Should Migraine Patients Start with Cannabis?

Migraine treatment is tricky and cannabis may be the best place to start.

Migraine affects about 18% of women and 6% of men in the US and Europe, and 10% of the population worldwide.  This means 700 million people suffer from this condition at any given moment. Cannabis provides effective and safe migraine treatment.

In 2016, migraines were the the 2^nd leading cause of all global disability and 2^nd leading neurological disease. They cost $20 billion per year because of 113 million lost workdays.

Pharmaceuticals For Migraine Treatment Not Effective For Most

Migraine treatment divides into acute and preventative therapy. Most existing preventive therapies come from anti-epileptic, antidepressant, and antihypertensive medications. However, most people cannot tolerate these drugs. This creates gaps in pharmaceutically-based migraine treatment.

The most frequently used acute medications include analgesics, such as nonsteroidal anti-inflammatories (NSAIDs) and triptans. Unfortunately, despite the only medication developed specifically for migraines, 25% of patients do not respond to triptans. In addition, only 1/3 of patients taking triptans are pain free at 2 hours, and 17-25% remain pain-free for 24 hours. This confirms a largely unmet need for migraine treatment.

What Research Says About Cannabis for Migraine Treatment

Medical literature regarding headaches and migraines shows supporting evidence in the cannabis/cannabinoids treatments for chronic headaches, migraines including chronic migraines, medication overuse headache, cluster headaches. To date there are no placebo-controlled studies of cannabis for headache disorders. However, there is a multicenter study evaluating the efficacy and safety of the synthetic THC, dronabinol, in a dose inhaler for the treatment of migraine, but the results have not yet been published.

There was a study of the headache disorders, involving 30 patients for the treatment of medication overuse headaches (MOH). Participants demonstrated daily analgesic use for five years and failed at least 3 detoxification attempts. Each completed a course of either ibuprofen 400mg or nabilone (a synthetic cannabinoid) 0.5mg for 8 weeks, following a 1-week washout and then 8 weeks of the other medication.

Results showed that nabilone (0.5mg) was superior in reducing daily analgesic intake, pain intensity, level of medication dependence and improved quality of life for these patients.

How Cannabis Treats Migraine

Over 540 phytochemicals, 18 different chemical classes and more than 100 different phytocannabinoids have been described in cannabis (so far). The most abundant cannabinoid is called tetrahydrocannabinolic acid (THCa) and is converted to the ∆9-tetrahydrocannbinol (THC) in the presence of heat.

THC Has Powerful Anti-Inflammatory Action

THC binds to CB1 and CB2 receptors, with a stronger preference for CB1. Through this, THC reduces NMDA responses by 30-40%.  NMDA mechanisms play a significant role in chronic pain syndromes, such as fibromyalgia and chronic migraine. THC also gives antioxidant neuroprotective benefits.  Even more relevant, it has well documented analgesic and anti-inflammatory benefits with 20 times more anti-inflammatory action than aspirin and twice as much as hydrocortisone.

Terpene Entourage Effect Boosts THC Binding to CB1 Receptors

Terpenes and terpenoids are major contributors to plant’s essential oils and resins, and responsible for the pharmacological properties of many plants, including cannabis. Terpenes form the largest group of phytochemicals. Cannabis contains about 200 different terpenes, but primary and secondary ones are present at the highest concentrations. They influence the binding of the THC to the CB1 receptor, and interact with other neurotransmitter receptors that contribute to cannabinoid-mediated analgesic effect.

Unfortunately, in most of these studies did not assess percentages of other cannabinoids and other important compounds, such as terpenes. Because of the known entourage effect of cannabis and the influence of cannabinoids and terpenes on one another, it is not clear in some cases if the study results are due to the THC alone or due to the contribution of other cannabinoids and terpenes.

Flavonoids Reduce Oxidative Stress in the Brain

Flavonoids are phenolic compounds found in the cannabis plant. These compounds act as antioxidants in plants and protect against oxidative stress. They contribute to the vibrant colors of plants and vegetables. Cannabis contains about 20 different flavonoids. Similar to terpenes, many of these compounds have demonstrated neuroprotective, anti-inflammatory and some antitumor effects.

Cannabis is a broad spectrum medicine with many different compounds. Each compound has different targets, responses and side effects. People term the synergistic effect of cannabis compounds mixing together the “entourage effect.”

Further research will determine the most effective therapeutic ratio of the cannabinoids, terpenes, flavonoids and other compounds. Migraine isn’t the only condition benefiting from such information.