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Can Cannabis Help Tension Headaches?

Scientific and anecdotal evidence tells us that cannabis may be an effective treatment for migraine and cluster headaches, but what about tension headaches? 

Cannabis has been legalized as a medicine for pain relief and headache treatments in many different countries and US states. Research looking into cannabis and tension headaches is relatively sparse, and there isn’t a conclusive consensus in the scientific literature to date as to whether medical marijuana is an effective treatment for tension headaches. With that being said, recent research has shown promising results for using medical marijuana to manage pain in a variety of conditions, including headache disorders. Medical marijuana may also help alleviate tension headache symptoms indirectly by improving sleep quality.

As the legalization of medicinal cannabinoids becomes more common globally, further research will likely be carried out, which will help determine the true efficacy of cannabinoid treatments for tension headaches.

How Cannabis Works

The endocannabinoid system is a complex biological system of cannabinoids and receptors. Cannabinoids are neurotransmitters synthesized from fats which bind to cannabinoid receptors expressed throughout the body, and are present in the vertebrate central nervous system (including the brain). The primary role of the endocannabinoid system is to maintain homeostasis in the body, modulating crucial functions such as appetite, muscle control, sleep, mood, and pain responses. 

Phytocannabinoids, derived from the cannabis plant, such as cannabidiol (CBD) and tetrahydrocannabinol (THC) interact with the CB1 and CB2 receptors in the endocannabinoid system. When these receptors are activated, a range of effects are felt in users such as the psychoactive effects of medical marijuana, and therapeutic effects such as pain relief.

One of the most common treatments for tension headaches are pain relievers. Current scientific literature has established that signaling through both CB1 and CB2 receptors affect nociceptors (pain receptors). A systematic review and meta-analysis analyzing the results of 43 randomized controlled trials and a total of 2,437 patients concluded that medical marijuana may be effective for chronic pain treatment, especially for neuropathic pain, based on the limited evidence available. Given pain relief is one of the most common medical uses of medical marijuana, it seems plausible that the pain-relieving effects of cannabis could also be viable for relieving pain associated with tension headaches.

The primary cause of tension headaches is still not completely understood, however, likely causes include stress, sleep disturbances and issues with the jaw, neck pain and eye strain. Since a common symptom associated with tension headaches is poor sleep quality, medical marijuana could also help alleviate symptoms of tension headaches indirectly through helping to improve one’s sleep.

Medical Studies on Tension Headaches and Cannabis 

Research on cannabis and tension headaches is still in its early phases, with an overall lack of randomized controlled trials, primarily due to the legal status of cannabis, which has limited research in the past. 

Despite the lack of specific research on cannabis and tension headaches, there is still some promising research that may give us an insight into how and if medical marijuana could help.

Cannabis has been used for centuries to treat headache disorders such as migraines. Through the late 1800s – 1940s, medical marijuana was viewed as an effective remedy for headaches within the medical community.

To date, there haven’t been any specific clinical trials looking at medical marijuana and tension headaches, but we do have some clinical research looking at the effects of cannabis on cluster headaches and migraines.

One study set out to explore the effects of cannabis on the monthly frequency of migraine headaches. Participants who had been diagnosed with migraine headaches were recommended to use medical marijuana or prophylaxis with cannabis for their migraine headaches. By tracking the patients for four years, researchers found that migraine frequency decreased from 10.4 to 4.6 episodes per month on average with daily cannabis use. Half of the patients reported positive effects (primarily the prevention of headache symptoms and decreased frequency of migraines), and 11.6% of patients reported negative effects. The negative effects included drowsiness and difficulty controlling the timing and intensity of cannabis dosing.

A comprehensive review of cannabinoids for migraines and other headache disorders concluded that overall, medical marijuana may have a therapeutic role for chronic pain disorders, including headache disorders like migraines and cluster headaches.

  • In a case series, five cases of chronic migraine headaches were treated successfully with dronabinol or medical marijuana. In one case, medical marijuana improved symptoms more than dronabinol.
  • A case report of a patient with refractory cluster headache showed that smoked medical marijuana or dronabinol when a cluster headache began provided immediate relief.
  • A case series looking at three subjects with chronic headaches showed that smoking cannabis provided comparable relief to ergotamine and aspirin.
  • A case report of a patient with migraine found that after 18 years of treatment failure with standard medications, success was found using smoked medical marijuana.

It’s important to note that these results are limited to case-based research and don’t include control groups. Placebo due to the notoriety of cannabis’ medical benefits must also be considered. While these case series and reports are promising, randomized controlled trials are still needed.

One 2012 preliminary double-blind, active-controlled, randomized trial looked at the effects of THC on headaches disorders. Participants who were experiencing medication overuse headaches were administered oral doses of either nabilone or ibuprofen daily. Both medications were found to be effective. Interestingly, the participants reported greater improvements and an overall higher quality of life when using the synthetic form of THC. Nabilone was also shown to cause less intense pain and also lowered drug dependance. While neither drug had a significant effect on migraine frequency, researchers attributed this to the relatively short duration of the trial. These results are promising, but still, larger scale studies are needed, especially with THC rather than nabilone.

The changes in brain structures between sleep disorders and tension headaches share many similarities. Research has shown that sleep disruption is a common cause of increased pain receptors firing, which may increase tension headache symptoms. One study published in the Journal of Clinical Sleep Medicine found that 59% of tension headache sufferers say too little sleep worsens their headaches.

A 2010 randomized study looking at 21 people with chronic neuropathic pain found that patients experienced “significant improvements” in sleep quality and anxiety after being treated with THC. Other studies show less promising results, with a 2008 study showing that THC strains lessen rapid eye movement (REM) sleep, while a 2015 study showed regular cannabis use impairs sleep. If cannabis can help improve sleep, this could help to alleviate tension headache symptoms indirectly.

As laws surrounding medical marijuana continue to change for the better, more specific research will most likely be carried out on medical marijuana and tension headaches. Based on limited, but promising evidence of cannabis’ pain-relieving effects and multiple case series and reports, it seems that medical marijuana could, at least for some people, help relieve tension headache symptoms — but we simply can’t yet say for sure.

 

Side Effects

In general, medical marijuana is well-tolerated in patients, especially in comparison to other pain-relievers such as opiates. Few side effects of medical marijuana cause patients to withdraw from studies.

Cannabis Side Effects

Some common side effects of cannabis include dizziness, dry mouth, problems concentrating and drowsiness. Less common side effects include incoordination, paranoia, and anxiety. Research also shows that with continued use, tolerance to these minor side effects occurs quickly. Withdrawal symptoms after ceasing medical marijuana use are possible, with one study showing that 23% of patients experienced headaches after stopping regular medical marijuana use. 

Lethal overdoses on cannabis do not exist; no single death has ever been directly attributed to cannabinoids. More serious side effects are possible for medical marijuana users with higher genetic predispositions to developing mental illnesses like schizophrenia. Cognitive developmental issues are also a possible side effect of heavy medical marijuana use during adolescence due to the on-going development of the brain.

About Tension Headaches Overview

Tension headaches are the most common form of headaches, affecting practically everyone at some point in their lives. Women tend to get tension headaches more often than men, generally beginning during the mid-teens and reaching their peak in one’s 30s. They feel like a steady, dull pain or tightness around the head. 

There are two types of tension headaches:

  • Episodic tension headaches can last for anything from 30 minutes to a whole week. They occur on fewer than 15 days a month, over at least three months.
  • Chronic tension headaches occur more than 15 times a month, three months in a row. They can last for hours, and might even become continuous. About 3% of adults get chronic tension headaches. 

Tension headaches are sometimes confused with migraines, but unlike migraines, tension headaches are less severe, and don’t include sensitivity to light, sound, or smells, or nausea and vomiting. Tension headaches also aren’t usually severe enough to stop you from carrying out your daily activities. 

Symptoms

The primary symptom of a tension headache is the dull, steady pain felt all around the head. People often describe it as feeling like a tight iron band around the head. You might also feel pain or tightness in your neck, the back of your head, your jaw, and your shoulders, and/or a sense of pressure behind your eyes. 

Tension headaches tend to come on gradually and typically last between 30 minutes and a few hours, although they can last for days or even weeks. They usually begin later in the day or in the evening.  

Complications

Tension headaches rarely lead to any more serious disorder, but they can affect productivity and ability to focus at work or at school. If you get frequent tension headaches, the pain can lower your quality of life, can impact your mood, and other aspects of your life.  

Diagnosis

Diagnosing tension headaches mainly relies on your description of your symptoms. You can expect to be asked:

  • When you get headaches
  • What the pain feels like, and whether it’s steady or throbbing, dull or sharp
  • Where you feel the pain
  • How long your headaches last
  • Whether the pain increases when you change position, move around, sit up or lie down
  • Whether you have a history of stress or head injuries
  • If you have trouble sleeping

Your doctor will also carry out a thorough medical examination. If the examination and your answers match the symptoms of tension headaches, you probably won’t need any further tests. 

But if your doctor wants further confirmation, or your symptoms don’t conclusively indicate tension headaches, your doctor could order any or all of these tests:

  • Blood tests, to check for other underlying conditions
  • Imaging such as CT scans or MRI scans for further evaluation

If you have headaches that come on very suddenly, are accompanied by a stiff neck, fever, slurred speech, or numbness, you should seek emergency treatment.

Causes

It’s not clear what causes tension headaches. They’re considered primary headaches because they aren’t caused by any other underlying condition. A genetic reason has not been found.  Some people develop tension headaches while others don’t when in the same situations.

If you get tension headaches, there are some known risk factors that are likely to trigger one:

  • A buildup of stress and anxiety, or a single, highly stressful situation (depression and anxiety disorders can often come along with tension headaches)
  • Squinting or vision issues
  • Poor posture
  • Tiredness, lack of rest
  • Dehydration or hunger, skipping meals or eating badly, and/or low iron levels
  • Too much alcohol and/or caffeine
  • Not enough physical activity 
  • Bright sunlight
  • Noise
  • Certain smells 
  • Jaw or dental problems

Treatment

There are two main approaches to treating tension headaches: medication to ease the pain once a headache has begun, and lifestyle changes to help prevent a tension headache from beginning. Certain therapies can also help to decrease the frequency and severity of tension headaches, especially when you use them together with lifestyle changes.

Medication 

Your doctor will consider the frequency and severity of your headaches, your age and health, and your preferences before prescribing medication. 

  • Over the counter painkillers, like ibuprofen, aspirin, and naproxen, are generally the first line of treatment for tension headaches. 
  • Prescription drugs like naproxen, indomethacin, and ketorolac, are prescribed if OTC drugs don’t help. 
  • Combination drugs include caffeine or a sedative with painkillers like aspirin or acetaminophen.
  • Triptans may be prescribed if you have both migraines and tension headaches.

Sometimes, doctors prescribe preventative medication like antidepressants, blood pressure medication, or anti seizure medications. These medications are taken daily on a regular basis in order to reduce the frequency and intensity of headaches over time.  

Lifestyle changes

There are a number of lifestyle changes that can help stop a tension headache from beginning. 

Recommendations include:

  • Getting regular exercise 
  • Reducing the amount of alcohol, caffeine, and sugar you consume
  • Quitting smoking
  • Getting the right amount of sleep, and going to sleep and waking up at the same time each day
  • Eating a healthy diet without skipping meals
  • Drinking plenty of water
  • Learning stress management techniques like yoga, meditation, and other relaxation exercises
  • Avoiding any foods that you’ve found can trigger headaches

Therapy 

  • Biofeedback training can teach you how to control your body’s responses to stress in order to reduce pain. It guides you to release tension in your muscles and slow down your heart rate and breathing. 
  • Cognitive behavioral therapy (CBT) can help you to lessen stress and lower the severity of your headaches.
  • Relaxation techniques like deep breathing therapy, yoga, and meditation.
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Can Cannabis Help Tension Headaches?

by Dr. Roni Sharon, MD

Dec 18, 2019

Scientific and anecdotal evidence tells us that cannabis may be an effective treatment for migraine and cluster headaches, but what about tension headaches? 

Cannabis has been legalized as a medicine for pain relief and headache treatments in many different countries and US states. Research looking into cannabis and tension headaches is relatively sparse, and there isn’t a conclusive consensus in the scientific literature to date as to whether medical marijuana is an effective treatment for tension headaches. With that being said, recent research has shown promising results for using medical marijuana to manage pain in a variety of conditions, including headache disorders. Medical marijuana may also help alleviate tension headache symptoms indirectly by improving sleep quality.

As the legalization of medicinal cannabinoids becomes more common globally, further research will likely be carried out, which will help determine the true efficacy of cannabinoid treatments for tension headaches.

How Cannabis Works

The endocannabinoid system is a complex biological system of cannabinoids and receptors. Cannabinoids are neurotransmitters synthesized from fats which bind to cannabinoid receptors expressed throughout the body, and are present in the vertebrate central nervous system (including the brain). The primary role of the endocannabinoid system is to maintain homeostasis in the body, modulating crucial functions such as appetite, muscle control, sleep, mood, and pain responses. 

Phytocannabinoids, derived from the cannabis plant, such as cannabidiol (CBD) and tetrahydrocannabinol (THC) interact with the CB1 and CB2 receptors in the endocannabinoid system. When these receptors are activated, a range of effects are felt in users such as the psychoactive effects of medical marijuana, and therapeutic effects such as pain relief.

One of the most common treatments for tension headaches are pain relievers. Current scientific literature has established that signaling through both CB1 and CB2 receptors affect nociceptors (pain receptors). A systematic review and meta-analysis analyzing the results of 43 randomized controlled trials and a total of 2,437 patients concluded that medical marijuana may be effective for chronic pain treatment, especially for neuropathic pain, based on the limited evidence available. Given pain relief is one of the most common medical uses of medical marijuana, it seems plausible that the pain-relieving effects of cannabis could also be viable for relieving pain associated with tension headaches.

The primary cause of tension headaches is still not completely understood, however, likely causes include stress, sleep disturbances and issues with the jaw, neck pain and eye strain. Since a common symptom associated with tension headaches is poor sleep quality, medical marijuana could also help alleviate symptoms of tension headaches indirectly through helping to improve one’s sleep.

Medical Studies on Tension Headaches and Cannabis 

Research on cannabis and tension headaches is still in its early phases, with an overall lack of randomized controlled trials, primarily due to the legal status of cannabis, which has limited research in the past. 

Despite the lack of specific research on cannabis and tension headaches, there is still some promising research that may give us an insight into how and if medical marijuana could help.

Cannabis has been used for centuries to treat headache disorders such as migraines. Through the late 1800s – 1940s, medical marijuana was viewed as an effective remedy for headaches within the medical community.

To date, there haven’t been any specific clinical trials looking at medical marijuana and tension headaches, but we do have some clinical research looking at the effects of cannabis on cluster headaches and migraines.

One study set out to explore the effects of cannabis on the monthly frequency of migraine headaches. Participants who had been diagnosed with migraine headaches were recommended to use medical marijuana or prophylaxis with cannabis for their migraine headaches. By tracking the patients for four years, researchers found that migraine frequency decreased from 10.4 to 4.6 episodes per month on average with daily cannabis use. Half of the patients reported positive effects (primarily the prevention of headache symptoms and decreased frequency of migraines), and 11.6% of patients reported negative effects. The negative effects included drowsiness and difficulty controlling the timing and intensity of cannabis dosing.

A comprehensive review of cannabinoids for migraines and other headache disorders concluded that overall, medical marijuana may have a therapeutic role for chronic pain disorders, including headache disorders like migraines and cluster headaches.

  • In a case series, five cases of chronic migraine headaches were treated successfully with Dronabinol or medical marijuana. In one case, medical marijuana improved symptoms more than Dronabinol.

  • A case report of a patient with refractory cluster headache showed that smoked medical marijuana or Dronabinol when a cluster headache began provided immediate relief.

  • A case series looking at three subjects with chronic headaches showed that smoking cannabis provided comparable relief to ergotamine and aspirin.

  • A case report of a patient with migraine found that after 18 years of treatment failure with standard medications, success was found using smoked medical marijuana.


It’s important to note that these results are limited to case-based research and don’t include control groups. Placebo due to the notoriety of cannabis’ medical benefits must also be considered. While these case series and reports are promising, randomized controlled trials are still needed.

One 2012 preliminary double-blind, active-controlled, randomized trial looked at the effects of THC on headaches disorders. Participants who were experiencing medication overuse headaches were administered oral doses of either Nabilone or Ibuprofen daily. Both medications were found to be effective. Interestingly, the participants reported greater improvements and an overall higher quality of life when using the synthetic form of THC. Nabilone was also shown to cause less intense pain and also lowered drug dependance. While neither drug had a significant effect on migraine frequency, researchers attributed this to the relatively short duration of the trial. These results are promising, but still, larger scale studies are needed, especially with THC rather than Nabilone.

The changes in brain structures between sleep disorders and tension headaches share many similarities. Research has shown that sleep disruption is a common cause of increased pain receptors firing, which may increase tension headache symptoms. One study published in the Journal of Clinical Sleep Medicine found that 59% of tension headache sufferers say too little sleep worsens their headaches.

A 2010 randomized study looking at 21 people with chronic neuropathic pain found that patients experienced “significant improvements” in sleep quality and anxiety after being treated with THC. Other studies show less promising results, with a 2008 study showing that THC strains lessen rapid eye movement (REM) sleep, while a 2015 study showed regular cannabis use impairs sleep. If cannabis can help improve sleep, this could help to alleviate tension headache symptoms indirectly.

As laws surrounding medical marijuana continue to change for the better, more specific research will most likely be carried out on medical marijuana and tension headaches. Based on limited, but promising evidence of cannabis’ pain-relieving effects and multiple case series and reports, it seems that medical marijuana could, at least for some people, help relieve tension headache symptoms — but we simply can’t yet say for sure.

 

Side Effects

In general, medical marijuana is well-tolerated in patients, especially in comparison to other pain-relievers such as opiates. Few side effects of medical marijuana cause patients to withdraw from studies.

Cannabis Side Effects

Some common side effects of cannabis include dizziness, dry mouth, problems concentrating and drowsiness. Less common side effects include incoordination, paranoia, and anxiety. Research also shows that with continued use, tolerance to these minor side effects occurs quickly. Withdrawal symptoms after ceasing medical marijuana use are possible, with one study showing that 23% of patients experienced headaches after stopping regular medical marijuana use. 

Lethal overdoses on cannabis do not exist; no single death has ever been directly attributed to cannabinoids. More serious side effects are possible for medical marijuana users with higher genetic predispositions to developing mental illnesses like schizophrenia. Cognitive developmental issues are also a possible side effect of heavy medical marijuana use during adolescence due to the on-going development of the brain.

About Tension Headaches

Tension headaches are the most common form of headaches, affecting practically everyone at some point in their lives. Women tend to get tension headaches more often than men, generally beginning during the mid-teens and reaching their peak in one’s 30s. They feel like a steady, dull pain or tightness around the head. 

There are two types of tension headaches:

  • Episodic tension headaches can last for anything from 30 minutes to a whole week. They occur on fewer than 15 days a month, over at least three months.
  • Chronic tension headaches occur more than 15 times a month, three months in a row. They can last for hours, and might even become continuous. About 3% of adults get chronic tension headaches. 

Tension headaches are sometimes confused with migraines, but unlike migraines, tension headaches are less severe, and don’t include sensitivity to light, sound, or smells, or nausea and vomiting. Tension headaches also aren’t usually severe enough to stop you from carrying out your daily activities. 

The primary symptom of a tension headache is the dull, steady pain felt all around the head. People often describe it as feeling like a tight iron band around the head. You might also feel pain or tightness in your neck, the back of your head, your jaw, and your shoulders, and/or a sense of pressure behind your eyes. 

Tension headaches tend to come on gradually and typically last between 30 minutes and a few hours, although they can last for days or even weeks. They usually begin later in the day or in the evening.  

Tension headaches rarely lead to any more serious disorder, but they can affect productivity and ability to focus at work or at school. If you get frequent tension headaches, the pain can lower your quality of life, can impact your mood, and other aspects of your life.  

Diagnosing tension headaches mainly relies on your description of your symptoms. You can expect to be asked:

  • When you get headaches
  • What the pain feels like, and whether it’s steady or throbbing, dull or sharp
  • Where you feel the pain
  • How long your headaches last
  • Whether the pain increases when you change position, move around, sit up or lie down
  • Whether you have a history of stress or head injuries
  • If you have trouble sleeping

Your doctor will also carry out a thorough medical examination. If the examination and your answers match the symptoms of tension headaches, you probably won’t need any further tests. 

But if your doctor wants further confirmation, or your symptoms don’t conclusively indicate tension headaches, your doctor could order any or all of these tests:

  • Blood tests, to check for other underlying conditions
  • Imaging such as CT scans or MRI scans for further evaluation

If you have headaches that come on very suddenly, are accompanied by a stiff neck, fever, slurred speech, or numbness, you should seek emergency treatment.

It’s not clear what causes tension headaches. They’re considered primary headaches because they aren’t caused by any other underlying condition. A genetic reason has not been found.  Some people develop tension headaches while others don’t when in the same situations.

If you get tension headaches, there are some known risk factors that are likely to trigger one:

  • A buildup of stress and anxiety, or a single, highly stressful situation (depression and anxiety disorders can often come along with tension headaches)
  • Squinting or vision issues
  • Poor posture
  • Tiredness, lack of rest
  • Dehydration or hunger, skipping meals or eating badly, and/or low iron levels
  • Too much alcohol and/or caffeine
  • Not enough physical activity 
  • Bright sunlight
  • Noise
  • Certain smells 
  • Jaw or dental problems

There are two main approaches to treating tension headaches: medication to ease the pain once a headache has begun, and lifestyle changes to help prevent a tension headache from beginning. Certain therapies can also help to decrease the frequency and severity of tension headaches, especially when you use them together with lifestyle changes.

Medication 

Your doctor will consider the frequency and severity of your headaches, your age and health, and your preferences before prescribing medication. 

  • Over the counter painkillers, like ibuprofen, aspirin, and naproxen, are generally the first line of treatment for tension headaches. 
  • Prescription drugs like naproxen, indomethacin, and ketorolac, are prescribed if OTC drugs don’t help. 
  • Combination drugs include caffeine or a sedative with painkillers like aspirin or acetaminophen.
  • Triptans may be prescribed if you have both migraines and tension headaches.

Sometimes, doctors prescribe preventative medication like antidepressants, blood pressure medication, or anti seizure medications. These medications are taken daily on a regular basis in order to reduce the frequency and intensity of headaches over time.  

Lifestyle changes

There are a number of lifestyle changes that can help stop a tension headache from beginning. 

Recommendations include:

  • Getting regular exercise 
  • Reducing the amount of alcohol, caffeine, and sugar you consume
  • Quitting smoking
  • Getting the right amount of sleep, and going to sleep and waking up at the same time each day
  • Eating a healthy diet without skipping meals
  • Drinking plenty of water
  • Learning stress management techniques like yoga, meditation, and other relaxation exercises
  • Avoiding any foods that you’ve found can trigger headaches

Therapy 

  • Biofeedback training can teach you how to control your body’s responses to stress in order to reduce pain. It guides you to release tension in your muscles and slow down your heart rate and breathing. 
  • Cognitive behavioral therapy (CBT) can help you to lessen stress and lower the severity of your headaches.
  • Relaxation techniques like deep breathing therapy, yoga, and meditation.

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