Cannabis and Migraine
Many suffer from occasional or frequent headache (20-40 million Americans). While all migraines are headaches not all headaches are migraine. Most headaches are of the “tension” or exhaustion type. These types can be nasty but migraine can be seriously disabling. Those who suffer from migraine find that attacks can occur occasionally (1-4x/year) or as frequently as daily. Attacks can last anywhere from 3-4 hours to 3-4 days. Migraine can be “classical” (with aura) or “common” (without aura).
Migraine refers to a type of headache that is vascular in nature. Spasm and narrowing of the blood vessels leading to the brain produces a migraine “syndrome”. Reduced blood to the brain causes lower oxygen levels, which in turn triggers the release of the brain chemical serotonin and the vasodilatation of blood vessels outside of the brain that can become congested with platelets. Migraine can be focused on one part of the head (hence the term “cluster”) or may involve the entire head and neck region. The origin of migraine remains mysterious but certain clues are being studied including:
- The role of nicotine and/or caffeine in initiating migraine
- The fact that most (certainly not all) migraine sufferers are women indicates a possible role of hormones in triggering events
- That migraine seems to run in families indicating a genetic basis
- The role of food or other allergens in prompting migraine
- The possible basis for changes in environmental conditions leading to migraine (temperature, barometric pressure, etc.)
- Emotional triggers including anxiety, stress, and anger may play a major role.
If you have ever had migraine you know how truly terrible they can be. Classic migraine is preceded by an “aura” 20-30 minutes prior to the onset of the attack. This aura may include a metallic odor and bursts of light in the corners of vision. As the migraine proceeds light sensitivity increases and nausea is common. Over sensitivity to sound may also be present. Head pain is intense from nerve inflammation and vessel congestion. The migraine sufferer can be almost entirely at the mercy of symptoms. Frequent bouts of vomiting may occur along with the head pain. Driving, talking, and walking can become difficult.
The most common and frequently effective treatment of migraine is to promptly reduce light, take Excedrin (acetaminophen/aspirin/caffeine), reduce noise, apply cool compresses, and wait. Additional traditional treatment may include drugs such as:
Ergomar (an ergotamine derivative) to dilate blood vessels
Imitrex (sumatriptan succinate) to dilate blood vessels
Inderal (proprananol) to reduce blood pressure and relax blood vessels (a preventative measure)
Elavil (amiyltriptaline)- a tricyclic anti-depressant (a possible preventative medication
Naprosyn (naproxin sodium) an anti-inflammatory pain reliever
Tigan (trimethobenzamide) an anti-histamine to treat nausea
Compazine (a phenothiazine) to treat vomiting
Narcotics such as Demerol, codeine, or morphine to reduce pain
Toradol IM to reduce pain and inflammation
Fiornal with or without codeine- a barbiturate medication to relieve vessel spasticity
Often, when acute episodes of vomiting are present, oral medication cannot be used. In these instances patients usually receive treatment from a physician or ER where IM or even IV injections are used. If vomiting is particularly severe dehydration is a consideration and IV fluids may be administered.
Many of the medicines prescribed for the treatment and/or prevention of migraine can have serious adverse reactions and side effects. Life style changes to reduce migraine “triggers” may be of real benefit as treatment once a migraine has started can be difficult. Non-drug preventative measures including recognizing and avoiding migraine “triggers” are important.
First and foremost, those who suffer from migraine need to receive proper medical care including diagnosis by a specialist. A variety of tests may be utilized including MRI, CT Scan, EEG, and blood analysis. Other causes for headache such as tumor or blood clot need to be identified or ruled out. Alternatives to drug therapy should be considered including behavior modification and biofeedback. Sometimes something as simple as pressure applied just in front of the ear on the side of head where pain is present can help relieve nerve inflammation and blood vessel congestion. In many cases, though, medicines are necessary although they are often ineffective or the side effects may be intolerable. One of the most serious “side effects” is the risk of long term addiction to narcotic painkillers used to dull the ache of migraine. Regular use of analgesic medication for headaches in general can create “rebound” headaches when patients decide to cut down. This is true of non-narcotic as well as narcotic pain relievers.
How then might adjunctive therapy with medical cannabis be of benefit to those victims of these terrible headaches? History shows that cannabis preparations in the 19th century were widely prescribed for migraine. In England and America, cannabis was the primary drug used to treat “sick headache”. Today tinctures are available that are absorbed under the tongue (sublingual) and work in minutes. Inhalation through a vaporizer or smoking can produce even more rapid relief. Absorption of cannabis through the lungs or sublingually is independent of the GI tract so is unaffected by nausea or vomiting.
Cannabis contains a variety of cannabinoids that act synergistically to help relieve migraine symptoms. Cannabis is both anti-inflammatory and analgesic in addition to its known anti-emetic properties. Recent research demonstrates that cannabis is also a mild vasodilator that can lower blood pressure. Cannabis can provide relief from muscle cramps that can accompany migraine (particularly of the neck and shoulders). Patients whose headaches may be anxiety related need to be cautious about cannabis as it can aggravate symptoms of anxiety in some patients.
Dose is patient dependent and is easily controlled with either tincture or through the smoking or vaporization of flowers (bud). A dose as low as 3-4 drops of tincture or less than a gram of flowers is often sufficient providing long lasting action (4-6 hours). Patients are advised to consult with their physician about adjunctive therapy with cannabis and initiate a trial period of treatment with the physicians expressed approval. Cannabis works best when combined with a migraine prevention program and non-drug relief such as restricted light and sound when attacks occur.