Most people have battled the pain of debilitating headaches at one time or another in their lives. Headache disorders are both common and diverse, ranging from stress and tension headaches, to cluster headaches, and to the most feared type of headache: the migraine headache.
Roughly 10% of the population suffers from migraine headaches, for which the exact causes of and treatment for are still unclear. These headaches tend to last upwards of 4 hours, with many expanding over multiple days.
As any migraine sufferer can tell you, these severe headaches can dramatically reduce one’s quality of life and ability to work. Yet, despite the large impact of this disorder on our communities, relief is often out of reach for many migraine sufferers.
With so many struggling to find relief for their headaches, many people ask us if CBD helps with the pain associated with migraines. In this article, we will review what science has to say with regards to headache pain and CBD oil.
Migraine Headaches and Current Treatments
The exact cause of migraine headaches is still not known, however it is believed that they initiate in the brainstem, hypothalamus, or possibly cortex of the brain.
Headaches trigger the overactivation of the trigeminovascular pathways. When this occurs, a variety of vasoactive peptides and mediators are released. These substances are thought to be the cause of the pain, with activation of nociceptive receptors in the neck and head.
Other effects of headache include inflammation, increased intracranial pressure, and serotonin signalling, which also are thought to contribute to some of the pain felt.
Treatments for migraines fall into one of two drug categories: abortive and preventative.
Abortive drugs are the ones most of us are familiar with. When a migraine hits or signs of a migraine start to appear, abortive drugs are intended to stop the pain of a migraine. These kinds of drugs fall into a variety of forms, including pills, injections, nasal sprays, and skin patches.
Two of the most commonly used abortive drugs are over-the-counter medications. These include ibuprofen and Excedrin Migraine (contains aspirin, caffeine, and acetaminophen), and triptans, which target serotonin specifically.
Other drugs exist that fall under abortive drugs, including narcotics, barbiturates, and analgesics. These drugs can be effective for pain, but they can be habit forming. Because migraine attacks are often frequent, habit forming painkillers are not an ideal or long-term solution.
Preventive treatments are prescribed to those who generally experience one or more migraines each week, with a goal of lessening the severity and frequency of migraines.
Some examples of medications used as preventative treatments for migraines include medications for high blood pressure, antidepressants, anti-seizure medications, and botox.
As with many medications, there is a long list of side effects associated with one or more of the above treatments.
According to a 2003 survey of close to 1,200 migraine sufferers published in the journal Headache regarding migraine medications, two-thirds of sufferers reported putting off, or even completely avoiding, their prescription medications due to fear of their side effects. (8) These patients listed nausea, fatigue, rapid heartbeat, and trouble thinking as common side effects.
While the treatment options for migraines are vast, they are consistently ineffective. According the headache specialist Roger Cady, MD, even the best migraine medications are only effective half of the time.
It is estimated that about one half of migraine sufferers cease seeking care for their headaches, likely losing hope that an effective treatment without undesirable side effects exists.
These findings highlight the needs for treatment options that do not come with quite so many side effects, which is why so many migraine sufferers turn to the plant Cannabis sativa in hopes of relief.
History of Cannabis and Headaches
While in recent times the legality and reputation of cannabis, colloquially referred to as weed, marijuana, pot, and many other names, has made it less common than prescription and over-the-counter medications in treatment of conditions such as migraines, in ancient times its use as medicine was common and widespread.
Thousands of years ago, in the second millennium BCE, Assyrian manuscripts recommended cannabis to “bind the temples.” Additional ancient cultures also recommended cannabis for headache treatments. Ayurvedic medicine encouraged the use of cannabis for “diseases of the head,” it was recommended in ancient Greece for “pain of the ears,” and cannabis was even mentioned in the earliest known document of Arabic pharmacology for headache disorders. This continued through to the middle ages, where prominent physicians were documented to recommend cannabis for the treatment of headaches. (1)
Cannabis was reintroduced in the West in 1839, with its use for headache disorders common until it became illegal in 1937. Because of this illegalization of cannabis, little research into its therapeutic properties was conducted until more recently, as certain states have legalized cannabis and put this plant back on the docket for medicinal research. (1)
From 1839 to 1937 many doctors and researchers experimented with using cannabis to treat frequency and intensity of headache disorders. These studies widely found a positive impact of cannabis on headache frequency and severity, with some examples of headaches being completely cured even following the cessation of cannabis. (1)
Additionally, it was touted that cannabis reduced the anxiety and nausea that came with headaches, and the long-term safety was praised.
In more recent times, researchers have learned even more about possible causes of migraines and how the compounds found in cannabis may be able to help offer relief.
While these results are promising, the research is in its infancy, often leaving consumers with more questions than answers.
Cannabis for Headaches
A 2017 review of previous studies on cannabis and headaches published in Cannabis and Cannabinoid Research found that there has yet to be any placebo-controlled clinical studies that examine cannabis as a treatment for headache, however there have been a large number of other published studies that can help to give us insights into how cannabis works and its possible therapeutic potential. (1)
A 2016 study published in the journal Pharmacotherapy conducted a retrospective review to examine the effects of marijuana on patients with migraine headache. The study selected 121 patients who were diagnosed with migraines between January 2010 and September 2014 and treated with medical marijuana.
It was found that migraine frequency on average dropped from 10.4 to 4.6 headaches per month, a clinically significant drop. (2)
While we want to be careful with these results since this was not a placebo-controlled study and brings in the difficulty of bias, this demonstrates the need for additional studies to see if these results can be replicated. With so many patients reporting positive results with marijuana as a treatment for headache, medical marijuana may turn out to be a promising treatment for those with migraine headaches.
One even more recent study presented at the 3rd Congress of the European Academy of Neurology in Amsterdam in June 2017 took 79 chronic migraine sufferers and had them take either a 200 mg THC-CBD combination or amitriptyline, a common antidepressant used in migraine treatment, daily for three months.
48 cluster headache patients were also assigned to either a 200 mg THC-CBD combination group or 480 mg of verapamil, a calcium channel blocker commonly used in cluster headache treatment, daily for three months.
The THC-CBD combination yielded almost identical reduction in migraine attacks as compared to the traditional medicinal treatment: THC-CBD patients experienced a 40.1% reduction in migraine attacks, while the amitriptyline group experienced a 40.1% reduction. (9) For those with cluster headaches, the frequency of attacks only fell slightly.
When these results were examined further, the researchers found that pain intensity for those with cluster headaches was reduced further only for those subjects who experienced migraine attacks as children.
Currently only the abstract of this study is available online, leading to questions regarding the more detailed aspects of the study, however the results are very interesting. The reduction in pain for those who have suffered from migraine but not those who have only suffered from cluster headaches is something that needs to be studied in further detail. This difference may help us to understand the mechanisms that the THC-CBD combination had for the patients who experienced headache pain relief.
While there have been few studies on cannabis and migraine headaches specifically, there have been numerous studies on cannabinoids and cannabis and their ability to treat nausea, muscle spasticity, and neuropathic/chronic pain. (3,4,5,6,7) While none of these studies were on headache disorders specifically, headache disorders share these same pathologies.
For example, migraine sufferers often experience migraine-induced nausea, and it is plausible that the antiemetic properties found in the treatment of nausea associated with chemotherapy with cannabinoids may carry over to help those who suffer from migraines.
Now that we have reviewed the science behind cannabis and cannabinoid in reducing headache pain and frequency and possibly helping those with migraines, we will delve into why this might be the case.
The ECS and its Role in Migraine Disorder
While the exact cause of migraines is not yet fully understood, preclinical data had tied endocannabinoid deficiency with multiple parts of migraine pathogenesis.
Essentially the endocannabinoid deficiency hypothesis proposes that migraine headaches and some other health conditions may be caused in part by reductions in endocannabinoids and changes in endocannabinoid function.
So what exactly does this mean?
Our bodies contain a series of cannabinoid receptors and endocannabinoids known as the endocannabinoid system (ECS). Discovered less than 30 years ago, the ENC consists of receptors found in our brain, organs, immune cells, connective tissues and glands.
There are 2 types of receptors: CB1 (cannabinoid 1) receptors, found mostly in the brain, and CB2 (cannabinoid 2) receptors, found mostly in immune tissues and cells.
These receptors respond not only to endocannabinoids (cannabinoids produced by our bodies), but also to external cannabinoids, such as the phytocannabinoids THC and CBD found in cannabis.
Migraines have been tied to genes, with certain genetic factors lending to people being predisposed for migraines. Multiple of these factors are tied to the ECS system.
One example has to do with the CB1 receptor. The cnr1 gene encodes for the CB1 receptor, and a decrease in the expression of this gene is positively correlated with migraines.
Another example involves an enzyme tied to a decrease in the levels of endocannabinoids. Women who suffer from migraines tend to have increased fatty acid amide hydrolase (FAAH) activities. FAAH is an enzyme that breaks down the endocannabinoid anandamide as well as the endocannabinoid membrane transporter, leading to decreased levels of endocannabinoids.
This increase in FAAH activities could even be an explanation as to why women tend to suffer from migraines more frequently than men do.
These links provide a logical basis for the idea that compounds that impact the ECS, such as THC and CBD, may be helpful in the treatment of migraine headaches.
CBD and Migraines
CBD appears to have its effect on our bodies through boosting the levels of endocannabinoids that our bodies produce. It is a shame that there have not yet been studies directly studying the effect of CBD oil on migraines as this leaves plenty of speculation with little science to directly back it up.
If the endocannabinoid deficiency hypothesis proves to be true, a compound that boosts the levels of our endocannabinoids could theoretically help to rebalance these levels, possibly leading to fewer migraine attacks, tackling migraines at the source rather than symptoms.
The benefit of straight CBD oil without THC is that it takes away the psychoactive effects of cannabis, which are thanks to THC, while still exerting an effect on the ECS.
Additionally, because CBD is non-psychoactive and can come from hemp, CBD products are more widely available throughout the United States.
While further studies are needed to fully understand the scope of possible side effects from CBD, the studies thus far have largely found it to be safe with few side effects. Of the side effects, the possible interaction with other drugs is one that should be discussed with a doctor.
One of the main concerns with CBD is that studies evaluating the chronic use of CBD are lacking, leaving many questions for the consumer.
Some studies have found that headache can be induced in patients who are stopping cannabis use. This is something that future studies will want to look for to see if patients experience increased headaches when ceasing treatment with cannabis or CBD oil.
Additionally, if using a THC-CBD compound, side effects such as fatigue and difficulty concentrating are common.