Headache & Migraine

Medical Cannabis and Migraines/Headaches

A headache is a continuous or short-but-regular pain in the head, whether dull or sharp. There are two groups of headaches: primary and secondary. Primary headaches are the most common type and are not caused by another problem or condition; migraines fit into this group. Secondary headaches come as a result of another disease or condition. Medical cannabis is one of the most common conditions for patients seeking a medical marijuana card.

What is a Migraine/Headache?

There are a considerable number of conditions that can cause migraines and headaches. Whether it’s the cold or the flu, stress, the side effects of another medication, depression, high blood pressure, chronic pain, chemotherapy, or hormonal changes, one of the side effects is often headaches or migraines. Environmental factors may also cause headaches, such as regularly being exposed to high levels of noise pollution. Headaches and migraines cost the United States approximately $13 to $17 billion annually.

Due to the considerable number of conditions that can cause headaches and migraines, it is a much-studied phenomenon. The causes of some types of headaches and migraines are more well-known than others, and they are different in many respects, even though they may share many of the same characteristics. To explain this, headaches are not a feature of all migraines.

Types of headaches include tension, sinus, thunderclap, and Chiari. Migraines do not always have head pain, but it is often a part of most migraine types. Head pain in migraines can occur in specific parts of the head, as opposed to a general feeling all around the head.

Unlike most types of headaches, migraines often include symptoms such as nausea and/or vomiting; seeing spots or flashes; temporary vision loss; sensitivity to light and/or sound; tingling and numbness in the face and hands; pain in specific parts of the head, such as at the temples or behind the eyes or ears; and confusion.

Migraines without headaches were previously known as “acephalgic migraines” or “silent migraines” but are nowadays simply just termed “migraine aura without headache.” Other debilitating symptoms, like nausea, vomiting, and sensitivity to light and sound, are still present in migraines without headaches.

Although the brain lacks pain receptors, pain can be detected in extracranial arteries, the middle meningeal artery, prominent veins, venous sinuses, cranial and spinal nerves, head and neck muscles, the meninges, falx cerebri, parts of the brainstem, eyes, ears, teeth, and lining of the mouth. Pial arteries are responsible for pain production.

Headaches often result from irritation of the meninges and blood vessels. The nociceptors may be stimulated by head trauma or tumors, which can cause headaches. Blood vessel spasms, dilated blood vessels, inflammation or infection of meninges, and muscular tension can also stimulate nociceptors. Once a nociceptor is stimulated, it sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts.

Doctors and scientists know more about headaches than others. Due to the vast number of variables in the cause of primary headaches, less is known about them. We do not know much about cluster headaches, migraines, and tension headaches. Serotonin seems to be involved in many types of headaches.

Brief Summary of Current Treatments

The most common go-to medications are over-the-counter (OTC) pain relievers like acetaminophen (paracetamol, Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) acetylsalicylic acid (Aspirin) and ibuprofen (Advil, Nurofen). Herbal remedies include peppermint, ginger, lavender, ginkgo biloba, feverfew, and butterbur.

Prescription medications include triptans like almotriptan (Axert), zolmitriptan (Zomig), and eletriptan (Relpax); anticonvulsants like gabapentin (Neurontin); antiemetics like dolasetron (Anzemet) in cases where nausea and vomiting coincide with the headache or migraine; and in some cases of treatment-resistant headaches, opioid analgesics like codeine.

Non-medication interventions include ensuring that you drink enough water and get enough sleep, exercise regularly, increase your magnesium intake, and reduce your nitrate and nitrite intake.

How Might Medical Cannabis Help?

Products derived from the cannabis plant have been used on various types of headaches and migraines, with varying results. However, there does seem to be a link between the endocannabinoid system (ECS) and the detection of many kinds of pain, including headaches. Many people utilize cannabis to manage headaches and migraines.

Cannabis also contains several anxiolytic, antidepressant, anti-inflammatory, antioxidant, analgesic, and stress-relieving compounds that can help alleviate not just migraine headaches but also any nausea and vomiting, appetite reduction, insomnia, anxiety, and depression associated with them.

Cannabinoids

• Tetrahydrocannabinol (THC) and tetrahydrocannabinolic acid (THCA/THCa)
• Cannabidiol (CBD) and cannabidiolic acid (CBDA/CBDa)
• Cannabichromene (CBC)
• Cannabinol (CBN)
• Cannabigerol (CBG)

Cannabinoid Ratios

• THC:CBD 1:20
• THC:CBD 1:1

Terpenes and Terpenoids

• Pinene
• Limonene
• Linalool
• Beta-caryophyllene
• Beta-myrcene

Flavonoids

• Cannflavins A, B and C
• Quercetin
• Luteolin

Effective Ways of Taking Medical Cannabis for Migraine/Headache

Routes of Administration

• Inhalation
• Ingestion
• Sublingual

Special Formulations

Cannabis products and varieties rich in beta-myrcene and beta-caryophyllene may be ideal for headache and migraine sufferers. Other terpenes like linalool, pinene, and limonene also help relieve stress and tension. THC, CBD, CBC, and CBN have anti-inflammatory and antiemetic properties that can help relieve pain and nausea.

Dosing Methods

• Combustion (smoking)
• Vaporizer
• Inhaler
• Tincture
• Edible

What are the Pros and Cons of Taking Medical Cannabis for Migraine/Headache?

Potential Pros

• Migraines are hard to treat, and some of the stronger medications have potential side effects, including heaviness in the chest and limbs, warm flushes, tingling, tightness, and, in the case of opioids, addiction and medication overuse headache (MOH).

• Cannabinoids may bind to areas of the brain that modulate pain transmission – the same areas in the brain opioid receptors are found.
• THC may reduce serotonin release. Nausea and vomiting are sometimes side effects of migraines, and THC may help prevent these side effects.
• CBD can help relieve stress and reduce inflammation.
• Terpenes like myrcene and beta-caryophyllene can also help relieve stress and pain.

Potential Cons

• “Rebound headaches” can occur if cannabis use is stopped.
• Some report increased pain or frequency of migraines after cannabis use. Others report an increase, followed by a decrease.
• Smoking cannabis may induce headaches in some people. For example, in cluster headaches, some reported relief from their headaches, while others reported worsening their condition. Interestingly, when it comes to cluster headaches, psilocybin may be of use due to its action on serotonin receptors.

Useful Anecdotal Information

“Does Cannabis Actually Help with Headaches? What Scientists Know So Far,” Sarah Sloat, Inverse, March 13th, 2022

“Does Weed Actually Help Migraine Attacks?” Greatist

“Sunderland mum: ‘I pay for medical cannabis to help my debilitating migraines‘’ Adam Clarkson, BBC News. March 17th, 2022.

Scientific Data Overview and Studies

• Total Studies = 35
• Positive Studies = 27
• Inconclusive Studies = 7
• Negative Studies = 1
• 28 Meta-Analyses (21 positive, 7 inconclusive); 6 Animal Studies (5 positive, 1 negative); 1 laboratory study (positive)
• 6 studies include CBD (5 positive, 1 inconclusive); 1 study includes CBDA (positive); 9 studies include THC (8 positive, 1 negative); 1 study includes THCA (positive); 1 study includes a 1:1 THC:CBD ratio (inconclusive)
• No. of Leafwell Patients (2022) = 3,823
• Possible Overall Efficacy: High

Quotes from Studies

“The effects were assessed of delta THC (the psychoactive component of cannabis) and CBD and DMHP-CBD (the non-psychomimetic components of marijuana derivatives) on 14C labelled serotonin release from normal platelets, when incubated with patient’s plasma obtained during migraine attack. A statistically significant inhibitory effect (p greater than 0.005) of 14C serotonin release was found at 10(-5)M, 10(-6)M, 10(-7)M delta THC concentrations.” Volfe Z, Dvilansky A, Nathan I. ‘Cannabinoids block release of serotonin from platelets induced by plasma from migraine patients.’ Int J Clin Pharmacol Res. 1985;5(4):243-6. PMID: 2997048.

“In 2019, Cuttler et al., in their survey study from a Canadian data application (Strainprint), focused on the inhaled cannabis usage and their effect of reduction in migraine severity and frequency along with the factors affecting the dosage used [19]. Survey results demonstrated that headaches were reduced by 47.3% and migraines by 49.6% [19]. A higher proportion of males (90.9%) compared to females (89.1%) reported a more favorable reduction with headaches, whereas females (88.6) compared to males (87.3%) reported a more favorable reduction with migraines [19]. It also investigated the tolerance development with prolonged cannabis use [19]. Lack of a control group and sampling bias were limitations of this study [19]. In 2018, Baron et al. did a literature review of cannabinoid usage to treat migraines, facial pain, and chronic pain and their medicinal benefits [20]. The study shows the significant advantage of medical marijuana in improving nausea and vomiting associated with migraines [20].” Poudel, Sujan et al. ‘Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature.’ Cureus vol. 13,8 e17407. 24 Aug. 2021, doi:10.7759/cureus.17407

Conclusion

Strong evidence suggests that medical cannabis can help manage and reduce the intensity of headaches and migraines.

Related Articles

Cluster Headaches

Chronic Pain, Muscle Pain, and Other Types of Pain

Note that the information in this article does not constitute medical advice.

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