For those who regularly experience migraines, life carries unique challenges. Seemingly harmless sensory stimuli, like bright lights, strong aromas, or loud noises, can trigger unbearable pain. Stress, neck tension, and even jet lag can set a crippling migraine in motion too. This intense pain can be accompanied by a loss of sensation, nausea, or alarming visual changes. The disruption associated with chronic migraines can be so constant it can even erode one’s sense of self.
Although drugs commonly prescribed for the prevention and treatment of migraines help some individuals, they don’t offer relief for all migraineurs. Similar to many heavy-hitting medications, a host of unwanted side effects may ensue with use. However, evidence is accumulating that cannabis may be an effective treatment for migraines and chronic headaches.
A November 2019 study published in the Journal of Pain reported that cannabis could reduce migraine and headache severity by 50%, and although tolerance can increase, cannabis use does not exacerbate headaches or migraines over time. Concentrates appeared to offer more significant relief than flower.
Additionally, a 2019 retrospective study published in Neurology found that 88.3% of a sample of 279 patients reported an improvement in their headaches after using cannabis. More than half of the patients noted a reduction in headache frequency, and 38.3% found that their sleep improved. Fifty percent of those using opioid medications were able to reduce their use.
So now we know cannabis can ease migraine symptoms, what are the most effective ways to harness its benefits?
The role of the endocannabinoid system in migraine
According to Dr. Jim Polston, who holds a PhD in neuroscience and is the Chief Science Officer at Helius Therapeutics, cannabis works on migraines via the endocannabinoid system.
“There is mounting evidence that the endocannabinoid system can directly reduce migraine pain when activated by naturally produced cannabinoids or medical cannabis taken by patients,” said Polston. Cannabis can help to reduce inflammation in the protective dura mater tissue covering the brain and minimize the release of pro-inflammatory substances, both of which contribute to the onset of a migraine.
Polston also points out that one cause of chronic migraines is anandamide deficiency. “Anandamide is one of two cannabinoids naturally produced in the brain and is associated with reduced inflammation and activation of pain centers in the brain,” he explained.
You feel the onset of a migraine—when should you dose?
While the science supporting the use of cannabis for the treatment of migraines is piling up, practical knowledge regarding how, how much, and when to dose is still lagging. That being said, those who are already acquainted with cannabis for migraines have valuable tips to impart.
“I use cannabis both as a prophylactic, to prevent migraines by reducing stress and relaxing muscles, and as a rescue remedy once migraine hits, to reduce intense pain and nausea,” explained Boston Marathon survivor Lynn Crisci.
Dr. Debra Kimless, MD, Chief Medical Officer at Pure Green, observes that cannabis may be most effective when the signs of an impending migraine first become apparent. “The patients I have treated using cannabis enjoy tremendous success in reducing and eliminating the acute onset of their migraine symptoms, especially if they can dose when they first experience symptoms,” she said.
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Cannabis can work as both a preventative and a treatment for migraines, because the triggers and symptoms of migraines are so varied.
“Migraines have a complex set of underlying causes, triggers, and various symptoms, noted Polston. “Cannabis may be an ideal migraine medication with its diverse compounds and widespread roles in many of the issues associated with migraines. It’s a potent anti-inflammatory agent, analgesic, and anti-emetic. Furthermore, CBD is a known anxiolytic [anxiety-reducer], thus its presence could be useful in the treatment of stress-induced migraines.”
Delivery methods: Which are most effective?
Most studies investigating cannabis as a treatment for migraine are based on oral administration and inhalation delivery methods.
“Though more research comparing methods is needed, we can theorize from the current research that oral cannabis use may be sufficient and should be attempted first to avoid smoking in certain patients,” advised Polston. “However, some patients may find inhalation useful for more rapid pain reduction as the onset of effects is faster.”
That’s not to say that inhalation and oral delivery are the only effective methods though. “The complexity of migraines means that patient variability may lead to various methods being successful, but in a patient or symptom-dependent manner,” added Polston.
For Kimless, tinctures administered under the tongue also work successfully. “Most of my patients prefer to use a sublingual delivery method; it is fast, effective, and discreet,” she explained.
Crisci has experimented with many ingestion methods to determine what offers the greatest relief for her personally and has settled on vaping. “I prefer vaporizing cannabis oil, preferably in a vape pen, she said. “Vape pens allow me to microdose and control exactly how much medicine I am ingesting, while avoiding inhaling smoke into my lungs.”
To THC, or not THC: The cannabinoids that work best for migraines
The 2019Journal of Pain study argues that different concentrations of THC and CBD do not impact efficacy. However, other recent research has found that migraineurs prefer hybrid strains with high-THC and low-CBD concentrations. This preference may be due to the potent analgesic, anti-inflammatory, and antiemetic properties of THC.
For Crisci, though, experience has led her to favor low-THC strains. “I prefer a sativa hybrid with a high CBD level as a prophylactic or preventative medicine, as a pure sativa can make some, myself included, feel anxious. I’ll microdose immediately, once I feel a migraine coming on.”
For full-blown migraines, Crisci prefers indica dominant high-CBD strains. “Indica strains lower pain levels more effectively for me, and CBD lowers the THC high. Personally, I do not want to feel high while suffering the effects of an intense migraine, she reflected.
Kimless notes that individual responses to cannabinoids vary—what works well for one may offer less relief for others. That said, some level of THC appears to offer greater alleviation. “Most of my patients require a small amount of THC and not just CBD alone to experience relief,” said Kimless.
Polston added that the therapeutic terpenes, flavonoids, and phytocannabinoids also present in cannabis may play a role in easing migraine. “More in-depth research is needed to determine what, if any, role these compounds may play,” he said.
The frequent use of prescription medication for migraines is often aligned with medication dependency and medication overuse headaches. Several studies, including a 2018 review, suggest that cannabis can reduce or even replace addictive opiate medications, something Crisci has experienced firsthand. “When I started to use cannabis to treat my migraines, I found I was able to stop using many of my prescription medications: no more opioid painkillers, muscle relaxants, or anti-anxiety meds,” she said.
If you’re already taking prescription medicines for migraines but contemplating cannabis as an alternative, it’s best to talk to a physician experienced in cannabis medicine. Kimless endorses the “start low, go slow” adage.
“A little bit goes a long way with cannabis medicine. The sublingual or inhalational method allows for incremental dosing, which will help patients learn how much is needed to be effective,” she advised.