CBD oil and migraines
Migraines can be profoundly debilitating, with migraine sufferers often experiencing additional troubling symptoms such as nausea and light sensitivity. An estimated 15% of individuals globally suffer from migraines. In the U.S., head pain is the fifth-leading cause of emergency room visits.
Current research indicates that migraines occur when the threshold for pain signaling drops in response to inflammatory agents. Environmental and hormonal triggers most likely initiate the onset of a migraine. Migraine medication often provokes adverse effects, which has resulted in a reduction of research into migraine drugs.
CBD’s analgesic effects, anti-inflammatory properties, and anti-emetic qualities may help relieve the pain and nausea associated with migraines. Photo by: Gina Coleman/Weedmaps
Given this context, many migraine sufferers are receptive to new treatments that promise to help manage migraine pain. Cannabidiol (CBD) oil has recently captured the attention of scientists and patients alike. CBD’s analgesic effects, anti-inflammatory properties, and anti-nausea qualities may help relieve the symptoms associated with the condition.
While there are still no clinical studies exploring the efficacy of CBD oil as a treatment for migraines, several scholarly reviews and studies point to the importance of modulating the endocannabinoid system (ECS) and the use of cannabinoids such as CBD as a potential therapy.
Endocannabinoid receptors are found in the pain processing areas of the brain. “Anandamide (an endocannabinoid) has been shown to target some of the same signaling pathways as triptans, a class of medications primarily used in the treatment of migraines and cluster headaches. This supports the therapeutic potential of cannabinoids in the treatment of migraine,” explained Rosalia Yoon, a cannabis research scientist for Toronto-based Apollo Cannabis Clinics, which advises patients and conducts studies on medical marijuana.
CBD has been shown to reduce inflammation and pain in animal models by targeting specific receptors within the endocannabinoid system.
A 2019 review published in “Current Opinion in Neurology” suggests that CBD may have a role to play in alleviating the pain associated with migraines. CBD can affect the function and activity of signaling pathways by targeting the receptors that play a role in pain control.
The review also points out that CBD can suppress the release of certain proteins, which are linked to inflammatory pain and modulate the immune cell system. The modulation of the ECS with cannabinoids could offer a tolerable and pharmacologically sound treatment for migraines; however, the study’s authors expressed the need for further studies to explore the mechanisms by which this occurs.
Another 2016 review published in Cannabis and Cannabinoid Research proposed the idea that migraines may be caused, in part, by a deficiency in the endocannabinoid system. Photo by: Gina Coleman/Weedmaps
There is clinical evidence that suggests this hypothesis could hold validity. A 2007 study published in the journal “Neuropsychopharmacology” showed evidence of depressed anandamide levels in the cerebrospinal fluid of migraine sufferers. Low anandamide levels are a possible indication of an impaired ECS. These findings point to cannabinoids as a potential therapy for chronic migraine sufferers.
According to Dr. Ethan Russo, author of the study in “Cannabis and Cannabinoid Research,” randomized, controlled trials utilizing standardized preparations with low THC and high CBD are long overdue. There is already preclinical evidence that THC can ameliorate migraine pain, according to the “European Journal of Pharmacology.”
Shelly Schneider, 39, is the president of a busy CBD e-commerce store and a mother. She first began to experience migraines while she was in college in 2003, which she attributes to ongoing stress and tension.
“When I get a migraine, it takes me out for the day. I need a heat pad and a dark, quiet room. Then I need to sleep it off. It makes me nauseated and makes my entire head throb,” she said.
Schneider had traditionally relied on Tylenol to help manage her migraines. She began taking CBD oil for cholesterol but realized it was also alleviating her migraines. “When I realized it was also helping with my migraines, I was sold,” she told Weedmaps News.
Some people anecdotally report that CBD oil helps with migraine prevention. Photo by: Gina Coleman/Weedmaps
Schneider said CBD oil also helps with migraine prevention. “Since CBD has anti-inflammatory properties, it helps with the tension and prevents the migraines from getting as bad if I do get one. They are also much less frequent.”
Schneider notes that her anxiety has diminished, and endometriosis pain is improved, benefits she also attributes to CBD oil.
What the experts say
Dr. Stephen Silberstein, Director of the Jefferson Headache Center in Philadelphia, recommends CBD oil for his migraine patients. Among its benefits, Silberstein points out that it is non-intoxicating, non-sedating, reduces anxiety, and doesn’t reinforce cravings or compulsive use.
“We use CBD topically in the area of the neck with good results. We’re uncertain as to the benefit of CBD taken orally for migraines, however.” This may be because CBD ingested orally has limited bioavailability.
Dr. Steven Zodkoy, a medical consultant at Monmouth Advanced Medicine, a New Jersey chiropractic clinic, noted that his chronic migraine patients use CBD in a preventative capacity. Zodkoy said that CBD helps to mediate their overall stress level, which is helpful as migraine patients often become fearful of triggering an episode. “Physiologically, CBD has a relaxing effect on the body, which makes it more pliable to adjust to stress. I have been using full-spectrum hemp products/CBD with my migraine patients for a few years with excellent results.”
Studies suggest that CBD and cannabis are at least as good as common migraine preventive medications, without the side effects. Photo by: Gina Coleman/Weedmaps
Anecdotal evidence suggests that CBD may be a potential first-line or adjunct treatment for migraines. But randomized, controlled trials are needed to determine CBD’s efficacies, and to develop dosage recommendations.
Migraine and CBD Oil: Doctor Q&A With Stephen Silberstein, MD, FACP, FAHS
Dr. Stephen Silberstein touches on CBD oil as a potential treatment for migraine and current barriers to its use
Dr. Stephen Silberstein is the director of the Headache Center at Jefferson University Hospital in Philadelphia. At the 60th Annual Scientific Meeting in San Francisco, Dr. Silberstein spoke with us about cannabidiol (CBD) and its relationship to the treatment of migraine and headache disorders.
What is CBD oil, and how is it different from marijuana?
Marijuana contains both tetrahydrocannabinol (THC), an active chemical that has psychoactive properties, and CBD. Unlike THC, CBD oil has no psychoactive properties and is currently on the market and available for purchase in stores and online.
There is a debate in the field of headache medicine right now. Health care professionals are currently asking if patients are better off using the marijuana plant and its extracts, which are natural, or if they are better off using the specific chemicals that come from marijuana, like THC and CBD? It is frequently debated, and there are people on both sides of the fence.
Is CBD oil effective for preventive or acute treatment of migraine?
There is very little evidence that any of the components of marijuana are effective for the treatment of migraine and headache disorders. That does not mean they do not work, however. What it means is that they have not been studied.
What are some of the obstacles patients with migraine and headache disorders face when it comes to using CBD oil?
Some states are legalizing marijuana and its derivatives; however, marijuana is still a federal crime. So, theoretically, if you bought marijuana in a state where it is legal and you travel to another state where it is illegal, you could be arrested by that state or even by the federal government.
In addition, studying marijuana and its derivatives is extremely difficult. There is only one source of plants researchers can use, and they are at a research facility in Mississippi. They are not the best, most pure plants for study.
Accessibility to CBD oil is widespread. You can order it from Amazon and Walmart.com. What are the legal implications of CBD oil?
It is a complicated topic. I can legally prescribe THC and there is no problem with that, but I could not legally prescribe CBD oil until recently, because it has just been approved by the Food & Drug Administration (FDA) for the treatment of epilepsy. Now, we will have CBD and THC both available as prescription drugs, despite the fact that it is still illegal to use the plant, according to the federal government.
What research exists on CBD oil and marijuana as treatment options for migraine?
There are no studies that have been done on either marijuana or CBD oil as treatment options for migraine, and no studies are in the pipeline.
If a physician has a patient who wants to explore CBD oil as a treatment option for migraine, how would you advise him or her?
It depends on your state. If you are in a state where it is illegal, you have no local or federal protection. But if you are in a state where it is legal, either recreationally or medicinally, you have options. For example, in Pennsylvania where I practice, marijuana is legalized for medicinal uses. But physicians in the state of Pennsylvania cannot prescribe it. If they did, their license would be removed, as it is a federal offense.
In some states, it is legal for recreational use, so there is no physician intermediary. Every state is different, and it is extremely important to know the laws in your state.
How does CBD oil interact with common migraine medications?
Theoretically, it should not interact at all. It works on an entirely different mechanism. It might even prevent nausea and vomiting. I cannot think of any reason why it could not be used in conjunction with other migraine medications.
What are the side effects of CBD oil?
Practically none. Unlike THC, CBD oil has minimal, if any, side effects.
Stephen Silberstein, MD, FAAN, FACP, FAHS, is a member of the American Headache Society, a professional society for doctors and other health care workers who specialize in studying and treating headache and migraine. The Society’s objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders, and to share and advance the work of its members. Learn more about the American Headache Society’s work and find out how you can become a member today.