Cannabis is probably the most satisfactory remedy for migraine.
—Sir William Osler, MD, one of the founding professors of Johns Hopkins Medical School and revered by today’s medical community (1849–1914; this statement from the late 1890s)
Migraines are the most common presentation of what are known as vascular headaches, a category that also includes cluster headaches. They are thought by most authorities to occur as a result of a spasm (constricting/narrowing) in the arteries at the base of the brain, triggering the visual “aura,” followed by rather sudden relaxation and dilation of the same arteries that trigger the phase of throbbing pain. Blood flow to the brain during the early vasoconstrictive phase of a migraine episode is severely compromised, so much so that ministroke-like effects are occasionally seen as a residual.
The Migraine Research Foundation reports that 18 percent of American women suffer from migraines and 6 percent of men, approximately 38 million people. Though more difficult to diagnose because the presenting symptoms are more obscure, migraine does also occur in children.
The classic migraine headache is one-sided and is frequently heralded by the onset of an aura of visual disturbances consisting of bright spots, zigzag lines, blind spots, or temporary loss of part of the visual field on the side involved. The pain is often severe and incapacitating. Untreated, the throbbing or pounding pain can last for hours or days and is often severe enough to also induce nausea and vomiting. It is often accompanied by excruciating sensitivity to light that forces the sufferer to seek shelter in a darkened room. Typical age of onset is before age thirty-five. The symptoms in children tend to be nonspecific, with nausea, malaise, vertigo, and abdominal pain being more common than the headache itself. Migraine episodes recede with advancing age, and postmenopausal women have a much lower incidence.
In a study done at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California, San Diego, researchers found inhaled and ingested cannabis to decrease symptoms of migraine. The study’s sample was 121 adults, of which 40 percent reported positive effects following the consuming of cannabis. Additionally, about 85 percent of participants reported having fewer migraines per month with cannabis. Participants found that inhaled cannabis reduced migraine symptoms faster than ingested cannabis.
Cannabis in tinctures was the most effective treatment for migraine in the U.S. through the latter half of the nineteenth and the early twentieth centuries, until marijuana was declared illegal in 1937.
Smoking or preferably vaporizing high-sativa flower strains or high-THC hash oil is typically recommended for treating migraine headaches. Timing is critical, and MMJ should be inhaled as soon as the aura of an impending migraine headache begins or within twenty minutes of the onset of the aura (or the earliest symptom that lets you know a migraine is imminent). The majority of migraine sufferers report that a “full-blown” migraine typically occurs within twenty to forty minutes of the beginning of the aura. As soon as you’re certain that a migraine is on its way (whatever the symptom is), that’s the best time to vaporize.
At the present time smoking and vaporizing are the most dependable delivery methods that work quickly enough to knock out the migraine before the pain becomes intolerable. However, since smoke is a possible trigger for migraine headaches, vaporizers are preferred over smoking. Although sativa strains typically contain higher amounts of THC, when they’re used for treating a migraine the psychoactive effect of the THC is not nearly as evident as if the same strain were used without a migraine.
I’ve also heard from a few patients with migraine headaches that if they are unable to vaporize flower during the initial window between the early warning and the onset of pain, and they’re left with intractable disabling pain, dabbing concentrates can relieve it. Once a migraine begins, this seems to be the only method of delivering marijuana capable of significantly reducing the pain.
As mentioned in Chapter 3, THC is a central vasodilator, which means that it dilates arteries to the brain, heart, and kidneys. This effect makes THC the ideal antidote for the vasoconstriction of the arteries to the brain that causes the aura. We can only speculate, but it makes good physiologic sense, that if THC relieves the constriction of these arteries to the brain, then they most likely will return to their normal size and are not dilated from the THC, as they would have been had an aura not been occurring. This is probably the reason that you don’t get as high from a sativa if you’ve used it to treat a migraine.
Perhaps the most effective strain for quickly preventing a migraine, if used at the appropriate time, is Durban Poison, a 70:30/sativa:indica. However, since stress/anxiety is the primary trigger for migraine headaches, and THC can potentially increase anxiety, I would also try using a 50:50 hybrid or a 60:40 sativa-dominant hybrid, and see if that works. Many patients report that these hybrids are often just as effective for treating migraines as the stronger sativas.
It’s also important to note that nearly all of my migraine patients have been able to stop taking their prescription medication, which is most often Imitrex (sumatriptan), after they begin using MMJ. And they’re very happy to do so, since Imitrex may cause several unpleasant side effects, such as dizziness, nausea, vomiting, and drowsiness. As with many of the pharmaceuticals, it relieves the pain but may render you unable to function normally.
Other MMJ options for treating migraines:
• Apothecanna Extra Strength or Mary’s Medicinals THC-sativa cream—a localized topical; effective if applied during the window between the aura and the onset of the headache, to both temples and forehead between the eyebrows. It should begin to have an effect within five minutes.
• Sativa tinctures—can potentially minimize the headache if they start working within thirty minutes from the beginning of the aura. Most tinctures take at least thirty, and often forty-five, minutes to begin working. This means you should have the tincture with you at all times, so you can take it immediately with the onset of the aura. Tinctures seem to work more quickly with an empty stomach, in addition to holding them under your tongue for ten to fifteen minutes, or even longer.
• Sativa MED-a-mints sublingual tablets—relatively new and haven’t been tested enough to recommend with certainty, but they do have the potential to begin working within twenty to twenty-five minutes if you adhere to the suggestions above for tinctures.
I’ve seen many migraine patients who report that their daily (or almost daily) use of MMJ has considerably reduced both the frequency and intensity of their headaches. If MMJ is used daily as a preventative measure, your primary objective is to reduce anxiety and stress.
MMJ recommendations for preventing migraines:
• Avoid sativa-dominant strains of flower and vaporize (no smoking) only 50:50 hybrids or indica-dominant hybrids.
• Use indica or high-CBD tinctures and edibles.
• Use CBD-only capsules.
Migraines can be caused or triggered by:
• Genetic predisposition—positive family history, in about one-half of people who experience migraines. There is considerable evidence that migraine-prone persons have low baseline levels of serotonin.
• Food sensitivities—see Headache Relief Diet below. Approximately one-half of all migraineurs (migraine sufferers) have a sensitivity/allergy to a food or beverage that triggers a headache.
• Histamine-containing and -releasing foods
• Chemicals (nitrates, monosodium glutamate [MSG], nitroglycerin, aspartame)
• Blood levels of magnesium well below levels in healthy people (predisposes to greater arterial constriction)
• Withdrawal from caffeine (caffeine constricts arteries)
• Smoke
• Sleep problems (too little or too much)
• Fatigue and exhaustion
• Weather changes, barometric changes, sun exposure
• Sun glare (off snow and water) and eyestrain
• Rebound from withdrawal of analgesic or vasodilating drugs
• Stress. A classic story is the onset of the headache in the let-down period immediately after an acutely stressful episode has passed. Numerous papers have described the precipitation of headache in migraine sufferers by submission to a stressful interview in which the patient has little control.
• Emotional changes and intense emotional experience. Anxiety and depression are strongly related to vascular headaches of both cluster and migraine varieties. Astute observers and researchers of migraine think there is a strong association with intense organized activity to attempt to manage feelings of anxiety, which drives the sympathetic nervous system to extremely high activity.
• Hormonal changes—menstruation, ovulation, oral contraceptives. Migraines are more common before and during a menstrual period and in women who take oral contraceptives. They are less common in pregnancy and in postmenopausal women. In migraine-prone pregnant women, headaches are much more common if pre-eclampsia is present; both conditions are related to lower levels of magnesium and are also often related to subnormal levels of progesterone.
• Chronic candidiasis—there is a higher percentage of migraine patients with high positive candida antigen or antibody titers than in a normal population. A majority of these migraineurs enjoy marked improvement or cessation of migraines when the yeast infection is treated.
I. Foods High in Tyramine (an amino acid that can trigger migraines)
• Ripened cheeses
Blue, Boursault, brick (natural), Brie, Camembert, cheddar, Emmentaler, Gruyère, mozzarella, Parmesan, Romano, Roquefort, Stilton; permissible cheeses are: American, Velveeta, cottage cheese, and cream cheese
• Aged meat and fish
Liver, caviar, pickled herring, fermented sausage (bologna, pepperoni, salami, summer sausage), and processed meats (hot dogs and ham)
• Alcoholic beverages
Red wine (chianti in particular), beer, sherry
• Vegetables
Sauerkraut, pods of broad beans (string, lima, pinto, garbanzo, and navy beans; and peas)
• Fruits
Avocados (especially if overripe—i.e., guacamole), bananas (especially if overripe), figs (especially canned), citrus fruit (no more than one serving per day: one orange or grapefruit, or one glass of orange juice), papayas, raisins
• Any fermented, pickled, or marinated food
Vinegar (especially red wine vinegar), yogurt, sour cream, buttermilk, soy, yeast extracts, brewer’s yeast, and sourdough bread
II. Foods That Dilate the Blood Vessels and Therefore Can Precipitate a Vascular Headache
• All alcoholic beverages
If you must drink, the following are recommended: Seagram’s V.O., Cutty Sark, Haute Sauterne Riesling, vodka (these are all low in tyramine).
• Monosodium glutamate (MSG)
May be identified on food labels as hydrolyzed vegetable protein, natural flavoring, or seasoning. Found in Chinese foods, canned soups, frozen dinners, Accent, Lawry’s Seasoning Salt, Hamburger Helper, etc. Check labels of all canned and packaged foods, as well as chips and other snack foods, many of which contain MSG.
• NutraSweet (aspartame) and AminoSweet
• Nitrites
Hot dogs, turkey dogs, chicken dogs, bacon
• Excessive amounts of niacin (niacinamide is fine) and vitamin A (over 25,000 IU daily)
III. Other Foods That Can Cause Headaches
• Cow’s milk, gluten grains (wheat, rye, barley, and spelt), corn, oranges, eggs, beef, yeast, chocolate, cane sugar, mushrooms, nuts, and seeds (sunflower, sesame, pumpkin)
• Caffeine, from coffee, cola drinks, and nonherbal teas (no more than two cups per day); and some aspirin medications, such as Anacin, Excedrin, and Vanquish—check the labels.
• Raw garlic and onions (cooked are fine)
• Hot fresh breads, raised coffee cakes, and raised doughnuts
IV. Eat Regularly, Don’t Skip Meals
This may result in hypoglycemia, which is another headache trigger.
Nutritional recommendations for prevention of migraine include decreasing fats from land animals and increasing foods that inhibit platelet aggregation (stickiness), including vegetable oils, onion, garlic, and fish oils. I recommend the Fully Alive Diet (see Chapter 5).
• Food elimination: In a number of studies of foods and migraine, a majority of migraine sufferers improved on elimination diets. This means eliminating all suspected food allergens and then challenging your system by adding one food back in at a time, waiting two to four days, and noting if you get a headache. This is an accurate way to determine specific food offenders that you should now avoid.
• Vitamins, minerals, and supplements:
1. Since magnesium-deficient people are more subject to migraine headache, adequate intake (400 to 600 mg/day) from food or supplements is essential. I recommend a powder that combines magnesium-L-threonate with magnesium glycinate for best effect. Both of these types of magnesium are very well absorbed, easily tolerated by the gut, and have been shown to reduce the frequency of migraines. The powder is called OptiMag Neuro from Xymogen. Take two scoops in water in the evening or before bed. This can be extremely effective.
Intravenous injection of one to two grams of magnesium by your physician can terminate an acute migraine headache within minutes—in up to nearly 100 percent of subjects in some reviews. Intravenous injection of folic acid, 15 mg, in one study achieved total subsidence of acute headache within one hour in 60 percent, with great improvement in another 30 percent. These two agents are strikingly successful.
2. Omega-3 oils (EPA and DHA, average dose 1,400 mg daily) greatly reduce intensity and frequency of migraines. I recommend OmegaGenics EPA-DHA 720 (Metagenics): one capsule two to three times a day.
3. Vitamin B2 (riboflavin) 400 mg daily for three months has been shown to reduce migraine frequency by two-thirds.
4. Vitamin C (2,000 mg/day)
5. Vitamin E (400 to 600 IU/day)
6. Vitamin B6 (100 mg/day)
7. Choline (100 to 300 mg/day); all of these vitamins plus choline reduce the tendency toward high platelets in migraine.
8. 5-hydroxytryptophan (5-HTP) (300 mg two times a day) works well for prevention of migraine, enhanced by taking with 25 mg of vitamin B6. This works by increasing serotonin, which is usually low in migraine sufferers. Do not take this if you are currently taking Imitrex.
• Herbs
1. Butterbur extract, 75 mg daily of a pyrrolizidine alkaloids–free (PA-free) extract. This can be used preventively. For the past three years I have been recommending to my migraine patients a supplement called Butterbur Extra (see Resources), which in addition to butterbur, contains magnesium, vitamin B2, and feverfew. For the vast majority of the patients who have taken it on a daily basis, it has been highly effective for reducing both the frequency and intensity of migraine.
2. Feverfew (Tanacetum parthenium), 0.25 to 0.5 parthenolide content daily, has markedly helpful effects in migraine.
3. Dried ginger, 500 mg four times daily, and pueraria root also provide substantial benefit with reduction in frequency and intensity of migraine occurrences.
• Hormones: Natural progesterone. Some women can be prone to migraines pre-period, and can experience great relief by using natural progesterone during the last two weeks of their menstrual cycle. This should be done under supervision of a holistic physician.
Brisk walking, jogging, sports activities, gardening, low-impact aerobics, and water aerobics are among the options for appropriate regular aerobic exercise that both releases tension from the system and reduces the frequency and intensity of migraine episodes.
Acupuncture in skilled hands can be very effective in treating migraine headache. In one study 40 percent of patients achieved a 50 to 100 percent reduction in severity and frequency of migraine episodes during treatment with acupuncture. Among the points that can also be conveniently used for acupressure are the following:
• The Hoku point in the soft tissue between the thumb and index finger
• The B2 point below the inner aspect of the eyebrow
• The GB20 and GV16 points over the spine and on both sides of the spine just below the back of the skull
Since 2011, I have seen more than six hundred patients who are using MMJ to treat and prevent their migraine headaches. The vast majority have been successful in significantly reducing the pain and frequency of their headaches. However, what I find most remarkable is the personality trait that nearly every one of them shares. People with migraine are very hard on themselves, and many will acknowledge, “You’re not the first person who’s told me that.” They tend to be perfectionists and hold themselves to a very high standard of performance, and it doesn’t seem to matter what the activity is that they’re engaged in. They could be cleaning their own house, working as a senior executive, performing as a professional athlete—and it’s not a boss, teacher, spouse, or parent telling them what to do. They do not have to meet someone else’s expectations. Their pressure is self-imposed. This mind-body connection is fascinating, and most migraine patients are shocked at how well I seem to know them, in spite of the fact that we’re meeting for the first time.
I’ve also learned from a medical intuitive that people with migraines have this belief: I am not smart enough. This belief might be the source of their perfectionism.
The most emotionally healing recommendation for migraine patients is the daily practice of self-compassion. Many people with migraine feel trapped by their circumstances and the gulf between the way life is and the way it should be. Releasing the demands (the “shoulds”) with a strong dose of forgiveness can lead to rewarding and sometimes dramatic changes. To practice self-forgiveness on a regular basis, I suggest the affirmation I’m always doing the best I can, and its corollary There are no mistakes, only lessons.
Learning and regularly practicing biofeedback or any of the systematic relaxation approaches achieves a 50 to 80 percent reduction or elimination in both severity and frequency of migraine headache. You can achieve the same results by learning and practicing regular meditation, which will help you eliminate or reduce your need for medication. Hypnosis too has significant success with migraine. Self-hypnosis has been shown to be particularly helpful in children and teenagers.
Jason P. is a forty-two-year-old IT manager who has been getting migraines since the age of five. Prior to moving to Colorado, he lived in Texas where he was prescribed a number of medications (including Imitrex), none of which was effective. Over-the-counter ibuprofen worked best but still didn’t prevent him from being temporarily incapacitated while he was working. He’d have to turn off the lights in his office and lie down on the floor for an hour or more before resuming work in a somewhat compromised state, still dealing with the headache.
I first saw him shortly after he moved to Colorado, and I recommended MMJ. At that time the migraines were occurring at least once a week, always triggered by stress. He did not have auras; his first warning of an impending migraine was a tension headache that usually began in the back of his neck at the base of his skull. I instructed him to vaporize a sativa as soon as possible after the tension headache began, and this proved highly effective for preventing the onset of the migraine.
I recently saw Jason for his fourth annual renewal of his MMJ license. The migraines are no longer a significant problem for him. They occur approximately once a month, but are never incapacitating. He’s able to prevent them by vaporizing a sativa, usually Durban Poison (a 70:30/S:I strain), as soon as he feels the headache starting.
On this last office visit, Jason mentioned a significant change he’s made. He now vaporizes an indica on a daily basis after work. This not only helps him relax, but also the mild psychoactive effect has given him more clarity on how self-critical he is (he was raised by a highly critical mother), and “it helps me to not be so hard on myself.” He frequently repeats (to himself) the affirmation I’m always doing the best I can, and overall he believes this is helping him also to be a better and more forgiving parent for his three young children.
• • •
Debbie P. is a thirty-three-year-old chemist working for a pharmaceutical company and is currently engaged in developing an anticancer drug. She’s been plagued with migraine headaches since age fifteen, and until she began using MMJ, about four years ago, she’d been taking Imitrex (Sumatriptan) to relieve the migraines.
At that time, her headaches occurred two to three times a week, usually late afternoon, toward the end of her workday, and almost never on the weekends. They were incapacitating. She would have to leave work immediately and take an Imitrex. The drug made her too drowsy and the pain was too debilitating to continue working.
After her first visit in 2012, I suggested Debbie take Butterbur Extra on a daily basis, which she did for about six months. This reduced both the frequency and intensity of the headaches. At the same time I also recommended that she repeat the affirmation I’m always doing the best I can, whenever she heard her inner critic questioning a decision or telling her she’d made a mistake. In addition, during this time frame, she often vaporized an indica to relax after work.
At the present time, she’s getting migraines once or twice a month and treats them with either vaporizing a sativa strain (60:40 or 70:30/S:I) or, when that’s not possible, applying the topical Apothecanna Extra Strength, which she always keeps in her purse, to her temples. Sometimes she will use both methods. The topical is not as effective as vaporizing the sativa, but it does relieve the pain, and now she rarely has an incapacitating headache requiring her to leave work early.
She acknowledges that although she sometimes falls back on old behaviors, she’s not nearly as hard on herself as she used to be, and finds it easier to relax. Her headaches are vastly improved and she hasn’t taken an Imitrex in more than three years.