Migraine Headaches

Migraine headaches are quite common, affecting 12% of the worldwide population. Migraine headaches usually start in response to a specific trigger. Typically there is mild pain that escalates to severe pain, characterized by throbbing or pulsing headache, often affecting one side of the head. Associated symptoms include nausea, vomiting and sensitivity to light and/or sound. Migraine sufferers may feel sensory warning symptoms, called an aura, prior to onset of the headaches. Migraines seem to run in families. The mainstay of treatment is a group of drugs called “triptans” which work by blocking the release of proinflammatory compounds in the brain. They are fairly effective for aborting or lessening severity of migraine headaches. Unfortunately, side effects can be significant and can include rebound headaches, pain or chest tightness, dizziness, nausea, vomiting, or warmth, redness, or tingling under the skin. Triptans are also costly and many insurance companies restrict the amount of these medications that can be dispensed to patients. Another group of medicines called ergot alkaloids are also prescribed for migraines, but they are less effective than triptans.

Unfortunately, little research exists that proves the mechanism by which cannabinoids alleviate migraines, despite the overwhelming anecdotal reports from patients suffering with them. Recent studies show that migraine headaches may be due to endocannabinoid deficiency and abnormal inflammatory response. Remember that the endocannabinoid system exists to maintain cellular homeostasis. Often migraine sufferers report that headaches begin in response to a trigger, such as bright light, hunger, hormones, or certain smells or foods. The trigger event causes an imbalance in the brain, which should then trigger the production of endocannabinoids to maintain homeostasis. If one is deficient in endocannabinoids, the imbalance continues, leading to development of the migraine headache. The trigger may also cause inflammation, which may become out of control and contribute to the resulting pain.

The few studies that have looked at the link between migraines and the ECS are summarized here:

• Endocannabinoids and synthetic cannabinoids inhibited receptors that control vomiting and pain, working to block these symptoms.¹
• THC reduces serotonin release (which blocks vomiting and pain) from the platelets of human migraine sufferers.²
• Cannabinoids were found to bind to areas of the periaqueductal gray matter (an area of the brain that modulates pain transmission), which have been implicated in migraine generation.³
• Three cases were reported of chronic heavy users of cannabis developing severe migraine attacks after abrupt cessation of use. The authors suggested that these rebound attacks are similar to the rebound headaches experienced by migraine patients when they abruptly stop other migraine treatment.⁴
• Genes that allow for increased inflammation were found in migraine patients and not found in control subjects.⁵
• Endocannabinoid levels were decreased in patients with chronic migraine and medication-over-use headaches suggesting that endocannabinoid dysfunction is involved in these two chronic conditions.⁶

Cannabis has been used for thousands of years to treat headaches. Medical cannabis patients are finding relief of pain, less nausea and better sleep. Patients also report less frequency and less severity of their migraine headaches with medical cannabis use. A number of well-known trigger factors for migraine headaches, specifically sleep deprivation and anxiety or stress, are alleviated with cannabis, thereby reducing the number of migraine attacks. Patients also report that they spend less on expensive migraine medications, have less missed days at school or at work and have overall improved quality of life.

There is no question that THC-rich cannabis can help abort or lessen the severity of a migraine, especially if taken at the onset of the pain. Some patients report that low-dose, regular use of THC-rich medicine significantly reduces the frequency and severity of the headaches. Other patients report that daily CBD-rich cannabis prevents migraine from occurring. Once the headache begins, a rapid delivery method such as inhalation or sublingual tincture is preferred by most. Specific chemovar choice results from trial and error for most patients.

Sources

[←1]

^{Burstein, R., et al. “EHMTI-0354. Abnormal expression of gene transcripts linked to inflammatory response in the periosteum of chronic migraine patients: implications to extracranial origin of headache.” The journal of headache and pain 15.1 (2014): 1-1.}

[←2]

^{Rossi, Cristiana, et al. “Endocannabinoids in platelets of chronic migraine patients and medication-overuse headache patients: relation with serotonin levels.” European journal of clinical pharmacology 64.1 (2008): 1-8.}

[←3]

^{Lichtman, A., et al. Investigation of Brain Sites Mediating Cannabinoid-induce Antinociception inRats: Evidence SupportingPeriaquaductal Gray Involvement. Journal of Pharmacology and Experminetal Therapeutics (1996) 276:585-93}

[←4]

^{El-Mallakh, R. Marijuana and Migraine. Headache (1987) 27:442-43}

[←5]

^{Burstein, R., et al.}

[←6]

^{Rossi, Cristiana, et al.}