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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.”

Reference

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

Marijuana for Migraine Treatment

Huma Sheikh, MD, is board-certified in neurology and specializes in migraine and stroke. She co-founded the migraine and vascular section for the American Headache Society.

Marijuana has been considered a possible treatment option for many medical conditions, including migraines. However, at the current time, research hasn’t proven whether marijuana is effective in treating these painful episodes.

There is some evidence suggesting that it might help in migraine treatment and prevention, but it isn't clear if there is a safe or recommended dose, and whether there may be a certain type of migraine that is more likely to improve with cannabis treatment. And, of course, the legality of access and use is under debate in many areas.

Chemical Components of Marijuana

Two of marijuana's active ingredients, cannabidiol (CBD) and tetrahydrocannabinol (THC)—termed cannabinoids—induce a variety of effects.

THC is associated with psychogenic effects and the feeling of being “high,” although it is not the only component of marijuana for which this is true. CBD does not induce altered perception or a sensation of being high. A form of CBD, Epidiolex, has been approved for treatment of certain types of epilepsy.

In learning about medicinal benefits of these chemicals, you'll hear two terms that are worthy of distinction: Marijuana refers to the hallucinogenic drug (which is usually smoked) known to induce a "high" and a state of euphoria and relaxation, as well as altered perception. It is just one form of Cannabis, the plant that marijuana comes from.

When it comes to marijuana and migraines, research is fairly new, and some studies use forms of marijuana, while others use the cannabis plant, CBD, or THC, making it difficult to interpret results.

Marijuana/Migraine Research

Overall, there have been small studies suggesting improvement of migraines or other types of headaches. Medical research about the effects of marijuana uses a variety of components of the plant, as well as a variety of formulations, some of which are ingested in pill form, taken as a liquid oil, or inhaled.

One of the larger studies included 121 adult participants who had migraines. They used migraine medications along with several forms of medical marijuana, including an edible and an inhaled form. Of this group of participants, 19.8% experienced a decrease in migraine frequency, 11.6% experienced improvement of acute migraine attacks, and 11.6% experienced side effects. The most common side effects were tiredness and difficulty controlling the timing and intensity of marijuana.

While these results suggest that marijuana can be helpful for some people with migraines, there are many unanswered questions. For example, the target dose and timing are important issues that need to be defined.

Patterns of response that could identify which type of migraine is most likely to improve with medical marijuana need to be established.

Experts note that the current information about marijuana's effects on migraine is limited, and well-designed studies including larger numbers of participants are needed to reach a conclusion.

How It Might Work

The body naturally makes endocannabinoids, which bind to endocannabinoid receptors located in the brain and throughout the body. Cannabinoids bind to these receptors, and some components of marijuana work as endocannabinoid agonists (augmenting cannabinoid effects), while others act as antagonists (inhibiting cannabinoid effects).

There is some evidence that cannabinoids may reduce inflammation and diminish pain, and CBD is the component believed to modulate these effects. The ways that endocannabinoids are understood to affect the body, as well as some preliminary research results and anecdotal reports, support a call for properly designed clinical trials that set out to determine whether there’s a beneficial real-world effect on headache disorders like migraine, according to a 2017 review published in the journal Cannabis and Cannabinoid Research.

Evidence also suggests that endocannabinoid deficiency may be a factor in some chronic illnesses, including fibromyalgia and chronic pain, and that cannabinoids could play a role in reducing symptoms of these conditions. This is the leading explanation for why migraine is considered among the conditions that may improve with medical marijuana.

Side Effects

Marijuana has several known long-term side effects, including apathy, reduced problem-solving ability, lowered intelligence quotient (IQ), memory loss, lung cancer, and the potential to induce addiction. Marijuana overdose may cause different effects, including hallucinations, psychosis, and heart rhythm abnormalities.

Daily use can lead to a rare but serious syndrome known as reversible cerebral vasoconstriction syndrome (RCVS), which is associated with a headache. Rebound headaches may occur upon stopping marijuana after chronic, daily use.

Controversies and Access

There is a degree of controversy about the use of marijuana for headaches and other medical conditions. Advocacy groups propose more access as legislators work through the issues that differentiate recreational from medical use. State and federal governments have created laws expanding recreational and medical use. New policies have also decreased some of the regulatory restrictions on marijuana research. The scientific and medical communities are evaluating available evidence to determine safety and efficacy.

A Word From Verywell

Marijuana's potential as a therapy for migraines is emerging. Right now, there are anecdotes describing its use in migraines and small studies with reasonably promising preliminary results. Better clinical trials may clarify the efficacy, side effects, and best method of use.

It is not advisable to "self-medicate" with marijuana for your migraines because you might not experience the effect you are hoping for, and you may experience side effects.

Also, keep in mind that marijuana is not legal in every state, and breaking any laws regarding substance use can cause you to have legal problems, potentially marking your record and creating long-term consequences. Be sure to find out the laws regarding marijuana and medical marijuana in your state before you pursue this route of treatment.

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