Is marijuana for “pot smokers” or are there legitimate medicinal applications for cannabis? Why are governments and health regulators changing laws and legalizing cannabis? Australia, Canada, and most US and European states have now legalized medicinal cannabis.
It turns out that marijuana or cannabis has some complex properties that may provide important health benefits in a wide range of conditions.
This article looks at the evidence for medicinal cannabis to treat migraine. If you can withhold judgment until the end, you might be surprised by the controversy, political agendas, misinformation and the truth behind this hotly debated topic.
Contents
What is cannabis?
Cannabis is a plant with leaves and flowering tops that contain at least 489 distinct compounds across 18 different chemical classes. Two of the best known compounds are cannabidiol (CBD) and Delta-THC (THC).
THC and CBD
THC is responsible for the ‘high’ or intoxicating effect that can accompany cannabis use. THC still has some therapeutic value and is thought to act synergistically with CBD. Both CBD and THC have strong anti-oxidant properties.[1]
CBD delivers a significant proportion of the health benefits associated with cannabis. It is thought to have potential for analgesic, anti-epileptic, anti-nausea, anti-emetic, anti-inflammatory, anti-psychotic and anti-ischemic properties.[1] In animal studies its anti-inflammatory properties were found to be several hundred times more potent than aspirin.[1]
CBD is the compound which has a great deal of interest in epilepsy syndromes (see Charlotte’s Web below). The ratio of THC to CBD is often noted in cannabis-based treatments and useful to understand given their combined synergy and treatment applications.
Aside from THC and CBD there are many other compounds in cannabis that have also shown some benefit including terpenes and flavonoids.[1] These are referred to as cannabinoids. These vary significantly due to different strains, climate, soil, and techniques of cultivation. This also helps explain the variety of potential medical benefits and side effects.[1]
What is marijuana, hemp and hashish?
Marijuana refers to the dried flowers, leaves and stems of the cannabis plant.
Image: Kief
The scientific name of the plant is cannabis. Generally speaking, marijuana is a variety of cannabis that has high levels of the THC and low levels of CBD.
Hemp is made up of the plant seed and fiber. It has high levels of CBD and very low, essentially insignificant levels of THC. Hemp is often used interchangeably as hemp or industrial hemp and was used in the production of industrial materials and fabrics before it was made illegal [see ‘The controversy, history and politics of medicinal cannabis’ below].
Image: hashish
Kief is a powder derived from the leaves and flowers of cannabis plants. Hashish is pressed kief often in the form of a resin cake or ball.
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The endocannabinoid system
Receptors in the brain for cannabinoids (the chemical compounds found in cannabis) are 10 times more common than opioid receptors.[1] The brain makes its own cannabinoids called anandamide. The brain has receptors which interact with our own cannabinoids. Interestingly, cannabinoid receptors have been found to be the most common receptor in brain.[1]
This endocannabinoid system is something we all have. It helps maintain the balance of normal function within the body. It extends to every organ system including our neurological processes. Components of the endocannabinoid system are also found throughout the nervous system in spinal and peripheral pain pathways.[1]
If a neuron is over stimulated or excited, the body may use cannabinoids to help the neuron calm down. Research suggests that the platelets of those with migraine may have lower endocannabinoid levels than healthy patients.[5]
Strains of cannabis
the 3 types of cannabis plant
There are three primary species or strains of the cannabis plant:
- Cannabis sativa
- Cannabis indica
- Cannabis ruderalis
Cannabis sativa
Cannabis sativa is a species of cannabis which has high levels of THC and low levels of CBD. The strain tends to have more uplifting, energetic, and euphoric properties. For this reason it is often used during the daytime.
Cannabis indica
Cannabis indicia contains a more balanced mix of THC and CBD. It has a moderate level of THC and very high levels of CBD. It has more calming, relaxing, and sedative properties. It tends to deliver a more full-bodied effect and may therefore be more appropriate for use at night as it can induce drowsiness.
Cannabis ruderalis
Cannabis ruderalis is essentially hemp with very low-to-zero levels of the psychoactive THC and high levels of CBD.
From these three cannabis species an almost infinite variety of combinations can be made up through crossbreeding strains and seeds. In the future, we may anticipate tailor-made strains that specialize in providing relief from certain symptoms specific to a disease or condition.
Forms of cannabis
Smoking is the classic form of consumption. It delivers the fastest onset and the shortest duration of effects. From a health perspective, smoking the plant gives off carcinogenic substances that are inhaled. It can also lead to pulmonary and lung issues. As a result experts will often recommend healthier alternatives to use medicinal cannabis.
Vaping is one of these alternatives. A vaping device is similar to an e-cigarette device. The vaping device heats the cannabis to a point where the cannabinoid vapors are inhaled but without overheating to the point of combustion which causes the smoke and respiratory toxins. It eliminates the dirty part of the smoke. Vaping has a very quick onset like smoking.
Oils or tinctures can deliver cannabis via an oil which is dropped under the tongue.
Sprays are also used in cannabis administration. Cannabis can be mixed into a liquid and used in nasal sprays or mouth sprays.
Topical formulations including creams, oils, and patches are also available.
Edibles are also common. This is where cannabis is mixed into foods. Common foods include candy, brownies, and other baked goods. Caution should be taken as the onset is typically delayed. It can take 1 – 2 hours before side effects are noticed. Secondly, it is also can be more potent when ingested and the effects can last longer.
Teas can also be made using cannabis as well as other drinks.
Pills can contain cannabis and help control the dose when made by an accredited manufacturer.
Suppositories can be used rectally and even vaginally for menstrual cramps.
What is medicinal cannabis?
Medicinal cannabis is a regulated and controlled formulation that may include pure or a crossbreed of hybrid strains to achieve a consistent and standardized ratio of CBD to THC and other chemical compounds.
The balance of these chemical compounds varies depending on the desired qualities of the treatment and the patient’s condition. The science of creating the optimal composition of cannabis-based chemical compounds to deliver the best therapeutic effect is in its infancy. There is tremendous potential for research to develop more effective treatments with fewer side effects.
Medical grade medicinal cannabis is different from what is considered “street” marijuana or cannabis. Street marijuana is not regulated. There are no guarantees of quality or composition. Those who obtain cannabis outside medical facilities or dispensaries have few assurances as to the type of cannabis they are receiving and any other potentially harmful substances or fillers that may be included. Street marijuana is often used for recreational use and is likely to contain significant levels of THC to deliver the psychoactive ‘high’ that recreational users seek.
Medicinal cannabis typically includes higher ratios of CBD to THC to maximize therapeutic benefit. THC levels are often insignificant which means patients may not experience any psychoactive effect or ‘high’ from use whilst still benefitting from its therapeutic properties. Current public perception paints all cannabis users, even those using medical formulations, as drug users seeking a ‘high’ which is simply untrue.
The controversy, history and politics of medicinal cannabis
The use of cannabis has evolved dramatically. In ancient times cannabis was used medically with roots in Western and Central Asia. It has been documented throughout Hindi literature, and 5,000 years ago Greek physicians used it for various aliments. In China, physicians used it for childbirth and joint pains.
Dr. William Brooke O’Shaughnessy introduced medicinal cannabis to the Western world in 1839. Based on his experiences in India as a professor and physician, he advocated for its use in pain relief and muscle relaxants. From around the mid 1800s to the early 1900s many prominent physicians prescribed cannabis. This included Sir William Osler, the father of modern medicine.[1]
These physicians used medicinal cannabis in both the prevention and acute treatment of headache. In 1845 cannabis preparations were listed on the US dispensary. It was produced by large pharmaceutical manufacturers many of whom still exist today including Bristol-Myers Squibb, Park Davis, and Eli Lilly.
In 1930 the Federal Bureau of Narcotics, which later became the DEA, began a campaign against cannabis led by Harry Anslinger. During the time of prohibition, cannabis was branded as a drug abused by minorities and low income communities. It was associated with psychosis, addiction, mental deterioration and violent crimes.[1] Some historians have argued that this was also to control the growing hemp industry. Hemp was widely used as a building material and provided strong fiber for clothing and fabric long before cotton.[2] The cotton industry had vested interests to see the use of hemp, its competitor, restricted.
Such claims and political agendas led to the Marijuana Tax Act of 1937 in the United States which delivered large fines and prison sentences to anyone with cannabis or hemp for medicinal or industrial use. This was despite the American Medical Association’s strong opposition to this legislation.[1] In 1941, cannabis preparations were removed from the United States Pharmacopoeia and National Formulary. Despite this, the editor of the Journal of the American Medical Association still recommended oral preparations of cannabis over ergotamine for menstrual migraine in 1942.[1]
Cannabis experienced a resurgence during the anti-establishment era of the 1960s and 70s in the US with its recreational use of marijuana. This counterculture image created a lasting impression that fuels much of today’s stigma associated with marijuana use. This is despite the overwhelmingly long and legitimate medical history of cannabis that existed for centuries prior.
The Controlled Substances Act of 1970 was the final nail in the coffin for marijuana. It labeled marijuana as a Schedule One drug alongside the most dangerous category of drug substances with no medicinal benefit. Marijuana was classified as dangerous as LSD and heroin. This new classification also prevented federal funding for research by making it illegal to conduct research in order to prove or disprove claims of medicinal benefit.
In 1976 a glaucoma patient sued the US government on the grounds that cannabis helped prevent glaucoma and vision loss. He won the case which led to a modest FDA investigation into cannabis use using a limited quantity. This closed in 1992. In 1996 California became the first state to pass the Compassionate Use Act which permitted medicinal marijuana. Since then lobbying has intensified from various medical associations and groups to reschedule marijuana from Schedule One to Two. This would enable research to be conducted and provide some access for patients who have failed standard treatments.
Medical groups and journals who have advocated for this transition include, amongst many others:
Image: dried cannabis flower buds
- Epilepsy Foundation
- American Medical Association
- American Academy of Neurology
- American Academy of Pediatrics
- American Journal of Public Health
- British Medical Journal
Today 29 states in the US have legalized medicinal marijuana use and 9 states have legalized recreational use. Federally, the DEA continues to refuse to change the “most dangerous” restriction. At the same time, the US government filed a patent for cannabinoids that was granted in 2003 for “cannabinoids as antioxidants and neuroprotectants”.[3]
Another contradiction to the Schedule One classification of marijuana is that the FDA approved synthetic versions in Dronabinol and Nabilone for medicinal use. Both treatments use key ingredients found in cannabis for medicinal treatment. The US government acknowledges the therapeutic benefit of cannabis with the approvals of these two treatments, yet the Schedule One status still remains.
What has reignited the cannabis debate?
In 2007 a young girl named Charlotte developed pediatric refractory epilepsy syndrome. She had literally hundreds of seizures per day and every medication she tried failed to help. Her parents had obtained all kinds of different and powerful medications which had significant side effects and were taking their toll. Charlotte remained unresponsive to treatment and within a few years her condition worsened until she was no longer able to walk, speak or eat. On several occasions she stopped breathing and came close to death.
As a last resort and in desperation her parents decided to try a cannabis oil. It was a blend that was high in the CBD and low in the psychoactive THC compounds. This meant Charlotte did not experience any intoxication or high associated with marijuana but still received the therapeutic benefits.
Astonishingly, her symptoms improved within hours and stayed that way. She improved dramatically and became a functional individual. Word began to spread within the epilepsy community and a flood of parents of children with epilepsy moved to Colorado where treatment access was available. Since then the treatment became known as ‘Charlotte’s Web’.
In 2013 the prominent CNN Chief Medical Correspondent, Dr. Sanjay Gupta retracted his anti-marijuana stance:
“Well, I am here to apologize. I apologize because I didn’t look hard enough, until now. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients whose symptoms improved on cannabis. Instead, I lumped them with the high-visibility malingerers, just looking to get high.
I mistakenly believed the Drug Enforcement Agency listed marijuana as a Schedule 1 substance because of sound scientific proof. Surely, they must have quality reasoning as to why marijuana is in the category of the most dangerous drugs that have “no accepted medicinal use and a high potential for abuse.” They didn’t have the science to support that claim, and I now know that when it comes to marijuana neither of those things are true. It doesn’t have a high potential for abuse, and there are very legitimate medical applications.
In fact, sometimes marijuana is the only thing that works. We have been terribly and systematically misled for nearly 70 years in the United States, and I apologize for my own role in that.”
From here advocacy efforts have taken off to lobby for fair access to effective and safe treatment. Many of the public still have uninformed views that people only take marijuana to get high, but this is gradually changing.
The US government’s restriction on research
Research has been greatly restricted due to the Schedule One classification of cannabis in the most dangerous category of substances alongside heroin and LSD. To date there are no placebo-controlled clinical trials examining the use of cannabis for headache or migraine. [5]
Little is known about the therapeutic role of the various other compounds that cannabis contains including flavonoids, terpenes, phenols, amino acids, vitamins, proteins, steroids, nitrogenous compounds, enzymes, glycoproteins, simple alcohols, hydrocarbons, ketones, aldehydes, fatty acids, simple esters and lactones, and pigments.[1]
In 2017, the National Academies of Sciences, Engineering, and Medicine released this report ‘The Health Effects of Cannabis and Cannabinoids: The current state of evidence and recommendations for research.’
They found “substantial” evidence[6] to support the use of cannabis or cannabinoids in:
- Chronic pain in adults
- Chemotherapy-induced nausea and vomiting
- Improving patient MS spasticity symptoms
They also found “moderate” evidence of efficacy in improving short term sleep outcomes in sleep apnea, fibromyalgia, chronic pain and multiple sclerosis.[6]
“Limited evidence” was found to support medicinal cannabis use in:
- increasing appetite and decreasing weight loss associated with HIV/AIDS
- MS spasticity symptoms
- Tourette syndrome
- Anxiety
- PTSD
Evidence for cannabis treatment in migraine
The substance classification of cannabis has greatly restricted large scale research investigations. Large scale randomized and placebo-controlled studies are needed to prove clinical observations and initial findings. The current Schedule One classification of cannabis makes this extremely difficult. As a result, evidence for cannabis-based migraine treatment is limited to a number of smaller anecdotal reports, case studies and surveys.
One of the larger of these studies was from 2016 in Colorado where 121 migraine patients who were recommended and prescribed medicinal cannabis were reviewed. The study found that over 85% of patients reported some level of decrease in their monthly migraine frequency. Falling from 10 to around 5 attacks on average per month. [7]
There have been larger, high quality studies conducted looking at the efficacy of cannabis for chronic pain. Studies have shown that medicinal cannabis and cannabinoid extracts increase pain thresholds and provide pain relief. In a review of 38 published randomized controlled trials 71% found that cannabinoids demonstrated a significant pain relieving effect.[1]
In the same study 91% of patients were using medicinal cannabis as both an acute and preventative treatment for migraine.
Below is a summary of recent research summarized in a peer-reviewed published study. [13]
A recent 2018 study evaluating cannabis use for migraine and headache found that hybrid strains were the most preferred option for treatment. “OG Shark” which has high THC relative to CBD was the preferred strain within this group.[14]
Cannabis involvement in migraine biology
Cannabis and its cannabinoids appear to work through several neurological pathways and electrical channels in the brain, nervous system, nerves outside the brain and spinal cord.[1]
In some of these pathways, they activate the same circuits and brain receptors that many migraine medications target. Cannabinoids including THC have been shown to have a protective quality against pain stimulation in the brainstem.[1] The brainstem is believed to play a central role in the generation of a migraine attack. It is also suspected to be involved in the transmission of pain.[1]
There is also evidence to suggest that the endocannabinoid neurotransmitter system is a potential target for migraine treatment. Triptans may act on the brain’s endocannabinoid system to help treat migraine attacks. [8] Activation of cannabinoid receptors in the brainstems may also reduce or prevent migraine pain by inhibiting cortical spreading depression and the subsequent migraine attack.[9]
A deficiency in the endocannabinoid system has also been theorized as a potential cause of migraine and other chronic pain disorders such as chronic migraine and medication overuse headache.[1]
Widely recognized migraine triggers are known to degrade the endocannabinoid system. This results in an imbalance that increases the levels of CGRP and other chemicals known to be involved in migraine.[1]
One study has suggested that cannabinoid compounds may be an effective treatment for migraine due to the platelet stabilization and inhibition of serotonin.[10]
Is cannabis an alternative to opioids?
CBD is several hundred times more potent than Aspirin[1] and there is some evidence that suggests it may deliver pain relieving effects similar to some opiates.[1] This is an interesting alternative given the US opioid crisis. Around 45 people in the US die per day from prescription opiates which are being used for various pain disorders. 60% of these deaths are from a legitimate medical prescription. [6]
There has not been one recorded death from overdose or overuse with medical cannabis. In the Journal of American Medical Association (JAMA) a study showed states with medical cannabis have a 25% decrease in opioid related overdose or death compared to those states which do not have medical cannabis laws. This suggests medical cannabis may be a legitimate weapon in the war against the opioids.
Cannabis may also address migraine comorbidities
Medicinal cannabis has a wide range of potential medicinal applications in conditions that are often comorbid with migraine. It’s important to remember that these are not high quality placebo-controlled clinical trials. Many of the studies that support its potential are anecdotal, case based or laboratory based. That’s why it’s important to remember this is a list of potential areas where there are currently promising signs for therapeutic benefit. These include[1]:
- chronic pain
- neuropathic pain
- fibromyalgia
- rheumatoid arthritis
- inflammatory bowel disease
- irritable bowel syndrome
- headache
- facial pain
- epilepsy
- dystonia
- depression, anxiety and mood disorders
- post-traumatic stress disorder (PTSD)
- autism
- nausea and vomiting
- asthma
- autoimmune disease
Watchouts and side effects
Many of the most significant adverse events related to cannabis use come from smoking cannabis. Smoking cannabis (as opposed to vaping, oils or other formats) causes the release of harmful toxins and chemicals due to combustion. See ‘smoking’ above.
Research evaluating side effects suggest that medical cannabis is very well tolerated. Side effects that did arise they were mostly mild or moderate and temporary. Few side effects were sufficiently significant to cause a patient to withdraw from participation.[1]
Common side effects include:
- Dizziness
- Dry mouth
- Disturbances in concentration
- Drowsiness
Less common side effects:
- Incoordination
- Imbalance
- Euphoria
- Paranoia
- Anxiety
Studies have suggested that tolerance to many of these minor side effects improves quickly with continued use.[11]
It is possible to have withdrawal symptoms from cannabis. One study showed that as many as 23% of patients may experience rebound headache after ceasing cannabis treatment. [12]
Cannabis edibles can be confused as foo. Children are particularly vulnerable. Candies, cookies, and brownies often look the same despite containing cannabis. Take care to keep these away from children who might confuse the edibles as candy.
Depression and anxiety is a common comorbidity with migraine. There is evidence that suggests cannabis can improve or worsen these two conditions depending on the type of strain being used. CBD to THC ratios can play an important role, for example, cannabis sativa strains are more energizing and uplifting which may be appropriate for depression.
On the other hand, cannabis indica strains are more relaxing and calming so these may be used for anxiety. Many patients with migraine also have some type of sleeping disorder. Cannabis indica may be utilized in this context to assist with sleep.
Long term use raises more questions and concerns. Cognitive impairment has been associated with long term use in adolescents who still have a developing brain. Some studies have demonstrated a drop in IQ and neural cognitive functioning in those who frequently used marijuana under the age of 21.[7]
In adults there are mixed results. Some studies have suggested that long term chronic use of cannabis in adults affected verbal memory recall (i.e. for every five years of frequent cannabis use, one in two people may recall 1 word less in a list of 15 words). Frequent long term cannabis use was also associated with cognitive processing speed. This decrease was slight but a noted concern.[7] More evidence supported by high quality clinical trials are needed to understand the full spectrum of risks and potential side effects.
In terms of serious risks, high risk individuals are those who may be psychotic or schizophrenic. These symptoms can worsen with cannabis use. Those with psychiatric disorders should not use cannabis.
In chronic cannabis use it is possible to develop a syndrome called hyperemesis where an individual experiences intractable nausea and vomiting.[1]
Lethal overdoses do not exist from cannabis. In terms of fatal risk, cannabis is 114 times less lethal than alcohol. There has not been evidence of a single death attributed to medicinal cannabis.[6] Note: illegal synthetic substances which may combine elements of cannabis with other chemicals. These substances can cause serious harm or potentially fatal overdoses (i.e. ‘K2’ or ‘Spice’).
Who should not use medicinal cannabis?
Due to the lack of definitive evidence, medicinal cannabis is still viewed as a last resort after standard therapies have failed.
Given the minimal side effects and safety profile of medicinal cannabis it may be a viable alternative to opioids which are also considered a last resort.
Caution is advised in the following patient groups:
- young patients under 21 are not advised to use cannabis due to its potential effects on the developing brain
- individuals with a history of substance abuse or addiction
- those with a psychiatric disease, especially schizophrenia or family history schizophrenia
- lung disease should avoid inhaling forms of cannabis
- pregnant and breastfeeding women
- those who are required to regularly drive, operate machinery and other hazardous tasks.
Where is medicinal cannabis legal?
There is a clear trend towards legalization. Current regulations and enforcement vary significantly between countries:
- Australia – legal
- Canada – legal
- Mexico – legal
- USA – legal in 29 states. Federally illegal.
- United Kingdom – illegal
- Many European nations have legalized medicinal cannabis which are not listed here.
If you would like to know about your country’s current status feel free to ask in the comments.
What should we expect in the future?
Expect more heated debates, controversial headlines and the progressive relaxation of strict marijuana regulations.
We still don’t know what combinations or ratio of cannabinoids and cannabis compounds are going to be effective for what disorder and symptoms.
New medicines may be developed based on cannabis plant-derived cannabinoids. These may be more effective in targeting specific diseases or symptoms, and with fewer side effects.
To discover these potential new treatments, much more research is desperately needed. Fortunately, research is on the increase. We are still only in our infancy of understanding all the functions within the cannabis plant and its potential.
This plant holds promise to deliver a whole new class of treatments across a wide range of disease, chronic disorders and symptoms. Medicinal cannabis presents an exciting new frontier for medical scientists and researchers which will ultimately benefit the patient.
What do you think? Is medicinal cannabis for migraine a new hope or a smokey haze with little real substance in it? Let me know in the comments.
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Article References
[1] Baron, Eric P. “Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: What a long strange trip its been…” Headache: The Journal of Head and Face Pain 55.6 (2015): 885-916.
[2] Fattore, Liana, ed. Cannabinoids in Neurologic and Mental Disease. Academic Press, 2015.
[3] Hampson AJ, Axelrod J, Grimaldi M. Cannabinoids as antioxidants and neuroprotectants. 2003. U.S. Patent #6,630,507. Available at http://www.google.com/patents/US6630507 (Accessed March 20, 2015).
[4] Gupta S. Why I changed my mind on weed. 2013. Available at http://www.cnn.com/2013/08/08/health/gupta-changed-mind -marijuana/ (Accessed March 20, 2015).
[5] Lochte, Bryson C., et al. “The Use of Cannabis for Headache Disorders.” Cannabis and cannabinoid research 2.1 (2017): 61-71.
[6] National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. National Academies Press, 2017.
[7] Eric Baron, Migraine World Summit Interview 2016.
[8] Akerman S, Holland PR, Lasalandra MP, Goadsby PJ. Endocannabinoids in the brainstem modulate dural trigeminovascular nociceptive traffic via CB1 and “triptan” receptors: Implications in migraine. J Neurosci. 2013;33:14869-14877.
[9] Kazemi H, Rahgozar M, Speckmann EJ, Gorji A. Effect of ccannabinoidreceptor activation on spreading depression. Iran J Basic Med Sci. 2012;15:926-936.
[10] Volfe Z, Dvilansky A, Nathan I. Cannabinoids block release of serotonin from platelets induced by plasma from migraine patients. Int J Clin Pharmacol Res. 1985;5:243-246.
[11] Grotenhermen, Franjo, and Kirsten Müller-Vahl. “Medicinal uses of marijuana and cannabinoids.” Critical Reviews in Plant Sciences 35.5-6 (2016): 378-405.
[12] Karschner EL, Darwin WD, McMahon RP, et al. Subjective and physiological effects after controlled sativex and oral THC administration. Clin Pharmacol Ther. 2011;89:400–407.
[13] Baron, Eric P. “Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science.” Headache: The Journal of Head and Face Pain 58.7 (2018): 1139-1186.
[14] Baron, Eric P., et al. “Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort.” The journal of headache and pain 19.1 (2018): 37.
Australia – legal??? Ahh, it would be far more appropriate to be saying Federally approved IF (and that’s a BIG ‘if’) you can pass all of the regulations the Australian Federal Gov’t have put in place and then get approval from the designated state gov’t to have access. Presently the only people who can obtain such approvals are the big pharmas, who would much rather sell you their concoctions. So although federal legislation may say ‘legal’, you have a snowballs chance in hell of ‘legally’ obtaining it.
True. It is practically speaking. Difficult to obtain in Australia without a very willing doctor with the drive and will to support your application.
Thank you! I have had amazing benefit from cannabis use for the past 6 years! I went from full disability and bedridden with chronic migraine (for about 7 years) to restoring my life! No longer in disability and work full time. I still get 1-2 migraines per month but they treat nicely with cannabis and I rarely miss a beat!
What strain do you use and how do you take it? Cheers
Fantastic Terri, so glad you’ve found such relief from migraine. This is a promising frontier for many people.
Is there a specific strain of cannabis that worked for you? Did you find that you needed a certain minimum level of CDB and/or THC to get relief? You give hope to chronicle severe migraineurs!
What strain do you use?
Cannabis approval in Australia can be obtained for certain conditions/ailments, again if you can pass all of the regulations in Australia. Chronic migraine is NOT one of those listed ailments.
…not yet. Work perhaps for Headache Australia – the national patient advocacy group representing migraine and headache patients.
Please stop spreading misinformation about the legality of medical cannabis in Australia. Its indications are so limited that physicians must have every patient approved federally on a case-by-case basis. This is not the same as medical cannabis access in other countries and it is not helpful to the migraine community as migraine of any severity and chronic pain are not approved indications in Australia at this time. Your community members will have no luck seeking this treatment in Australia under current legislation.
Personal experience – marijuana has been an incredibly effective abortive for me and has helped me break the cycle of triptan and opiate use. However it’s just not a sustainable practice for me with the laws the way they are. I believe its effects would be life-changing if we had access here. I pray this will happen in my lifetime.
Hi Anne, medications are often used "off-label" when prescribed by a medical professional. It’s not illegal for patients with migraine to use medicinal cannabis even if it’s not indicated. Could it’s access be improved? Yes. An argument could be made that access could be improved everywhere at this point in time. Certainly, it is difficult in Australia but it is not misinformation say medicinal cannabis is legal in Australia, as the article states.
Is it available on Long Island, New York for migraines?
Yes, it is legal in NYS if you get a prescription from a licensed physician. Look into Dr. Mauskop at NY Headache Clinic on upper east side. Great migraine doctor in general, and can prescribe if you are looking for medical cannabis
I strongly encourage people to explore this topic, even if it is just research and not actual use. Yes there is a stigma, but the stigma will change when people understand the wide range of people who can benefit from medicinal cannabis and the ways the growing and medical communities have worked to develop plant strains and delivery technologies that minimise the negative or undesirable effects of cannabis use and preserve the beneficial ones. This isn’t your neighbor’s teen son’s pot smoked with a bong and a blacklight anymore! You may be really surprised at just how far things have come. Go into it with an open mind.
Cannabis legalisation is also a much-maligned topic in politics because it’s associated with certain lifestyles, counter-cultural groups and left-of-center parties, but I sincerely hope that members of the migraine community, chronic pain communities and friends and family who are interested in cannabis treatments for migraine and pain will realise that the only way access will be expanded is if we make it a priority to put our vote to use when this issue comes up at the polls. Please don’t hope for other people to make it happen! If you want it, find out who is lobbying to improve access in your community and support them. Our legislators need to see that we want safe and regulated expanded access. This is especially important for the invisible illness community because we are rarely seen OR heard on issues that are politically important to us. Marijuana legalisation in some form is a topic that comes up at the polls fairly regularly. Make it a priority when you decide where to use your vote!
Well said Sue. I would encourage anyone who is passionate about seeing a change to join or support the organizations working to improve fair patient access.
Hello,
I am in Australia and have tried to get medicinal marijuana. My specialist will complete all of the forms, but the government is asking for medical proof that it works. As there has been no trials to prove that it works, I cannot receive it.
I have been smoking marijuana for 5 years so I know it works but I want the high to go away and for my medical use to be legal.
I have anxiety , depression and sleep apnea, all created from my daily migraine. I have tried over 20 different drugs, with little relief. Marijuana is the only thing that works. While in the USA, I tried CBD, which helped with my anxiety, depression and sleep apnea, but it did not take away my migraine, so I tried CBD 3 to 1 ration THC and it solved all of my problems. My migraines disappeared.
Marijuana on the streets here is not the right type to solve my health issues.
Does anybody have sufficient evidence for the Australian government to fulfill their requirements.
Hi Kathy, refer to source 5. This contains a great summary of the evidence available so far.
My experience with marijuana started 20 years ago as a regular smoker. 3 years ago I started experiencing severe vertigo and migraine which has since been diagnosed as vestibular migraine. When these symptoms started if I smoked even 1 hit of marijuana it would trigger an attack. I have had to completely avoid it ever since. Even though I did have benefits from it for years for anxiety and depression, it does trigger my migraine symptoms immediately so beware.
Thank you for sharing your experience Jennifer. Its important people understand the risks involved.
Excellent point. The article talks of “Charlottes web” and the miraculous cure that marijuana was for that patient – and it truly was an amazing treatment and helped that young girl immensely. What I did NOT see in the article is that THC tends to make that epileptic condition worse and its the CBD that helps severe epilepsy in childhood.
Jennifer, I am researching a bit. Few studies out there on Medical Marijuana for Migraines and not sure if there are any specifically for Vestibular Migraine. Researching to see what type would help my Vestibular Migraines best. I’m in Atlanta Ga area where finally they have MM for certain conditions. I tried one type of MM which helps some but I can’t take it in the daytime as it makes my balance problems worse. But after 3 wks of taking the RSO each night, I am hopeful it is decreasing frequency etc of migraines, ok only thing is that the RSO type does nothing for the vertigo.
Thank you for this informative article. I hope it helps to clarify what medical MJ is and helps many!!
I am – rather was- a chronic migraine sufferer for 25 years. Unequivocally, medical mj has reduced both frequency and duration of my migraines – from 4 per month (plus predrome/postdrome) to one every couple months and it keeps getting better.
As others, I have tried many many treatments over the years, most with limited success. One year ago, I started medical mj (out of desperation) and after reading Neuroscientist Dr. Ethan Russo’s work on chronic cannabidiol deficiency and his recommendations.
I use both CBD on non-symptomatic days for the anti-inflammatory properties, and a high ratio (50/50) THC/CBD concentrate suspended in oil for abortive treatment. I do not smoke it for migraine relief as I find that to be an irritant. EVEN IF i break out into a migraine, the effects are mild and completely tolerable. I may be symptomatic (unilateral head pressure, nasal congestion, tinnitus, sound/light sensitivity but NO PAIN!!) No more Triptans! (my husband calls them my monster drugs because of personality changes). My family notices how much happier I am now! geesh.. after all those years 🙁
I live in Canada (yay) and though my primary care physician would not sign a medical card for me (ouch!) I found a naturopath who did, though that was their only involvement in the process. I plan on going back to my physician this summer (one year anniversary) and starting a dialogue with him on the success of my treatment.
My life has been greatly improved. I hope the rest of the world wakes up and see’s the evidence on this plant and it’s properties. At the very least offer it as am alternative medical treatment. No, it may not work for some, but isn’t this the case with most treatments? The evidence is mounting for it’s efficacy in a large portion of migraine suffers.
The one drawback at the moment is the lack of medical research to begin a standardized treatment. My experience has been based solely on my research, trial and error. I still don’t know if the strain/dose I am using is the best for me.
Now that Canada has fully legalized I hope that more pharmacologists will formulate a specific plant strain for neurological properties and dosage. There is hope ahead!
Tam – In Canada
Agree Tam. Well said.
Hi there Tam
Could you please provide the exact strains and product you’ve purchased as I am in Canada too and suffer from chronic daily migraines
And I’ve tried different oils and some of the ones with THC in them trigger or worsen the migraine for me so I really would like to know which exact strain and product you’ve tried that works for you
I will be ordering off the Ontario cannabis store website
Thank you
I am a premedical student who suffers from migraines. I am looking to get involved in endocannabanoid research and was wondering if anybody knows which labs around the US are leading this sort of work? I know federal funding for medical marijuana is not available, but are there any privately funded projects? Any federally funded endocannabanoid research projects that are not marijuana based and therefore still get funding?
Fantastic! We need more people like you.
Great questions. I would start with the authors of the research published in this area. They will know. A review of the sources listed in the article might be a good starting point. Dr. Stephen Silberstein is also involved in this area at Jefferson.
I think we need to end the hypocrisy that classifies cannabis as bad and dangerous, and alcohol as just fine. In terms of research, I suspect what is also holding it back is its limited appeal for pharma companies in terms of patents.
Agree. What’s holding further research back isn’t pharma. There’s lots of money to be made from more effective treatments. It’s government, outdated misperceptions and the current classification as a Schedule One substance in the US.
When you state that "medical cannabis" is legal in 29 states, but federally illegal, are you referring to CBD that has the lowest amount of THC in it? Or, by "medical cannabis" do you basically mean "medical marajuana"? CBD oil IS legal federally and otherwise in the USA, right?
This is where there is confusion. I’m not sure CBD oil is legal federally beyond the two brands who received FDA approval. Technically CBD oils are still cannabis (depending on the makeup of the oil) and cannabis remains illegal federally. This inconsistent stance causes confusion and could be seen to be hypocritical of the government to have a banned substance on one hand (as Schedule One), yet approval by another government agency with the FDA on the other hand.
The two brands mentioned in the article who received FDA approval are for synthetic cannabis and I am fairly certain they are primarily a THC product, not CBD oil.. They are a very purified isomer and thus lacking the other several hundred compounds that make up marijuana and so the experience of taking these products differs somewhat from the “real thing” (in terms of getting high – of course every person’s experience is different)
Wrong. Sort of. In the USA, any sort of marijuana, whether you call it cannabis or THC or CBD, it is illegal federally. However, you can get two drugs, Nabalone and Dronabinol which contain synthetic forms of cannabis and are legal to take anywhere in the US. But any form of natural cannabis is not legal federally.
I’m really hoping that the recent events in the UK will lead to lots of research and (as soon as possible) the legalisation of medicinal cannabis for many conditions that do not respond well to synthetic drugs.
Agree Di. More research, more evidence and more options for patients.
What "recent events" happened in the UK? Please expand on this? Thanks in advance
Thanks for the article, Carl. I just started a CBD oil under the tongue 2x a day and I do think I’m seeing it help my sleep and mellow out pain during an attack. I hope to see further benefits with more use. Luckily, I have lots of options in a US state where marijuana is legal in all forms, including growing for personal use. Since I can’t smoke, the oil is working for now. I appreciate your research!
On a related note, have you ever looked into the work of Angela Stanton? I am just discovering her research and it is fascinating, on the electrolyte imbalance in neurons that may lead to migraine, and the "ancient brain" DNA theory that explains migraine biochemistry. I would love to hear her speak at next year’s World Summit.
Thanks for all you do!
Hi Christine, thank you for sharing. Smoking is not a healthy way to take cannabis. Oil is an effective delivery that doesn’t compromise the lungs the way that smoking does.
Yes I have heard of her. I know what she proposes can help people and it may be part of the puzzle for some but it’s certainly no cure. We’re reviewing all the speakers and voting from the community which recently closed.
Thank you for your kind feedback.
Hey Carl, thanks this is a brilliant piece. Lots to consider and let’s hope we see more research into this area. I haven’t considered it as a treatment option but good to read everyone’s comments on their experiences so thank everyone for sharing : )
Couldn’t agree more Jane. I was the same prior to really looking into this space. Like many others I’ve changed my opinion as I learnt more about the facts. It’s an exciting new field. And as you said it’s so great to hear from others about it.
I have found marijuana to be a reliable tool in migraine relief as well as helpful in aborting migraines at the onset. I also suffer from anxiety and it always relieves panic attacks as well as aids in lifting depression. I am looking forward to the day it is legal everywhere in the US and the stigma is gone.
That’s great to hear Annie. I look forward to that day too.
I have been using cannabis for 4 years to abort migraines. I have a puff of sativa dominant and go into my dark room. I put ice on my head and close my eyes and meditate. In 10 minutes the headache has lifted and I feel great! I am so glad I don’t have to take opioids and triptans any more.
That’s a fantastic result! Also very interesting. Thank you for sharing the strain as well Robbie. Good to know.
Thank you! Great article! Can you tell me where/how to find a good Medical cannabis Doctor in the Greater Phoenix AZ area? Thanks in advance.
Hi Leslie, if you type your question into Google there are several options and directories which come up which you might like to explore.
My mom died because of a brain tumor. At first, she is experiencing severe headache from time to time. We went to a doctor to ask whats happening to her but they said its only a migraine, so he gave a medicine to cure the pain. She was bedridden at that time. 1 month later when were busy on something i heard my mom shout because of her head and that point we ran to the nearest hospital but sadly her journey is over. Yes, she died when that thing happens to her. We don’t know if who’s fault is that because the doctor in that hospital told us she has a brain tumor and all this time we only know that its a simple migraine. It’s been 11 years now but i still remember what happened to her. I am experiencing migraine now and i am afraid maybe one of these days it can happen to me also. But i read this article https://www.worldwide-marijuana-seeds.com/ that maybe marijuana can cure a migraine, i don’t know if this thing works so i want an opinion here. If somebody uses it already? Can you help me with this?
Hi Bella, words can’t explain how sorry I am for your loss. To clarify… there is not yet any evidence to demonstrate the medicinal cannabis will cure migraine. There is potential showing that it could help. But much more research needs to be done and strains need to be identified. We may even find that different strains work better for different people with migraine. We have a long way to go. I’d encourage you to subscribe to MigrainePal to stay up to date with the latest information.
Does migraine fall under the chronic pain section in qualifying for medical marijuana in Pennsylvania?
Great question. I don’t know from the top of my head. Rules may differ by state. Best to speak to a local expert in your state.
Sadly it doesn’t work for my neck pain and migraine. Tried medical CBD oil for 3 months daily to no effect. Very disappointing. Cutting out dairy reduced it more. I have suffered for 35 years and hope to find something that works for me.
Have you heard about the new generation of treatments called the CGRPs? More info is here:
As I am looking to create a business based on hemp, I find your article explaining that it can help heal different kinds of pain such as a headache, rheumatoid arthritis, and nausea. With this, my first step is to find a supplier of hemp. Finding a supplier of organic hemp would not only help start my own product line of hemp wellness products but also contribute to the industry as well.
It is early days for the industry but overtime I suspect it will become more regulated with quality and packaging standards required for consumers to better navigate and discern between products and brands. All the best Tim.
Hi, my personal experience is that after taking small doses of tinctures of CBD alone, THC alone and/or CBD with THC for rebound headaches, when I stopped using it, I got rebound headaches from that. It doesn’t work as a preventative for me.
Hi Heidi, thank you for sharing your personal experience. Were you working with a doctor to determine that or did you keep a diary? Sometimes a person with migraine can stop a preventive medication and start getting attacks again. For a designated preventive medication, attacks can return because the treatment was effective. With CBD we don’t really know yet if it works preventively or not at a population level, or if it can really cause overuse headaches or rebound attacks.
I like how you mentioned that studies have shown that medicinal cannabis and cannabinoid extracts increase pain thresholds and provide pain relief. I have struggled with super bad migraines since I was a child, and am always looking for ways to relieve my pain. I will definitely keep all of the great benefits of cannabis in mind when deciding if ti would be a good option for me.
The evidence is not strong, but there is potential for this Brooklyn. Until we get more robust studies and research we won’t know for sure. But certainly it is an exciting area of development. The more options we have the better.
How interesting that CBD works like opioids and it is a hundred times more potent. My dad has suffered from migraines for many years. I Will suggest he visit a cannabis dispensary for more information.
I live in a Australia. I used Cannabis to treat IBD after side effects from prescription meds (in my state medical cannabis is not legal for IBD). During that time I noticed that I had almost no migraines at all, where as I would get them at least each month and they are completely terrible and disabling. When I stopped using Cannabis the migraines returned. I need to take iron supplements continuously and I believe they can act as a trigger for my migraines, so I often skip them. When I am taking Cannabis I can take the full dose of iron every day and still I don’t get migraines.
If I decide to put my health above the law again and take Cannabis, I now see there are oils available. What I need to work out is what is better for migraines, THC or CBD ? I did try some THC / CBD oil a while again when I had a migraine coming on and it knocked it out flat … but I got itchy from the oil so don’t want to take it all the time. If I look for more pure oil should it be THC, CBD or a mix ? It was a plant material that kept the migraines at bay in the past .. high THC / low CBD.
Hi Steve, the research is still in its infancy and if you are finding great results with a current treatment then maybe considering another format (rather than oil) to dose with. I certainly cannot encourage going outside the law but it sounds like you have already found a formulation that works and just need to refine the treatment format.
Hi Carl,
Thx for your reply. Yes I ended up just using the plant material with a vaporizer. I have had several months of zero migraines, its been wonderful.
Another side benefit for me is that it drops my BP by about 20 S points and 10 D points … I have borderline high BP so this is a great benefit for me. I was worried that it would cause an increase in BP when I first started which it does for the first couple of days after a vape and then it drops (even when not ‘high’) .. I even have it graphed if you wish I can send to you. That could be an issue for those with low BP though … also when I stop my BP spikes up to above baseline for a couple of weeks which I don’t like.
Anyway due to the current situation with restrictions I am unable to get a supply of the medication at the moment and have been out for several weeks. Yesterday I had my fist migraine for months … you forget how bad they are, they just suck the life out of you.
It’s crazy that this drug that helps my bowel, lets me take my iron, totally stops my migraines and drops my BP is illegal as often hard to get a regular supply of. It replaces a hand full of pills and horrible side effects.
Thanks again for your reply and stetting up this chat for people.
Regards
Steve
It is indeed strange that it has had all this history and negativity despite real benefits for many people. I think that will be proven time and time again as more research is conducted and bans lifted.
I have suffered chronic migraines since I was a teen now in my fifties I finally found medical marijuana. I was getting 2-3 migraines a week that basically put me in bed, I tried all types of doctor meds and when they no longer worked the doctor wanted to prescribe heavier meds, which I refused as the side effects were as bad as the migraines. I started to research migraines and alternatives and came across using marijuana. I found a company that helped me get my medical license and also a doctor that would work with me. The results have been life changing I only get the occasional migraine like 1 a month and no longer puke when I do get one. I take cbd oil from a license producer not the hemp crap a true marijuana plant that has less than 1% thc I take it 2x day morning and night approx .7 ml to one ml, that is the preventative took about ten days and I really started started to feel a difference and if I feel a migraine starting I use a vaporizer and use a high thc strain like og kush and it can get rid of it in around ten minutes. Sometimes if I am at work and I can’t take anything the migraine can get set in and it’s realty hard to completely get rid of it but the marijuana will at least make it so I can function not bed ridden. For anyone that is looking for migraine relief find a doctor that will work with you and give it a try
Thank you for sharing Marty. Very encouraging to hear.
Great summary article! I’ve a pretty good understanding, and was looking for an unbiased assessment with good technical information. Well written and concise! Appreciate it.
Thank you Ts. I’m glad you enjoyed the article.
I was initially searching for auras because my neurosurgeon introduced me to that word a followup appointment. My search led me to this website and due to my struggle with my eyes now I switched devices and found this part which discusses cannabis and it’s relationship with treating migraines. My question/comment is not cannabis related since that’s not an issue for me but is aura related. just before it was determined that I should have brain surgery for resection of brain tumor(s) I was experiencing what my doctor has told me were auras. I was diagnosed with stage 3 lung cancer in the fall of 2018 and have had major treatment for that since then. I have felt “unwell” since then and have been on a lot of drugs as a result of my condition. In the spring of 2019, I had a seizure and later learned that my lung cancer is now stage 4 and my seizure was a result of metastasis and 3 tumors in my brain. At first, the least invasive treatments were utilized. I had two gamma knife radiation therapies and one stereostacit radiosurgery. After each of these, I was prescribed strong steroids and anti seizure medications to name a few of my prescriptions. Before the most recent event, I was having auras apparently. I thought that my prescriptions were making me see things. Now that it’s been almost 6 months into this I’m getting more knowledgeable about the anti-seizure meds and steroids. I find that it’s “getting real”. Here’s the thing, I’m afraid of having another seizure/brain surgery. Are auras a symptom in my case that another event is going to happen?
I’m sorry to hear about your cancer and I wish you the best of luck with your treatment. If you hadn’t mentioned cancer (and all of the associated treatments that brings) then I would have said that aura is just a symptom of migraine. Sometimes it is the only symptom. But when cancer and other issues are involved then the aura could be a secondary factor (i.e. caused by other factors). I’m not a doctor and I don’t know the answer to that. For aura, to get rid of aura without headache the treatment and strategies are essentially the same as managing migraine with head pain. For more information about aura visit this page >>
Sorry for my typos above. I didn’t proofread.
Does medical marijuana help people with vestibular migraines?
It is too early to say if it helps with any type of migraine in a definitive way. Also, consider that there are hundreds of subtypes of medicinal marijuana… all of which could act in different ways. It is more complicated than people realize but a very interesting area for potential future treatments.
We should really expect so much debate about this matter and maybe because some of us used it too much and government are worried that it would be abuse in the future.
I suffer from terrible migraines frequently. They have taken away so much of my life.
When I use Cannabis habitually I don’t get migraines at all something I only discovered in my 40s. Cannabis completely stops them. Sometimes I get a mild normal headache for the first day or 2 of starting the cannabis but thats all.
It’s illegal in my country (Australia) but I have to put my health and well being above a silly law. It’s the right thing to do.
Ooops I just realised I posted here before !
Anyway I since had several months on plant material cannabis and it was bliss, not from the high (not that I mind that) but from the fact I had NO migraines !
I ran out a few weeks ago and yesterday I had my first big whopper of a migraine .. another day and night wiped from my life. . I’m still recovering today and hoping I don’t get a rebound on the other side tomorrow.
Can’t wait to get back on the Cannabis ASAP. !!
Good Job! Thank you for sharing this informative blog.