Migraine Sufferers Say Cannabis Brings More Relief Than Standard Treatments, According To Recent Study
Migraine headaches are a fairly common condition, but for those who suffer from them, they can make life extremely difficult. With symptoms like throbbing headaches, nausea and vomiting, sensitivity to sound and light, and even changes to vision like flashes of light or blind spots, when a migraine hits it can be difficult to engage with everyday life. In fact, migraines are so debilitating they are the second leading cause of disability for those younger than 50.
Unfortunately, migraines can also be difficult to treat. While multiple prescription medications exist for migraines, they aren’t always effective for many of the migraine sufferers who try them. This has left many looking for alternative treatments for migraines.
But a new study may give migraine sufferers a reason to hope that cannabis could be a helpful alternative for treating these intense headaches. According to the study’s results, migraine sufferers who have used both cannabis and prescription treatments for their migraines say that cannabis works better at bringing on relief.
This study, from the University of Colorado, Boulder, was designed to investigate how migraine sufferers use cannabis and whether they find relief when they do. To do this, researchers recruited 589 adult cannabis users who were living in states with full legal access to both medical and recreational cannabis. These participants completed an online survey that included questions about their cannabis use, their migraine experiences, and their experiences treating migraines using both cannabis and other medications. They even rated different treatments in terms of how much relief they brought from the migraine symptoms.
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From these cannabis using participants, 161 (or 27.3%) reported that they did experience migraines. And of those who had migraines, 123 (or 76.4%) said that they use cannabis specifically for treating their migraines. And 86 of these participants (or 69.9%) also said that they used other medications for their migraines.
Interestingly, migraine sufferers reported significantly more migraine relief from cannabis than from non-cannabis treatments – such as prescription migraine medications like triptans. The average reported relief with cannabis was 75.82% while non-cannabis products were only reported to bring an average improvement of 51.01%. Even looking at just the scores from those who used both types of treatments – cannabis was rated as a much more effective treatment.
There are many different types of cannabis products available in states with recreational or medical . [+] cannabis.
NurPhoto via Getty Images
Details on the type of cannabis used, how it was used, and factors like dosing and frequency should also be considered for future studies. This study only asked about cannabis use in general in terms of its effect on migraines, but cannabis contains a large amount of variety. The plant species has many different strains, which contain different blends of active chemicals that can lead to varied effects. And then there are many different types of cannabis products (such as raw flower, cannabis topicals, concentrated oils, or edibles). There can be big differences in effects depending on how the plant is used. Tracking these factors could also offer a more nuanced picture of cannabis’ effects.
While more detailed surveys, or preferably double blind clinical trials, could bring us more reliable data on these questions, this study does provide some insight into how people are treating migraines with cannabis. And the results are extremely hopeful for those who haven’t found relief from standard migraine treatments. Hopefully in the future, clinical trials will help fill in some of the blanks, and give migraine sufferers clear parameters for how to treat migraines with cannabis.
Review Explores the Current Role of Medical Cannabis in Migraine Treatment
Results of a literature review published in Cureus revealed medical cannabis use was associated with a decrease in the duration and frequency of migraines and headaches of unknown origin.
Moreover, migraineurs and patients suffering from related conditions may benefit from medical cannabis therapy due to its convenience and efficacy, authors wrote.
“Cannabis has been used since ancient times to manage various conditions, including acute pain, anxiety, cancer pain, chronic pain, depression, headaches, and migraines,” they added. It is thought that the cannabinoid system mitigates migraine though the glutamine, inflammatory, opiate, and serotonin pathways—both peripherally and centrally—while cannabinoids have also demonstrated dopamine-blocking and anti-inflammatory effects.
Despite these findings, updated research is lacking within the United States, due in part to few randomized controlled studies. To address this knowledge gap and document the validity of how medical cannabis can be utilized as an alternative therapy for migraine management, researchers analyzed 34 articles from PubMed and Google Scholar.
All studies included in the review were published between 1987 and 2020, and investigated outcomes among adults aged 18 and older.
Among the investigations that explored the benefits and efficacy of medical cannabis use, one prospective clinical trial published in 2020 focused on 68 migraineurs who smoked or vaped medical cannabis inflorescences. These individuals “reported better migraine symptom reduction, less negative headache impact, better sleep quality, and decreased medication consumption,” the authors explained.
Additional surveys, retrospective studies, and literature reviews yielded mixed findings regarding the effectiveness of medical cannabis on headaches and migraines. However, “there is a consensus for the indication of medical marijuana therapy when first and second-line treatment fails,” they noted.
Adverse reactions to the treatment reported in studies included dizziness, dry mouth or eyes, nausea, vomiting, and psychosis.
When it comes to the form medical cannabis takes, one cross-sectional survey found the primary use was via smoking, followed by vaporization and dabs. In addition, “the dried cannabis flower may be an effective medication for the treatment of migraine- and headache-related pain, but the effectiveness differs according to characteristics of the cannabis plant, the combustion methods, and the age and gender of the patient,” the authors said.
Another survey showed males preferred smoking and vaporizing medical cannabis more while females ranked edible, tincture (oil-based), and topical cannabis as preferred first-line methods.
The current review concluded that finding an ideal dose of a medical cannabis product can be difficult due to the treatment’s variation among users. “Some studies have shown that tetrahydrocannabinol (THC) + cannabidiol (CBD) had a good outcome when used as prophylactic or when given in acute attack,” the researchers said. However, more controlled studies are needed to better understand the route and dose of THC/CBD for migraineurs.
The number of studies included in this review and the lack of standardization mark limitations. However, results do indicate the use of medical cannabis can be expected to increase as more and more states legalize the substance.
Overall, both long- and short-term effects of medical cannabis were reported, and the treatment was associated with decreasing daily analgesic intake, dependance, and level of migraine pain intensity. More positive effects than adverse effects were reported by migraineurs.
“Careful questioning and discussing with the patients about the use of marijuana, its risks, and benefits should be documented and researched,” the authors concluded. “More information about the doses, frequency, methods, and forms of marijuana consumed, as well as alcohol use, illicit drug use, and prescription drug use, should be explored to form the definitive treatment goal for migraine and headache patients.”
Poudel S, Quinonez J, Choudhari J, et al. Medical cannabis, headaches, and migraines: a review of the current literature. Cureus. Published online August 24, 2021. doi:10.7759/cureus.17407
Does Cannabis Have Potential Therapeutic Use in Migraine, Headache?
While studies support the use of cannabis for pain in adults, a lack of clinical data and an inability to perform studies has slowed the medical community’s understanding of the drug’s conceivable use in headache conditions.
Eric P. Baron, DO
The substantial evidence supporting the use of cannabis and cannabinoids for chronic pain in adult patients has led many to believe that this may infer a potential benefit for their use in chronic headache disorders, though studies on the topic are lacking.
During an advanced pre-meeting course at the American Headache Society’s 2018 Scottsdale Headache Symposium, Eric P. Baron, DO, a clinical assistant professor of neurology at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, presented an extensive review of the clinical findings for cannabis’s use in pain, and noted that its potential in headache disorders warrants further study. 1
“Many cannabinoids and terpenes have strong anti-inflammatory and analgesic properties, and supporting evidence suggest cannabis may assist in opioid detoxification and weaning,” he said during the course. “Data are needed to determine the most effective ratios of cannabinoids, terpenes, and other compounds for pain and headache disorders.”
In his review of the clinical data, Baron’s presentation produced recommendations for when it is utilized. He noted that its vaporized form is most likely the best option as opposed to the smoked and oral forms. Additionally, he explained that the recommended doses are varying for both tetrahydrocannabinol (THC) and cannabidiol (CBD) based medications.
“With THC, starting at 1 mg to 2.5 mg is a good starting dose. Going up to 5 mg will still provide a clinical benefit for most patients with excess [adverse] effects,” Baron said. “Once you get up to 10 mg, it will start to produce common [adverse] effects for most, and 15 mg or more can cause the psychiatric [adverse] effects. For CBD, starting at 5 mg to 20 mg per day and titrating to effect is optimal. Once you get up to 160 mg or higher doses, sleep duration tends to increase, and some can experience sedation issues.”
Ultimately, Baron suggested that starting low, going slow, and staying low with doses is the best general use recommendation. This, he noted, allows for a promotion of tolerance to the psychoactive effects of THC. Additionally, using them in combination is best, “as CBD attenuates the THC [adverse] effects. A good place to start is 15% to 20% CBD with less than 1% THC,” he said. He also suggested CBD preparations for daytime use, with THC preparations for post-work, nighttime use.
He acknowledged the work of MacCallum et al, for the general use recommendations, which suggest using long-acting oral formulations for chronic conditions and their symptoms, and suggested vaporization as an add-on for episodic symptom exacerbations. 2 Additionally, MacCallum and others recommend avoiding driving for 4 hours after inhalation, 6 hours after ingestion, and 8 hours if euphoria is experienced.
Baron said that with the increasing number of states allowing the use of medical marijuana—currently, 32 states allow it—and now up to 10 legalizing its recreational use, the need for physicians to further the research into its medicinal capabilities is more important than ever. He acknowledged that while currently, the qualifying conditions for patients vary state to state, the need for physicians to be able to have knowledgeable conversations with patients is essential.
“Doctors can’t prescribe cannabis. They can recommend or approve of its use,” Baron explained, “and under the 1 st Amendment, both physicians and patients can discuss its pros and cons.”
Additionally, while the use of medical marijuana is not federally allowed, the 2013 Cole Memorandum reinforced that the US Justice Department would not enforce federal prosecution in states where it is legalized. However, in January 2018, former Attorney General Jeff Sessions rescinded the Cole Memorandum. And despite President Trump’s reinforced support of medical marijuana programs, “things are somewhat up in the air,” Baron said.
One of the challenges, he detailed, is that marijuana remains a Schedule I drug under enforcement of the Drug Enforcement Administration (DEA), which presents issues with receiving grants and approvals for studies of its use in headache. These challenges have been overcome in other areas, though, Baron said. In June 2018, the FDA approved the use of Epidiolex (CBD, GW Pharmaceuticals) for Dravet syndrome and Lennox-Gastuat syndrome, rare forms of pediatric epilepsy. It is a Schedule V therapy. Additionally, dronabinol (THC, AbbVie) and nabilone (THC, Mylan) are both approved for chemotherapy-associated vomiting and nausea.
Baron also reviewed the possible adverse effects of cannabis, concluding that current evidence suggests limited indications of cardiometabolic risk, as well as no evidence of oncologic risk, maintained psychosocial adverse effects, nor a risk of death. Current clinical evidence, he said, suggests a risk of respiratory issues with smoked variations, especially in children, as well as impaired ability to operate vehicles.
During a question and answer session after Baron’s presentation, Stephen Silberstein, MD, the director of the Thomas Jefferson University Headache Center and moderator of the session, asked the attendees to raise their hands if they’ve never had a patient inquire about the use of medical marijuana or CBD for their condition. Not a single hand went up.
“So, 100% of us have been asked,” Silberstein said. The room appeared relatively split, however, about the drug’s potential for the treatment of migraine or chronic cluster headache, with the majority of the panel of speakers pointing to the need for more data.
1. Baron EP. The health effects of cannabis and cannabinoids in headache: benefits, harms, and legal implications; addiction, cannabis hyperemesis, spice syndrome, RCVS. Presented at: AHS Scottsdale Symposium; Scottsdale, AZ; November 14, 2018.