The onset of migraines typically occurs early in life, between childhood and young adulthood, making patients who use cannabis for migraines from all walks of life.
The condition can move through four stages, though patients may not experience all of them. The prodrome phase occurs a day or two before a migraine begins and can produce one or more of the following symptoms: mood changes, food cravings, constipation, stiff neck, increased thirst and urination, and increased yawning.
The aura stage is rare and can happen right before or during a migraine. Aura refers to disturbances of the nervous system including uncontrollable jerking, audible hallucinations, visual hallucinations, difficulty speaking, vision loss, numbness or weakness on one side of the body, and tingling in an arm or leg.
The migraine attack itself can last anywhere from a few hours to multiple days. Migraines may be a rare occurrence for some, while others may experience migraines multiple times in one month. The symptoms of a migraine include throbbing head pain, sensitivity to any sensory stimuli, blurred vision, nausea and vomiting, and lightheadedness that could lead to fainting.
The post-drome phase occurrs once the migraine attack dissipates. Patients may experience joy while others may feel exhausted. This phase can last up to a day and may include the following symptoms: sensory sensitivity, confusion, weakness, moodiness, and dizziness.
Migraine Triggers and Risk Factors
Researchers continue to investigate the causes of migraines, but there is no certainty about their origins. Migraines could be a result of chemical imbalances in the brain. Though it is unclear at this point, some research suggests that an imbalance of serotonin, a neurotransmitter responsible for pain regulation, may play a role in the onset of migraine pain. When serotonin levels drop, the trigeminal nerve may respond by releasing neuropeptides, chemical signals in the brain, which travel to the meninges (the brain’s outer lining), triggering pain.
Patients are more at risk of having migraines if they have a family member with migraines or are younger than thirty. Women are more likely to get migraines. This could be a result of the hormonal changes that occur during different phases related to a woman’s reproductive health. Women who have reported a history of migraines say that they often come before or during their menstrual cycle, pregnancy, or menopause. The fluctuation of estrogen that occurs throughout these phases may contribute to migraines.
Outside of chemical imbalances and risk factors beyond a patient’s control, there seem to be an array of triggers that can lead to migraines.
For example, certain foods may trigger migraine headaches. Processed food, aged cheese, and salty foods can lead to an attack. Aspartame, a common sugar substitute, can trigger migraines as can monosodium glutamate (MSG), a savory additive common in many fast and processed foods. Alcoholic beverages, as well as highly caffeinated ones, have also been connected to the condition. Finally, skipping meals and an irregular eating cycle can lead to migraines.
Factors such as stress levels and sleep patterns can lead to migraines as well. Highly stressful situations and too little sleep or too much sleep have been shown to trigger migraines in some patients.
Non-Cannabinoid Drug Therapies
There are two categories of migraine treatment that medications will fall into: pain relief and preventative. Conventional medicines in these categories can be very helpful to most people. However, patients with severe cases of migraines may suffer from the side effects of taking these drugs for the long-term. One of the painfully ironic side effects of these medications are the onset of medication-overuse headaches, or headaches that are caused by the medication itself.
Medications that provide pain relief are meant to be consumed as soon as a migraine begins. Mild migraines can usually be treated with aspirin, ibuprofen, and acetaminophen. These medicines are not effective at treating severe migraines, and long-term use can result in gastrointestinal bleeding, ulcers, and headaches.
Triptans are a stronger type of pain relief. These medications work by constricting blood vessels and blocking signaling in the brain. Though triptans are effective at eliminating the pain, they have a side effect profile including nausea, dizziness, muscle weakness, and drowsiness. Because of their effect on blood vessels, triptans should not be taken by anyone with a high risk of heart attack or stroke.
Other forms of medication include ergots, anti-nausea medications, and opioid medications. The former two are not as effective as triptans and the opioids are extremely addictive and can easily be overdosed.
The Case for Cannabis
Though cannabis has been used to treat pain for thousands of years, medical professionals are reticent to even mention it as a therapy for migraines. However, that may soon change as studies continue to suggest that cannabis demonstrates efficacy to treat this debilitating condition.
Migraine’s May Be Symptomatic of Endocannabinoid Deficiency
Cannabis and Cannabinoid Research, the only peer-reviewed journal devoted to the study of cannabis and its derivatives, published a July 2016 report by Dr. EB Russo suggesting that treatment-resistant conditions including fibromyalgia, migraines, and irritable bowel syndrome may be symptoms of clinical endocannabinoid deficiency.
The endocannabinoid system (ECS) is comprised of endocannabinoids and cannabinoid receptors which are located throughout the body. Endocannabinoids are chemical compounds produced from within the body, namely, anandamide and 2-arachidonoylglycerol (2-AG). The importance of a healthy ECS cannot be understated as it is responsible for functions including sleep, mood regulation, metabolism, pleasure and reward systems, and the immune system. The bulk of research surrounding cannabis as medicine is centered on the relationship between cannabis and the ECS, the system which is aptly named after the plant. The cannabinoids, chemical compounds housed within the cannabis plant, interact with the ECS in ways that promote physical and mental wellness.
Russo’s article explained that the similarities between migraines and other treatment-resistant conditions suggests a problem with the patients’ ECS, specifically, a deficiency in the patients’ endocannabinoid levels. This deficiency produces a range of disorders that could be treated by cannabis consumption. In tandem with the importance of healthy lifestyle choices, Russo draws attention to studies suggesting that cannabis can decrease pain and improve sleep, among many other benefits.
In July 2017, the International Journal of Molecular Sciences published an article expanding on the relationship between migraines and the ECS. Disorders such as migraines seem to be connected to both the ECS and the kynurenine pathway. The kynurenine is the main route by which the amino acid tryptophan catabolizes in the liver. Tryptophan is a precursor to the biosynthesis of many neurological compounds including serotine and melatonin. There is some evidence that there may be a relationship between the ECS and the kynurenine pathway, and the significance of that relationship could provide additional explanation and incentive for the use of cannabinoids to treat migraines.
In extreme cases, migraine headaches do not respond to conventional medications, a maddening experience for patients. The aforementioned studies suggest that the reason for this unresponsiveness is because treating the migraine alone is not enough. Effective therapy for these patients requires the treatment of their ECS’ deficiency, and that can be done with cannabinoids.
Cannabis Decreases the Frequency of Migraine Headaches
A May 2016 study published by Pharmacotherapy found that the use of medical cannabis decreased the frequency of migraine headaches in adults. The study included 121 adults who had been diagnosed with migraine headaches and whose doctors recommended cannabis to treat the condition preventatively and/or upon onset of the headache. The study’s primary outcome was to determine the number of migraines per month during cannabis treatment. Its secondary outcomes included the dose and type of cannabis consumed, former and current migraine therapies, and the effects as reported by the patients.
The study’s results demonstrated that migraine headaches decreased from 10.4 to 4.6 migraines per month, a decrease of almost 56 percent. The majority of patients used multiple forms of cannabis every day with the intention of preventing a headache from occurring. Patients typically inhaled cannabis to treat acute migraines, and most reported that this intake method eliminated the headache completely. Two negative outcomes were reported, and they won’t come as a surprise to anyone who has ever consumed cannabis: two of the study’s patients reported feeling sleepy, and two of the patients said that they had a hard time managing the effects of cannabis when consumed as an edible.
The study did not determine if the decrease of migraine headaches was due to a cause-and-effect relationship; it merely reported observations. However, it did recommend that future studies examine this possibility as well as the effects of different strains, doses, and types of cannabis on migraines.
Cannabis is Superior to Prescription Medications for Migraines
At the 3rd Congress of the European Academy of Neurology held in Amsterdam in late June 2017, researchers presented the findings that cannabis is more effective at treating migraines than the prescription medications conventionally administered to patients. The study included 127 patients who lived with cluster headaches and migraines. The therapy administered to the patients was a cannabis derivative made of THC and CBD.
The study was broken up into two phases. In the first phase, chronic, acute migraine patients were given one 200 mg dose daily for three months. Those patients experienced a 55 percent reduction in pain. In the second phase, migraine patients were either given the cannabinoid medication or an antidepressant. Cluster headache patients were either given the cannabinoid medication or a calcium channel blocker. In both cases, the cannabinoid was slightly more effective at treating the patients’ pain.
The side effect profile is perhaps the most exciting incentive for the consideration of cannabis as treatment over more conventional therapies. Those who took prescription medicines experienced more gastrointestinal pain. The side effects experienced by the cannabinoid patients included some tiredness and difficulty concentrating.
Patients Use Cannabis to Self-medicate Cluster Headaches
In September 2017, Harm Reduction published a study unlike the ones already reviewed but still pertinent to this discussion. The purpose of the study was to provide increased information on the use of alternative treatments of migraines and cluster headaches in patients who are desperate for relief. The information for the study was gathered from online forums from shroomery.org, blughlight.org, and clusterbusters.org.
The study concluded that patients consider the use of illicit psychoactive substances including LSD, psychedelic mushrooms, and cannabis as a last-ditch effort to alleviate their debilitating pain. These patients were not interested in the psychoactive effects, and the forum discussions were centered on methods that maximize treatment while minimizing potential adverse reactions.
The implication of this study is that patients who are desperate for treatment will do whatever they need to do for relief, even if that requires engaging in illegal and dangerous behavior. Cannabis does not have to be considered a dangerous behavior, but it is still an “illicit substance.” It is medically available in 29 states, and study after study show its medical efficacy. Despite this, it remains federally illegal, branded as contraband because of its Schedule I designation. Until cannabis is legal at the federal level, research will come slowly and at a much smaller scale than what is required to provide the medical community with the most accurate information. This puts patients in unnecessary danger since black market cannabis is untested and far more likely to contain mold and dangerous pesticides than regulated cannabis.
A Healthy Lifestyle
Though the exact causes of migraine headaches are still misunderstood, medical research has made it clear that there are certain lifestyle choices patients can make that, at the very least, will not exacerbate symptoms. They also happen to be the lifestyle choices that most people have been urged to make throughout their lives: get enough but not too much sleep, include a daily dose of exercise, drink enough water, and follow a healthy diet.
The argument that cannabis consumption promotes wellness—that it makes one’s lifestyle healthier—has strengthened as more evidence emerges delineating the plant’s medicinal attributes and as intake methods other than smoking become more popular. Once a plant diseased by stereotypes and stigma, cannabis is slowly blooming into mainstream culture, and the beauty it offers the sick is undeniable.