-to-treat conditions, including inflammatory bowel syndrome, fibromyalgia, and migraines.

The strongest evidence for this hypothesis came from a 2007 study which found that individuals with chronic migraines had lower levels of anandamide in their cerebrospinal fluid than healthy people. The study’s researchers proposed that these insufficient levels can result in the failure of the endocannabinoid system to inhibit the trigeminovascular activation that produces migraines.

Lastly, there’s evidence that certain genetic variations of the CB1 receptor can predispose a person to migraines, which further supports the CED theory because anandamide works primarily through this receptor.

Migraines & Cannabis

Despite the long history of cannabis use for migraines, there isn’t a lot of research in this area. However, the current findings are overwhelmingly positive and support the theory that endocannabinoid deficiency is the underlying cause of migraines.

One 2016 study by the University of Colorado examined the efficacy of medical marijuana in 121 people with migraines. The treatment was effective in 85.1% of the patients, reducing the number of migraines from an average of 10.4 to 4.6 headaches per month. It was noted that cannabis not only reduced the number of migraines but also aborted (stopped) them if taken when a migraine attack was happening.

Meanwhile, a 2019 study looked at the effects of medical cannabis in 316 patients with chronic migraines. In total, 88.3% of the patients reported improvement of migraines, with an average 42.1% reduction in monthly migraine frequency. Some patients experienced an even higher reduction (50% or more), and many reported improvements in sleep, anxiety, and mood. 

Interestingly, the study also found that cannabis with a 20:1 ratio of THC to CBD resulted in better improvements than cannabis with a 1:1 ratio. This finding could be explained by the fact that unlike CBD, THC resembles anandamide in its function and effects.

Furthermore, a 2018 controlled animal study found that isolated THC reduced migraine pain in female rats, supporting the suggestion that cannabinoids may be useful in treating migraines in people.

Additionally, a 2001 review paper by the aformentioned Dr. Ethan Russo discussed historical records of successful cannabis use for migraines going back thousands of years. This review included particularly detailed case reports written by Western doctors between 1842 and 1942, when cannabis became a popular remedy for migraines. Dr. Russo concluded that “Based on the above review, it is convincingly the case that ‘medical marijuana’ deserves formal scientific scrutiny for migraine treatment.”

Also, there’s evidence that medical marijuana can help with the two main symptoms of migraines: pain and nausea. The pain-relieving effects of cannabis have been demonstrated by dozens of studies, so much so that the National Academies of Sciences, Engineering, and Medicine released the following statement in 2017: “There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults.” 

Meanwhile, the anti-nausea effects of cannabis are also backed by research, and cannabis-derived pharmaceutical drugs such as Marinol are already used to relieve specific types of nausea. 

On the whole, while more high-quality studies are needed, the existing evidence demonstrates that medical cannabis can relieve migraines.

Although cannabis appears to be an excellent option for treating migraines, it does have some unwanted effects.

In particular, the major barrier to increased medical use of cannabis is its psychoactive side effects, which include euphoria, memory impairment, and anxiety. In addition, cannabis can cause other side effects such as dry mouth, drowsiness, and fatigue.

Ultimately, however, cannabis is considered a safe substance. This is especially the case when we compare it to pharmaceutical drugs used to treat migraines, such as NSAIDs. A related benefit of cannabis is that it helps people reduce the use of opioids, which are sometimes prescribed for chronic migraines despite their addictive properties and ability to induce medication overuse headache (MOH).

Legal Use

Chronic pain, including migraine pain, is the most common reason for medical cannabis use. For this reason, the vast majority of countries and states with medical cannabis programs list chronic pain as a qualifying condition. This includes Canada, Germany, and the Netherlands. 

However, there are some exceptions. For instance, the UK has a strict medical cannabis program that does not currently list chronic pain or migraines as a qualifying condition.

In the United States, the medical use of cannabis for migraines is allowed in the District of Columbia and 33 states: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Washington, West Virginia, Utah, and Vermont.

About Migraines

Overview

Many people think that migraines are just headaches. Those who suffer from migraine headaches know they are so much more. Migraines are a neurological condition that causes significant disability in sufferers. As a matter of fact, it is one of the leading causes of disability worldwide. Patients suffer from severe, debilitating nausea, vomiting, and a host of other symptoms, often leaving them incapacitated and unable to complete their daily activites. 

Migraine is considered to be the third most common disease worldwide, affecting 11% of people globally. It’s estimated that 6 million people in the UK suffer from migraines, and that 190,000 migraine attacks happen every day there. Across Europe and North America, about 6% of men and 15-18% of women get migraines every year. Most people who get migraines begin getting them at around the age of 10, and they tend to decrease in frequency after the age of approximately 45-50. 

Symptoms

Migraines are generally divided into two types:

  • Migraines with aura 
  • Migraines without aura

Although the primary symptom of a migraine is severe headache, it also has a unique set of symptoms that makes it distinct from other types of headaches. Migraine symptoms frequently include:

  • A throbbing pain in the head, often on just one side of the head
  • Extreme sensitivity to light, to the extent that one needs to stay in a dark room
  • Nausea and vomiting
  • Lightheadedness, dizziness, and feeling faint
  • Blurred vision
  • Extreme sensitivity to sensory stimulation like smell, touch, and taste


Migraine attacks generally last for between 4 and 72 hours. Some people experience an “aura” just before or during an attack. The aura is usually visual, although it can also include other sensations. The aura symptoms tend to build up gradually, and then last for 10-30 minutes and up to 60 minutes. An aura can include:

  • Seeing flashes or spots of light, zig-zags or wavy lines
  • Losing one’s vision
  • Feeling weak, numb, or a pins-and-needles type of tingling in one arm or leg, or along one side of your body
  • Difficulty talking and controlling movement
  • Hearing sounds that aren’t there


Some people who suffer from migraines experience a warning stage, called a “prodrome,” before the migraine begins. This can start as much as one or two days before the migraine attack itself. Advance signs of a migraine can include:

  • Mood swings
  • Craving particular foods
  • Constipation
  • Feeling very thirsty, but also urinating more than normal
  • Stiffness in your neck
  • Frequent yawning
  • Irritability 
  • Trouble sleeping

Often, people have a “postdrome” after the migraine attack is over, when they feel exhausted, confused, and drained.

When to see a doctor

It can be hard to know when to go to the doctor about a headache that could be a migraine. If you have regular headaches, and/or they are accompanied by nausea and vomiting, visual auras, or other signs of a migraine, you should discuss it with your doctor.

Diagnosis

Generally, a neurologist who has experience identifying migraines will diagnose your migraine based on the symptoms and medical history that you share with them, along with a physical and neurological examination. 

Your doctor may also do a workup to rule out other causes of your headaches. This can include blood tests for certain conditions that can cause headaches or worsen migraine headaches. Your doctor may also want imaging of your head, neck, or the blood vessels leading to your head. This can be a CT scan, a MRI scan, or both. 

Causes

Migraines are caused by a combination of genetic and environmental factors. Genetics definitely plays a role — parents have approximately a 50% chance of passing on migraines to their children, That rises to 75% if both parents have migraines. 

A migraine is generally caused by overactive nerve cells that activate your trigeminal nerve, which controls sensation in your head and face. The trigeminal nerve releases chemicals that make the blood vessels in the brain swell, causing the inflammation and pain of a migraine. It is a complex process involving different parts of the brain and different neurotransmitters such as CGRP (Calcitonin Gene Related Peptide), Serotonin, and others. 

Many things can trigger a migraine. Not all migraines are triggered by the same issues, however. Migraine triggers frequently include:

  • Stress, which causes the blood vessels in the brain to swell.
  • Caffeine, either too much of it when you are not used to it, or not drinking it when your brain has already become accustomed to it.
  • Hormonal changes, particularly in women. Many women with migraines tend to get them when their estrogen levels change, like just before or during their menstrual periods, in pregnancy, and during menopause. There is even a condition called menstrual migraines where women experience migraines during each menstrual period.
  • Food. Some people find that aged cheese, salty and processed foods, alcohol and especially wine, and certain food additives like aspartame and MSG trigger a migraine. Skipping meals or fasting can also bring on a migraine.
  • Changes to your sleep patterns, whether it’s a lack of sleep, jet lag due to travel, or even too much sleep.
  • Strong sensory stimulation, like powerful smells, secondhand cigarette smoke, bright sunlight, and loud noise.
  • Physical exertion that pushes your body to a certain point.
  • Changes in the weather or in barometric pressure.
  • Medication, like oral contraceptives, and vasodilators like nitroglycerin.

Treatment

There’s no way to cure migraines. However, many people find that they can decrease the number of migraines they get by making changes to their diet and general lifestyle that reduce or avoid triggers for migraines. Some of the main lifestyle and diet recommendations include:

  • Developing a fixed routine for eating and sleeping, without eating or sleeping too much or too little. 
  • Keeping well hydrated.
  • Exercising regularly. Aerobic exercise is particularly recommended because it relieves tension and stress. Make sure to warm up slowly, because sudden and intense exercise can trigger migraines. Maintaining a healthy body weight also helps prevent migraines, since obesity is a risk factor.
  • Practicing relaxation and stress management techniques to reduce the amount of stress in your life and control your response to it when it does occur. 
  • Keeping a headache diary, so that you can look for patterns in your behavior, environment, or activities that reveal what causes your migraines.
  • Sleep hygiene. Developing habits that contribute to better sleep such as sleeping at the same time each night, avoiding LED lights before bedtime, maintaining a dark quiet cool environment, avoiding large meals before bedtime, and others.

There are also medications to help prevent migraines from occurring so frequently, and to lessen the pain when they do occur. 

Abortive Medications

Practically all migraine sufferers need medication to stop the migraine when it starts. It is often needed right when the headache begins, or else it may not be very effective. There are many types of medications used to stop migraines. They often don’t work perfectly, are sometimes used in combination, and may carry burdensome side effects. 

  • NSAIDs – Medications that reduce inflammation. They can be taken as pills, suppositories, powders, sprays, or shots. Common ones include Advil (ibuprofen) and Aleve (naproxen). 
  • Triptans – medications that work on the neurotransmitter serotonin and are specific for migraine headache. 
  • Anti-emetics or anti-nausea medications are often prescribed when nausea and vomiting is part of your migraine attack.
  • Analgesic medications such as Tylenol (acetaminophen, paracetamol).
  • Combination therapies such as an NSAID, Analgesic and Caffeine. They also have the name migraine including in their names such as Excedrin Migraine. 
  • Dihydroergotamines (D.H.E. 45, Migranal) are the most effective for people whose migraines generally last longer than 24 hours, but they can make the vomiting and nausea worse. These medications are often used when others above have failed. 
  • Opioid medications with codeine and other opiate drugs can be a solution for people who can’t take other treatments or drugs, but they are highly addictive so they are only used when other options have failed. They also cause nausea and other side effects, making them a less attractive solution for migraineurs when nausea is a very common symptom. They are generally not recommended in the treatment of migraines.

Preventive medication for migraines

Preventive medicines are generally prescribed when migraines are a significant aspect of one’s life. This can mean migraines that are not frequent than once a week, migraines that don’t respond to medication, or migraines that can last for days on end. These medications are taken on a regular basis, with the intent of reducing the frequency and severity of migraines. 

  • Beta blockers and other medications that lower blood pressure.
  • Some antidepressants can help reduce the frequency of migraines.
  • Anti-seizure drugs such as valproic acid (Depakote) and topiramate (Topamax).
  • Botox injections where botox is injected to 31 to 39 sites around the back of the neck, once every 12 weeks. 
  • CGRP inhibitors, a new type of therapy, administered by injection once a month, preventing the release of CGRP which is protein that significantly contributes to the process causing migraine headaches. 

Alternative treatments for migraines

 

Depending on your symptoms and triggers, various alternative treatments might help relieve your migraine:

  • Biofeedback is a way of recognizing and controlling your reaction to stressful situations, so that it doesn’t trigger a full migraine.
  • Transcranial magnetic stimulation (TMS) is a device that you put on the back of your head when you feel a migraine with aura beginning. It runs a pulse of magnetic energy to part of your brain which can stop or reduce the pain of a migraine.
  • Acupuncture can reduce stress, encourage your body to produce hormones that help you relax, and lessen your migraines.
  • Cognitive behavioral therapy (CBT) can help you manage your reaction to stress so that it doesn’t lead to a migraine.
  • Herbal and nutritional supplements. Feverfew, magnesium, and riboflavin (vitamin B2) supplements may prevent or reduce the frequency of migraines.

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