Can the use of Cannabis Combat Migraines?

                                                                        

     Migraine headaches syndrome currently affect about 28 million Americans and over a billion people worldwide. As with most disease processes, there are multiple forms and characteristics of the various migraine types (i.e. aura migraine, hemiplegic, abdominal, retinal, etc.…) These all have common features, and usually include severe and debilitating symptoms. These include disturbed vision, light sensitivity, sensitivity to smells and sounds, nausea, vomiting and head pain. Other adverse symptoms are also possible, and they can last between 4 and 72 hours. Hospitalizations are sometimes required and IV drug cocktails may be necessary in order to ameliorate symptoms and provide relief for the patient.

 

     Migraine sufferers have a host of issues and problems than go beyond just a routine headache, and current drugs and medications may prove ineffective or have limited effect to resolve migraine symptoms in spite of persistent and skilled medical care.

 

     It should be noted at the outset, that the classification of cannabis as a controlled schedule one substance has greatly restricted large scale research investigations. Large scale randomized, controlled studies are needed to prove clinical observations and initial findings. As a result, studies and results for cannabis-based migraine treatment is limited to a number of smaller anecdotal reports, case studies, surveys and individual reports. However, due to the nature of this disease, cannabis may prove to be a valuable tool in treating migraines. The psychoactive and cerebral effects of cannabis are quite well known, as well as the vasodilator effect and alteration of neurotransmitter regulation, glutamate signaling, and serotonin metabolism. Cannabis is known to increase heart rate, increase blood pressure initially, and cause systemic vasodilation. However, at this point most research is not from controlled clinical studies, so there is no definitive answer if cannabis can combat migraines directly, but we can investigate further…

 

     Historically, when cannabis was introduced in western culture in 1839, this began a decade of use for headache disorders which ended with its illegalization in 1937. Cannabis was one of the most commonly prescribed remedies during this period, and used for headaches, stomach issues, menstrual pain, cramps, and pain, etc.…

Early reports of cannabis for the treatment of headaches and migraines appear to be quite positive, with many patients experiencing a decrease in the frequency and intensity of their migraine episodes. Cannabis has a huge margin of safety, and also effectively combats the nausea and anxiety associated with migraines. Interestingly those cannabis users who refrain from use have about 25% increase in headaches.

 

 

     In looking at cannabinoids, it is possible that several may play a role in migraine mediation, but it has been shown that THC plays a major role in pain reduction, and decrease in nausea and vomiting. The exact cause of migraines is unclear, but it is thought it is a result of blood vessel constriction or an issue related to serotonin metabolism. Other researchers and clinicians feel that perhaps the migraines are caused by an endocannabinoid deficiency, called the endocannabinoid deficiency syndrome or EDS. This condition – EDS - arises when your body is unable to produce or maintain sufficient levels of endocannabinoids (Anandamide or AEA) to regulate your homeostasis and provide regular function of your major bodily systems. In fact, some studies demonstrate that levels of Anandamide are decreased in cerebrospinal fluid of individuals with chronic migraine, and that female migraineurs have increased levels of FAAH which is an enzyme that breaks down Anandamide.

 

     One recent study in Colorado involved 121 patients, and had the following results:

 

     *Around 40 percent of the 121 participants reported positive effects.

     *A decrease in the number of migraines, which fell from 10.4 to 4.6 per month.

     *On average, 19.8 percent of participants said that medical cannabis helped prevent their chronic headaches.

     *Around 11.6 percent of patients said weed stopped their migraines altogether.

     *Approximately 85 percent of participants reported medical marijuana helped them have fewer migraines each month.

 

     Another recent study conducted by The Journal of Neuroscience indicated that: “This study made two significant advances: it confirmed the role of the endogenous marijuana neurotransmitter system as a potential target for treating migraines, and their results suggest that triptan drugs may produce their migraine relief by activating the brain’s own endogenous marijuana-like chemicals.  This study may lead to the development of more effective migraine prevention and treatment.   The challenge will be to find a dose of marijuana that produces pain relief without disturbing normal cognitive function.”

 

     It has been demonstrated and reported anecdotally that inhaled or vaporized cannabis high in THC may help to prevent or minimize a migraine if used during the Aura (or prodromal period) when the attack is first starting. However, it is possible that higher doses may be required than the patient can tolerate to achieve results. Cognitive deficits and unwanted side effects may occur.

The concurrent use of CBD may allow higher doses of THC to be administered with less unwanted adverse effects.

Sativa strains administered by vaporizer at the onset of an attack may mitigate or reduce symptoms, while it is also possible that a daily regimen of THC:CBD 5:1 ratio can be used daily for prevention or prophylaxis against migraines. Specific products and dosages can be ascertained thru simple trial and error for each individual patient.

 

     It is possible that cannabinoids will be used for migraines in the future after more knowledge is obtained and studies are performed. Their use with other drugs currently being used is highly likely in order to potentiate current pharmaceuticals. Perhaps another cannabinoid such as CBC, CBD or CBN will play a role. Until more clinical research can be performed, clinicians prescribing cannabis for migraines should be prepared for a variety of issues. Results may be mixed or hard to quantify, but it appears likely that cannabis will emerge as a potential treatment for some migraine sufferers. The anecdotal evidence is clear that many can benefit using cannabis who have this syndrome, but experimentation and close follow up is required for these patients to achieve a possible benefit.

 

Dr. Stanley R Manstof

Marylandcannabisconsultants.org