Can Marijuana Treat Migraines?
Approximately one in seven people throughout the world suffer from migraines. This neurological disease presents as a massive headache that attacks intermittently, causing immense stress for the people who suffer with them. They can be incapacitating, causing people to miss work or have difficulty raising their children. Some people only have a migraine attack a few times a year, but others can have them several times a day.
Studies have shown that medical cannabis can help treat migraines via the endocannabinoid system acting within the brain, where is alleviates pain and may reduce inflammation.
Because the components of medical marijuana – THC, CBD, other endocannabinoids, and terpenes – help alleviate pain, cannabis is a fantastic alternative to traditional pain killers such as opioids.
The Different Types of Migraines
In the medical field, we divide migraines into two basic classes that include:
Migraines without aura. This is the more common type of migraine. They tend to be unilateral (meaning the pain is felt on one side of the brain more than the other) and present with quick pain that escalates in 30 minutes to an hour. They can be triggered by things like physical activity, loud noises, lights, and lack of sleep. The headaches are often accompanied by nausea and tearing from the eyes. A single attack can last from 8 hours to three days.
The second class of migraines is called migraines with aura. These headaches come with a prodromal phase, where the patient experiences symptoms that let him or her know a headache is about to come. This phase is characterized by different types of neurological symptoms such as flashes of lights across the eyes, specifically smells (the taste of orange is a common example), prickly skin sensations, stuttering or other difficulties with speech, and a sense of vertigo or dizziness.
The aura phase can last from 30 minutes to an hour before the actual headache sets in. The underlying pathology of this migraine class is thought to be due to a lack of blood flow to the brain – perhaps causes by spasms of the blood vessels within a particular area of the brain that controls the sensations they experience. Once the headache begins, it is indistinguishable from the headache of a person who doesn’t experience the aura phase.
Migraines Are Also Classified into Subforms:
- Hemiplegic migraine (“complicated migraine”): People who have hemiplegic migraine suffer from movement restrictions and are unable to move certain limbs, for example, and the symptoms usually go away after about an hour.
- Basilar migraine: This type of migraine mainly affects young adults. It is a headache in the back of the head. Other symptoms can include problems with speech, vision and movement, hearing loss, dizziness, paraesthesia and loss of consciousness.
There are also rare forms of migraine involving the eyes. These include ophthalmoplegic and retinal migraines, where vision problems are the most common.
Migraines Are Also Linked to Hormones
About seven percent of all migraine patients suffer from menstrual migraines, which occurs about two days before or two days after menstruation. Shortly before that, estrogen levels drop sharply while progesterone levels rise. This can be the cause of the headaches with or without an aura.
Acute migraine attacks usually last for a few hours or days. In between, the patients are symptom-free. If patients have migraine attacks for more than 15 days in a month over a period of three months, doctors assume that it is a chronic migraine.
Another form of migraine is an abdominal migraine, which mostly affects children. This is not usually a headache, but a dull pain around the navel. Children often complain of other symptoms like loss of appetite, nausea and vomiting. Doctors assume stress or mental strain to be the triggers of this type of migraine.
Then there are vestibular migraines, which affect the balance system. The main symptoms are vestibular disorders and dizziness. Headaches, on the other hand, are usually only slightly noticeable.
Migraine: symptoms in four phases
A migraine attack is divided into four stages phase with different symptoms: the pre-phase (prodromal stage), aura phase, headache phase and regression; each phase being of varying severity. In addition, not every person affected goes through all phases. The following symptoms can occur in the stages:
- Pre-phase: Many people have the first symptoms of a migraine attack a few hours or days before they have a migraine headache. This can be signaled by irritability, digestive problems, loss of appetite or ravenous appetite, difficulty reading and writing and frequent yawning.
- Aura phase: Here patients suffer from visual disturbances such as zigzag lines or flashes of light in the field of vision. They can also have visual field failures with grey or black spots (negative scotoma) or optical hallucinations (positive scotoma). Other possible symptoms include paralysis or tingling in the arms and legs.
- Headache phase: Headaches can last for several hours or even days. Both the intensity and duration of the pain can vary from attack to attack. Patients complain of a strong unilateral pain in a particular area of the head (e.g. behind the eyes, behind the forehead or at the temples). Common accompanying symptoms are nausea and vomiting as well as sensitivity to light and noise.
- Recovery phase: The symptoms gradually subside in this phase. People who have had a migraine attack often feel exhausted, tired and irritable. In addition, there is a loss of appetite and concentration problems.
What is the cause of a migraine attack?
A number of different factors are being discussed as the cause of a migraine attack. Apart from genetic factors, it could be caused by a circulatory disorder in combination with a malfunction of the neurotransmitters in the brain. The messenger substance serotonin (“happiness hormone”) seems to play a particularly important role in this. This is because it conveys certain information from one nerve cell to another nerve cell or to other organs. Finally, however, the effect of serotonin in a migraine attack has not yet been clarified. Nevertheless, it is assumed that the messenger substance plays a role in the brain (central serotonin) and outside the brain (peripheral serotonin). If this balance shifts in these two areas, it could trigger a migraine attack.
In some areas of the brain, circulatory problems, or rather the vessels in the affected area being narrowed, can be detected during an aura. The reason for this could be high serotonin levels.
What are migraine triggers?
Although the causes of the disease are not yet clear, trigger factors are known to trigger an attack. Which triggers these are in each individual case varies from person to person. Possible triggers could be:
- Stress and emotional strain
- Sensory overload
- Weather changes
- Changes in the sleep-wake rhythm
- Certain foods (e.g. citrus fruits or foods containing tyramine such as chocolate, bananas or red wine)
- Certain stimulants (e.g. nicotine or alcohol)
- Fluctuations in hormone balance
- Hormonal contraceptives (e.g. contraceptive pill)
To find out the individual trigger factors, patients should keep a migraine diary. The entries (date, time of day, duration and severity of headaches) often show a pattern.
Non-drug therapy for migraine
People can do a lot themselves to prevent migraines. These measures include avoiding trigger factors. It is also helpful to reduce stress, learn a relaxation technique (e.g. autogenic training) and take advantage of cognitive behavioral therapy. With the help of the therapist, patients learn to break through stressful and negative thought patterns.
Therapy with medication
The following drugs or active ingredients can be used in the medicinal treatment of migraine:
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, paracetamol, naproxen and acetylsalicylic acid (ASAA) are suitable for mild to moderate headaches.
- Triptans (e.g. zolmitriptan or sumatriptan) are used for severe migraines. These drugs are serotonin receptor agonists that bind to the same receptors as the neurotransmitter serotonin in the brain. As a result, the messenger substance can no longer bind to these receptors, which reduces pain and nausea. Triptans also cause the blood vessels in the brain to narrow, which can also reduce headaches. You need to see a doctor before taking triptans, as these drugs are not allowed to be taken for a number of conditions like high blood pressure or coronary heart disease.
- Ergotamine (ergot alkaloids) is usually only given to patients if the migraine attack lasts for a particularly long time or if other drugs are not effective. Ergotamines can cause severe side effects and should not be taken by patients with cardiovascular disease.
Measures in acute cases and prophylaxis
At the first sign of trouble, it can help to retreat into a darkened room and switch off all sources of noise such as the television or smartphone. Sometimes it is also possible to stop a seizure by taking painkillers early on. But it is important that you do not take painkillers too often. This is because there is a risk that the drugs themselves could become the trigger (drug-induced headache).
The following drugs are available for preventive treatment:
Migraine prophylactics of the first choice:
- Anticonvulsants such as valproic acid or topiramate
- Beta-blockers such as propranolol or metoprolol
- Tricyclic antidepressants like amitriptyline
- Calcium antagonists such as flunarizine
Migraine prophylactics of the second choice:
- antidepressants (SNRI) like venlafaxine
- anti-epileptic drugs such as gabapentin
- Vitamin B2 and magnesium (riboflavin) in combination with omega-3 fatty acids, coenzyme Q10 and berry extracts
What role does the endocannabinoid system play in migraines?
Clinical and experimental studies suggest that a lack of regulation in the endocannabinoid system, or a lack of the body’s own cannabinoids (endocannabinoids), could trigger migraines.
For example, in a group of migraine patients, the amount of the body’s own cannabinoid anandamide, which is produced by the body as needed, was reduced. Anandamide is then broken down by the enzyme FAAH (fatty acid amide hydrolase).
However, it is still unclear whether the body simply does not produce enough anandamide in migraine patients or whether FAAH breaks down the endocannabinoid too quickly.
Studies on migraine and treatment with medical cannabis
Italian researchers investigated whether medical cannabinoids are suitable for the prophylaxis or acute treatment of migraine. A total of 48 people with migraines took part in the study, who were initially given two different cannabis preparations. While the first preparation contained 19 percent tetrahydrocannabinol (THC), the second preparation contained 9 percent of the non- intoxicating cannabinoid cannabidiol (CBD). However, doses of less than 100 milligrams each had no effect. Only from 200 milligrams onwards did the drugs have an analgesic effect.
In the second phase of the trial, the participants were given either the try-cyclic antidepressant amitriptyline (25 milligrams a day) or a combination of THC and CBD (200 milligrams a day) for three months as prophylaxis. For acute headaches, the volunteers took another 200 milligrams of THC-CBD.
The results showed that the frequency of migraine attacks decreased by 40.4 percent when they were treated with cannabis and by 40.1 percent when they were treated with amitriptyline. It is interesting to note that the cannabinoids THC and CBD reduced the intensity of pain by 43.5 percent.
In the summary, the researchers explained that medical cannabis might be an alternative therapy for the prevention of migraines.
In a recent study from 2019, researchers wanted to find out whether inhaling cannabis can reduce migraines and headaches, and whether gender, type of cannabis (concentrate vs. flower), delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) or dosage contribute to changes in these assessments.
The researchers obtained the data from the medical cannabis app Strainprint. This allows patients to track their symptoms before and after using different cannabis strains and doses. Data from 12,293 sessions using cannabis for headache treatment and 7,441 sessions for migraine treatment were analyzed.
The results show that headache and migraine values decreased significantly after cannabis use. Men reported a greater decrease in headaches than women. In addition, the use of concentrates was associated with a greater reduction in headache than the use of cannabis flowers.
It is also reported that inhaled cannabis reduced the severity of headaches and migraines by about 50 percent. However, the effect seemed to diminish over time, so patients had to increase the dosage. This suggests that tolerance to the effect might develop with continued use.
Unfortunately, there are hardly any clinical studies that provide clear evidence of treatment with cannabis-based drugs for migraine attacks. However, many patients with migraine report a positive effect or pain relief. The frequency of migraine attacks also seems to be reduced by the use of THC and CBD. From experience reports, it is also known that taking freely available CBD oil can have a positive effect on the disease
Marijuana and CBD Oil
Some people use marijuana, or forms of the cannabis plant such as CBD oil, to treat migraine. Cannabis has been used for thousands of years as a natural remedy for a number of conditions. While there are not enough high quality studies to support the use of marijuana for migraine, there is anecdotal (based on people’s experiences) and preliminary evidence that cannabis has been helpful for those with migraine. More trials are needed before marijuana can be considered a standard treatment for migraine. 1
What is marijuana and is it legal?
Traditionally, the smoking form of cannabis has been called marijuana. Today, some oral forms are also called marijuana. Topical forms that you rub into your skin are more often known as CBD oil as CBD is the active ingredient. 1,2
Cannabis for recreational and medicinal use is illegal under federal law. However, several states allow medical marijuana, and a few states have legalized recreational use. Each individual should talk with their doctor and learn the laws of the state they live in before using medical marijuana.
What are the differences between CBD and THC?
While there are over 400 different compounds (called cannabinoids) in the cannabis plant, the two most often studied are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). 2
THC is thought to reduce nausea and pain, and increase appetite. It may also produce psychological effects like euphoria, anxiety, and altered sensory perception, which can make users feel “high” or intoxicated. CBD (cannabidiol) does not cause intoxication. It does produce sedative effects that can help reduce pain, convulsions, nausea, and inflammation. There are a variety of preparations with varying doses of CBD and THC.
More studies are needed to decide if oral, inhaled, or topical forms of marijuana work best for which type of migraine and at what doses. 1
How does medical marijuana work in the body?
Researchers have discovered that the human body has an endocannabinoid system (ECS). “Endo” means internal or within the body. The ECS is distributed throughout the body. It plays a part in regulating many functions, including pain, mood, appetite, and the movement of the gastrointestinal system. The ECS includes the cannabinoids the body produces, the receptors on which they act, and the enzymes that are involved. 3
Studies on medical marijuana and migraine
Research on marijuana has been limited, due to the federal regulations and lack of funding. However, there have been recent studies on the use of cannabis or medical marijuana in people with migraine.
Migraine attacks decreasing from medical marijuana
In 2016, a study reviewed past data from 121 adults with migraine who were recommended either a migraine preventive drug or medical marijuana by their doctor. The study found that migraine attacks decreased from 10.4 to 4.6 a month with the use of medical marijuana. The types of marijuana used varied. Plus, many patients used more than one form and used it daily as a prevention strategy. Inhaled forms of marijuana were used most often as an acute strategy for migraine attacks and were reported to help ease symptoms. 2
The challenges of this study are that the types of doses of marijuana varied. This makes it impossible to know which form or dose worked best as a preventive or acute treatment. However, the study offers interesting data for future studies.
Was marijuana effective in relieving your migraine symptoms?
Cannabis for prevention and acute treatment of migraine
In 2017, Italian researchers provided more evidence on the use of cannabis for both prevention and acute treatment of migraine. The researchers first studied the proper dose of cannabis. A group of 48 people with chronic migraine were given oral doses with different levels of THC and CBD. Investigators found that at an oral dose of 200 mg, acute pain dropped by 55 percent. In phase 2 of the research, 79 people living with chronic migraine were given either a daily dose of marijuana or amitriptyline (a common antidepressant used as a treatment for migraine). The participants were also able to use 200 mg of marijuana for acute attacks. 4
After 3 months, those who received marijuana had a 40.4 percent reduction in migraine attacks compared to 40.1 percent of those who received the antidepressant. Researchers also found that the medical marijuana used for acute treatment reduced pain intensity by 43.5 percent. The most common side effects were drowsiness and difficulty concentrating. In addition, many participants reported less stomach aches and muscle and joint pain. 4
Another study in Europe found that 10.2 percent of people with migraine self-medicated with marijuana. Results were varied, with some people reporting that low doses helped relieve migraine while higher doses triggered headaches. 3
Side effects and other precautions
Marijuana is not approved by the U.S. Food & Drug Administration. Because marijuana is not tightly regulated the way approved drugs are, it is difficult to list side effects because its strength and purity may vary with each use.
The long-term negative effects of medical marijuana are not known. Few studies have been conducted on the long-term safety of cannabis, and those that have been completed are often conflicting or are of poor quality. 1
Short-term side effects of medical marijuana are better understood and include:
- Temporary impaired short-term memory and concentration
- Increased in anxiety or paranoia
- Possible physical or psychological dependence or addiction
- Impaired motor skills like driving
These are not all the possible side effects of marijuana. Patients should talk to their doctor about what to expect with treatment with marijuana.
Who should not take marijuana?
If you are pregnant, breastfeeding, or plan to become pregnant, or are breastfeeding, you must consult your doctor before taking any supplement. It is well-known that smoking endangers the health of developing babies and should be avoided by pregnant women. The effects of marijuana have been studied in pregnant or breastfeeding women, and it is not recommended to take marijuana as it can pose a danger to the unborn child. 6
How would you rate the side effects you experienced with marijuana?
As always, the best source for advice on treating migraine is your own migraine specialist. These descriptions of natural remedies are provided only for informational purposes. You should begin no medication or supplement without first checking with your health care provider and should let them know of any other prescriptions, OTCs, and herbals you are taking to ensure there are no interactions.