Headache & Migraine and Medical Cannabis
A headache is just that – a continuous or short-but-regular pain in the head, whether dull or sharp. Headaches are often a symptom of other conditions (secondary headaches), but can occur on their own as well (primary headaches).
Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Headache & Migraine
Varies – low to high, depending upon the source of the headache/migraine.
Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help
Pinene and limonene could be useful terpenes.
Non-decarboxylated, acidic cannabinoids such as THCA and CBDA may also be useful.
CBD:THC 20:1; CBD:THC 1:1.
Medical Cannabis Pros for Chronic Pain
Migraines are hard-to-treat, and some of the stronger medications have rather horrible side-effects.
Cannabinoids may bind to areas of the brain that modulate pain transmission – the same areas in the brain opioid receptors are found.
THC may reduce serotonin release. Nausea and vomiting are sometimes side-effects of migraines, and THC may help prevent these side-effects.
Medical Cannabis Cons for Chronic Pain
“Rebound headaches” can occur if cannabis use is stopped.
Some report an increase in the pain or frequency of migraines after cannabis use. Others report an increase, followed by decrease.
Smoking cannabis may induce headaches in some people. In cluster headaches, for example, some reported relief from their headaches, whilst others reported their condition worsening. Interestingly, when it comes to cluster headaches, psilocybin may be of use!
More About the Condition
There are a huge number of conditions that can cause migraines and headaches. Whether it’s the cold or the flu, stress, the side-effects of another medication, depression, high blood pressure, chronic pain, chemotherapy or hormonal changes, one of the side-effects is often headaches or migraines. Environmental factors may also cause headaches, such as regularly being exposed to high levels of noise pollution. Headaches and migraines cost the United States approximately between $13 and $17 billion per year.
Due to the huge number of conditions that can cause headaches and migraines, it is a much-studied phenomenon. The causes of some types of headache and migraine are more well-known than others. It is also worth remembering that headaches and migraines are quite different in many respects, even though they may share many of the same characteristics physiologically. To explain this simply, headaches are not a feature of all types of migraines.
Types of headaches include tension headaches, sinus headaches, thunderclap headaches and Chiari headaches. Migraines do not always include head pain, but it is often a part of most migraine types. Head pain in migraines can occur in specific parts of the head, as opposed to a general feeling all round the head.
Unlike most types of headache, migraines often include symptoms such as: nausea and/or vomiting; seeing spots or flashes; temporary vision loss; sensitivity to light and/or sound; tingling and numbness in the face and hands; pain in specific parts of the head, such as at the temples or behind the eyes or ears; and confusion.
Broadly speaking, headaches are split into two groups: primary and secondary. Primary headaches are the most common type of headache, and are headaches that are not caused by another problem or condition. Secondary headaches are headaches caused by another problem or condition. Migraines are considered primary headaches.
Although the brain lacks pain receptors, extracranial arteries, middle meningeal artery, large veins, venous sinuses, cranial and spinal nerves, head and neck muscles, the meninges, falx cerebri, parts of the brainstem, eyes, ears, teeth and lining of the mouth can all detect pain. Pial arteries are responsible for pain production. Headaches often result from irritation of the meninges and blood vessels. The nociceptors may be stimulated by head trauma or tumors, which can cause headaches. Blood vessel spasms, dilated blood vessels, inflammation or infection of meninges, and muscular tension can also stimulate nociceptors. Once a nociceptor is stimulated, it sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts.
We know about some types of headaches than others. Due to the huge number of variables in the cause of primary headaches, less is known about them. We do not know much about cluster headaches, and we know little about migraines and tension headaches as well. Serotonin seems to be involved in many types of headache. Cannabinoids have been used on various types of headache and migraine, with varying results. However, there does seem to be a link between the endocannabinoid system and the detection of pain of many kinds, including headaches.
Quotes from Experts
“Historical reports, though not ideal forms of evidence, are important resources for understanding the potential use of cannabis in the treatment of headache disorders. Clinical publications between 1839 and 1937 provide valuable insights into the most effective practices, challenges, and benefits during an era when cannabis was commonly used to treat headache. A summary of historical treatment practices using cannabis for migraines can be seen in Table 1. Historical sources indicate that cannabis was used as an effective prophylactic and abortive treatment for headache disorders. Although dosing varied among physicians, most prescribed alcohol extractions of the drug in the range of ¼ to ½ grain (16–32 mg).28,32,36–40 This dose was likely chosen to minimize the effects of intoxication while also providing effective therapeutic relief. Other providers suggested that doses should be progressively increased until modest effects of intoxication were felt.19 For prophylactic treatment, these doses were usually administered two to three times daily for weeks or even months.28,32,36–38 Acute treatment often involved higher doses taken as needed and, in some cases, smoked cannabis was recommended.19,41–42” Source: Lochte, Bryson C et al. ‘The Use of Cannabis for Headache Disorders.‘ Cannabis and cannabinoid research vol. 2,1 61-71. 1 Apr. 2017, doi:10.1089/can.2016.0033
Case Studies – Patient Stories
Low to high, depending on the type and cause of the headache/migraine.