Migraine: Cannabinoids and CBD Research Overview

Migraines are a type of intense throbbing and pulsating headache that commonly cause nausea, vomiting and sensitivity to light and sound. While migraines and their debilitating symptoms affect 10% of the world’s population, studies have shown cannabinoids are effective at inhibiting the system that causes migraine pain and therefore offers relief.

Overview of Migraine

A migraine is a type of headache that is characterized by pulsing or throbbing in an isolated area of the head8. The pain can be so intense that it causes nausea, vomiting and sensitivity to light and sound⁷. The International Headache Society distinguishes a migraine by the intensity of its pain and the frequency of attacks (at least five, lasting 4 to 72 hours if untreated)⁸. It’s not uncommon for those who suffer from migraines to first experience auras, which can include visual disturbances like flashes of light, the seeing of zig-zag lines, and vision loss. Migraines generally begin during childhood, adolescence, or early adulthood, with women suffering from migraines three times more often than men⁷.

While the pathophysiology of migraines is still not fully understood, research suggests they’re the result of fundamental neurological abnormalities caused by genetic mutations in the brain⁸. This fluctuation in neuronal activity likely activates the trigeminovascular system, which includes both the nerve and vascular system in the meninges, and the associated inflammatory response causes pain8. Genetics are also likely involved in the cause of migraines⁷.

Migraines are currently incurable and therefore the treatment focus is on preventing the attacks and relieving the symptoms once the attacks occur. The efforts to prevent migraines can include medications, stress management, exercise and nutritional adjustments, hydrating adequately, establishing consistent sleep schedules, and avoiding known behaviors that trigger attacks. Once a migraine hits, focus turns to the administration of pain relief medications⁷.

Findings: Effects of Cannabinoids and CBD on Migraine

Cannabis has been used to treat migraines for centuries. Between the years of 1874 and 1942, it was among the most prominent remedy used by physicians^6,10.

Research suggests that cannabis’ effectiveness for migraine relief can be attributed to the cannabinoids contained in cannabis, including cannabidiol (CBD) and tetrahydrocannabinol (THC). CBD and THC activate the CB₁ and CB₂ receptors of the body’s endocannabinoid system, which in turn inhibits responses of the trigeminovascular system and restricts the inflammation that causes migraine pain^1,2,4.

A January 2016 study found medical Cannabis to be effective at decreasing the frequency of migraine headaches. In a first-of-its-kind study, because of previous federal regulations, the researchers found that 103 of 121 of participants diagnosed with migraines saw a decrease in migraine frequency. The average migraine frequency reduced from 10.4 a month to 4.6 per month⁹.

Further, studies suggest that cannabis is effective at providing analgesia effects caused by chronic neuropathic pain conditions that are otherwise resistant to other pain relief treatments³. The findings of one study even suggest that a dysfunction of the endocannabinoid system may contribute to the development of migraines. Researchers then came to a conclusion that the activation of the CB₁ and CB₂ receptors would correct this dysfunction and be useful in treating migraine pain⁵.

Because of the effectiveness of cannabinoids on migraines, there continues to be prominent Cannabis use by migraine patients outside of physician recommendations and in locations where cannabinoids use continues to be illegal⁶.

States That Have Approved Medical Cannabis for Migraine

Currently just California and Illinois have specifically approved medical cannabis for the treatment of migraines.

However, other states allow medical cannabis to treat nausea or chronic pain. These states include: Alaska (nausea, chronic pain), Arizona (nausea, chronic pain), Arkansas (nausea, intractable pain), California (nausea, chronic pain), Colorado (nausea, chronic pain), Delaware (nausea, chronic pain), Hawaii (nausea, chronic pain), Maine (nausea, chronic pain), Maryland (nausea, chronic pain), Michigan (nausea, chronic pain), Minnesota (intractable pain), Montana (severe nausea, severe pain), Nevada (severe nausea, pain), New Hampshire (nausea, severe pain), New Mexico (chronic pain), North Dakota (nausea, severe pain), Ohio (chronic pain, severe pain, intractable pain), Oregon (nausea, chronic pain), Pennsylvania (chronic pain, intractable pain), Rhode Island (nausea, chronic pain), Vermont (severe pain, severe nausea), Washington (nausea, intractable pain), and West Virginia (severe pain).

In addition, other states allow medical cannabis for the treatment of migraines, but use must be first approved and accommodated with a recommendation by a physician. These states include: Connecticut (other medical conditions may be approved by the Department of Consumer Protection) and Massachusetts (other conditions as determined in writing by a qualifying patient’s physician.

In Washington D.C., any condition can be approved for medical cannabis as long as a DC-licensed physician recommends the treatment.

Recent Studies on Cannabinoids and CBD’s Effect on Migraine

Cannabinoids reduced frequency of migraines in 103 of 121 participants.
Effects of Cannabinoids on Migraine Headache Frequency in an Adult Population.
(http://www.ncbi.nlm.nih.gov/pubmed/26749285)

A review of studies examining cannabis’ effect on migraine pain suggests that Cannabis can play a therapeutic role in the treatment of migraines.
Comprehensive Review of Medicinal Cannabis, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It’s Been.
(http://www.ncbi.nlm.nih.gov/pubmed/26015168)

Cannabis-like medicine caused rats with experimentally-induced migraines to experience less pain than rats that didn’t receive medicine.
Activation of CB2 receptors as a potential therapeutic target for migraine: evaluation in an animal model.
(http://www.ncbi.nlm.nih.gov/pubmed/24636539)

Resources:

1. Akerman, S., Holland, P.R., Lasalandra, M.P. and Goadsby, P.J. (2013, September). Endocannabinoids in the brainstem modulate dural trigeminovascular nociceptive traffic via CB1 and “triptan” receptors: implications in migraine. Journal of Neuroscience, 33(37), 14869-77.
2. Baron, E.P. (2015, June). Comprehensive Review of Medicinal Cannabis, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It’s Been. Headache, 55(6), 885-916.
3. Boychuk, D.G., Goddard, G., Mauro, G. and Orellana, M.F. (2015, Winter). The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. Journal of Oral & Facial Pain and Headache, 29(1), 7-14.
4. Greco, R., Mangione, A.S., Sandrini, G., Nappi, G. and Tassorelli, C. (2014, March). Activation of CB2 receptors as a potential therapeutic target for migraine: evaluation in an animal model. The Journal of Headache and Pain, 15, 14.
5. Greco, R., Mangione, A.S., Sandrini, G., Maccarrone, M., Nappi, G. and Tassorelli, C. (2011). Effects of anandamide in migraine: data from an animal model. The Journal of Headache and Pain, 12(2), 177-83.
6. McGeeney, B.E. (2013). Cannabinoids and hallucinogens for headache. Headache, 53(3), 447-58.
7. Migraine (2013, June 4). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/definition/con-20026358.
8. NINDS Migraine Information Page. (n.d.) National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/migraine/migraine.htm.
9. Rhyne, D.N., Anderson, S.L., Gedde, M., and Borgelt, L.M. (2016, January 9). Effects of Cannabinoids on Migraine Headache Frequency in an Adult Population. Pharmacotherapy, doi: 10.1002/phar.1673. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26749285.
10. Russo, E.B. (2008, February). Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management, 4(1), 245-259.
11. Russo, E.B. (1998). Cannabis for migraine treatment: the once and future prescription? An historical and scientific review. Pain, 76, 3-8.
12. Russo, E.B. (2001). Hemp for Headache: An In-Depth Historical and Scientific Review of Cannabis in Migraine Treatment. Journal of Cannabis Therapeutics, 1(2), Retrieved from http://www.drugpolicy.org/docUploads/hemp_for_headache.pdf.