Using cannabis can have a big impact on your physical and mental health—for better and, once in a while, for worse. That’s why it’s important to consult a healthcare provider before experimenting.
Here at GreenState, cannabis clinician Dr. Leigh Vinocur is here to answer your questions on healthy living with cannabis.
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Editor’s Note: The answer to this question is meant to supplement, not replace, advice, diagnoses, and treatment from a healthcare provider. Always consult a medical professional when using cannabis for medicinal purposes, and do not disregard the advice of your healthcare provider because of anything you may read in this article.
Q) Can cannabis help with my migraines?
Migraine headaches are a very common debilitating neurologic syndrome affecting about 16 percent of all Americans and are three times more prevalent in women. They cause episodic, recurrent severe headaches that can be associated with nausea, vomiting, and light sensitivity. They can also start with preceding neurologic symptoms, first called an aura, which can be visual disturbances like flashing lights or even stroke-like symptoms such as muscle weakness and slurred speech. It can be so debilitating that its estimated migraines result in over 112 million bed-ridden days, causing $13 billion/year in missed work days.
Despite the precise cause and events in the brain leading to migraines still being unclear, theories suggest that migraines result from complex interactions. These involve changes in brain blood flow and the excitation of certain neurons, such as the trigeminal nerve. This neuronal activity leads to the imbalance of brain chemicals glutamate, dopamine and serotonin.
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We know that the endocannabinoid system (ECS) is a ubiquitous neuromodulating system that is activated during times of stress and has neuroprotective, anti-inflammatory, and analgesic (pain-relieving) properties. We also know that besides interacting with the cannabinoid receptors in the brain, these endocannabinoid compounds, such as anandamide and -Arachidonoylglycerol (2-AG), also influence many different brain chemicals and neurotransmitters.
Interestingly, well-known cannabis researcher and neurologist Dr. Ethan Russo describes migraines as one of the hard-to-treat medical conditions that may be due to what he was the first to theorize as a Clinical Endocannabinoid Deficiency Syndrome. In fact, some studies have found that there are lower levels of endocannabinoid anandamide in the cerebrospinal fluid that surrounds the brain in migraine sufferers, supporting the theory of a dysfunction of the ECS. Therefore, it is speculated that the use of plant cannabinoids, such as THC and CBD, could be beneficial in the treatment of migraines.
What does science say about cannabis and migraines?
A study from 2016 found almost 40 percent of patients reported a decrease in the number of monthly migraines from 10.4/month to 2.6/month while using cannabis. Additionally, 11.6 percent of participants reported that cannabis could abort their migraines when used early. Patients used both inhaled cannabis flower and edible cannabis products. Patients reported using cannabis daily for the month. They found that inhaled forms of cannabis, when used at the start of a headache, not only shortened it but also could abort the migraine. Edible forms cause more sleepiness, which was reported as a side effect.
A 2018 study hypothesized that cannabinoids can control the pain receptors affecting the trigeminal nerve that contributes to migraine pain. Another study that year published in the Journal of Headache and Pain looked at registries for chronic pain and examined patterns of cannabis use that included migraine sufferers. They found in the migraine headache group, there was a preference for cannabis products that were high THC/THCA with low CBD/CBDA and with a prevalence of the terpenes, β-caryophyllene, and β-myrcene. The reported added benefits of anti-nausea properties of THC, which can be better tolerated when inhaled versus orally ingested for nauseous patients.
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A 2020 study published in the Journal of Pain found an almost 50 percent reduction in the severity of headache score from 0 (none) to 10 (extreme) when using inhaled cannabis; that was more pronounced in men than women.
A cluster headache is another type of severe, recurring headache that is neurovascular, like a migraine. Unlike migraines that build up slowly and sometimes have a warning aura, cluster headaches occur suddenly, with severe one-sided sharp stabbing pain, often behind the eye. They are also very difficult to treat. A small observational study on cannabis use in cluster headache patients found that a little over 25 percent experienced relief.
A case report on a male patient with refractory cluster headaches, not responding to any typically prescribed medications, found that the legal FDA-approved synthetic THC (Schedule III) called dronabinol was equally effective at aborting attacks as recreational cannabis use. This may be a viable option for those patients living in states where both medical and/or recreational adult-use cannabis is still not allowed.
Additionally, the recurrent and debilitating chronic nature of migraines and cluster headaches, just like any other chronic pain conditions, can lead to anxiety and depression. A recent study found that using medical cannabis for pain treatment can also help reduce anxiety and depression associated with chronic pain and improve sleep and quality of life.
While this research is encouraging and highlights the potential benefits, we still need further, larger, high-quality studies to confirm these findings. This will help us better identify dosing and specific types of cannabis products that should be recommended. As always, it is important to speak with your physician before trying a medical cannabis regimen for your migraines.
Got cannabis questions? Ask Doctor Leigh. Send your questions to GreenState’s Editor at editor@greenstate.com and keep an eye out for new answers from Dr. Leigh Vinocur every month.
Dr. Leigh Vinocur is a board-certified emergency physician who also has a cannabis consulting practice for patients and industry. She is a member of the Society of Cannabis Clinicians and a graduate of the inaugural class, with the first Master of Science in the country in Medical Cannabis Science and Therapeutics from the University of Maryland School of Pharmacy.
The response to this question was not written or edited by GreenState. The author is solely responsible for the content.