Posted on

Dose of cbd oil for headache

Best CBD Oil for Migraines & Headaches: Benefits, Dosage, & Side-Effects

Migraines can turn an otherwise normal day into a complete write-off — and they’re notoriously hard to treat.

CBD may help by regulating serotonin release, fighting inflammation, controlling vascular spasm, and more.

Article By

Migraine headaches are the most common neurological disorder in the Western world . They affect roughly 6% of males and 18 % of females every year.

Most of the treatments for migraines involve prophylactic and/or symptomatic support rather than addressing the underlying cause.

One of the best candidates as a new, effective treatment for migraine headaches is cannabidiol (CBD) from the hemp plant.

In this article, you’ll learn how CBD can help with migraines, how much CBD oil to use, and where to find the best CBD oils for cluster headaches and migraines.

MEDICALLY REVIEWED BY

Carlos G. Aguirre, M.D., Pediatric Neurologist

Updated on November 13, 2021

Table of Contents
Recommended products
$49 – $229
Royal CBD
Royal CBD Oil 30 mL

5 / 5

Total CBD: 500 – 2500 mg
Potency: 16.6 – 83.3 mg/mL
Cost per mg CBD: $0.12 – $0.18
Extract Type: Full-spectrum
THC Content:

Best CBD Oils For Migraines

  • Royal CBD Oil— Best CBD Oil For Migraine Headaches
  • Gold Bee CBD Oil— Best Organic CBD Oil
  • Endoca CBD Oil— Best CBD Oil For Migraines (Europe)

Can CBD Oil Help With Migraines?

One of the most common traditional the cannabis plant is for treating headaches.

Over the past few years there’s been a lot of research exploring the impact of CBD and other cannabis-derivatives for treating migraines and other forms of headaches.

Hemp extracts have so far been proven effective for chronic headaches [18], migraine headaches [6], headaches resulting from medications [19], cluster headaches [20], intracranial hypertension [21], and multiple sclerosis neuropathic head pain (trigeminal neuralgia) [23].

CBD (cannabidiol) is the primary compound responsible for the painkilling benefits of the plant and the most relevant compound for the anti-migraine effects.

Other related compounds (called cannabinoids) offer additional support. The best CBD oils for migraine headaches are made from a full-spectrum extract that contains a variety of active ingredients — such as CBG (cannabigerol), CBC (cannabichromene), THC (tetrahydrocannabinol), and several hemp-derived terpenes.

All of these compounds work alongside CBD to support the painkilling effects of CBD and provide other anti-migraine benefits.

Some of these compounds prevent the release of serotonin from platelet cells (one of the main causes for migraine attacks), others regulate inflammation and blood flow to the brain.

The benefits of CBD oil for migraines include:

  • May prevent serotonin-related causses
  • Inhibits brain inflammation
  • Prevents or alleviates vascular spasms
  • Alleviates head pain

1. May Prevent Serotonin-Release (Cause For Migraines)

We’ve long known about the ability for cannabis to inhibit the release of serotonin from the platelets [4].

This effect could help prevent and treat migraines caused by excessive serotonin release from platelets — which is one of the predominant theories for the underlying cause of migrane attacks (more on this later).

Interestingly, this same effect on serotonin release is also considered one of the primary ways CBD can be used to treat nausea and vomiting, which are also common symptoms associated with migraine headaches.

2. Inhibits Brain Inflammation

One of the ways marijuana was used in the past to treat headaches, was by wrapping its wet leaves around the head and neck for several hours at a time [6]. This practice, mainly documented among the Sumerians, is most likely a direct result of these anti-inflammatory effects.

Modern treatments of migraines often involve anti-inflammatories such as Aspirin or Tylenol.

CBD exerts its effects through a number of different anti-inflammatory mechanisms including adenosine [8] and NF-kB [9]. Both of these inflammatory channels are considered the primary causes of migraine headaches.

3. Reduces Vascular Spasms

The trigeminal nerve is responsible for causing the vascular system in the brain to spasm out of control — causing cluster headaches and migraines.

One of the main reasons this happens is hyperactivity involving the N-methyl-D-aspartate (NMDA)/glutamate system. This system is responsible for causing many of the stimulating activities in the brain.

It’s like the gas pedal in the car. Once activated, RPM increases and the car goes faster.

In the brain, it’s very similar — when NMDA is active, your neurons fire faster and faster.

Much like a car, the brain also has a brake pedal. We call this Gamma-aminobutyric acid – or GABA. It slows us down and helps us relax, directly opposing the effects of NMDA.

In some cases, NMDA activity can go out of control, causing the trigeminal nerve controlling the vascular system in the brain to go haywire and spasm. This results in severe migraine headaches, which can last hours on end.

CBD slows this process down by stepping on the brake pedal (GABA) [10], similar to Valproic Acid, slowing everything down, and stopping the arterial system spasm.

4. Alleviates Head Pain

CBD is a master modulator. This means that it doesn’t work on any single pathway, forcing it in one direction or another.

This effect allows CBD to help regulate how much pain we perceive. Like playing with the volume control on your speaker system it can help “turn down” the volume on pain.

When we experience migraine headaches, the pain volume is cranked all the way up.

CBD helps promote the processes that are meant to control this by telling some of the responsible receptors (such as the TRPV1 and opioid receptors) to step up and turn the volume back down to an appropriate level.

There are 10 times as many CB1 receptors as there are mu-opioid receptors in our central nervous system and pain pathways [16,17]. This means the CB1 endocannabinoid receptors are likely a key regulator of pain sensation within the brain, and intimately involved with the regulation of migraine or cluster headache-related pain.

What’s the Dose of CBD Oil for Migraine Headaches?

Dosing CBD can be a challenge, especially since it tends to react differently in everybody.

For some people, a small dose is all that’s needed to produce effects, while others need much larger doses. This can make dosing difficult at first, but once you understand how it works in your body, it’s very straightforward.

There are some general CBD dosage guidelines you can follow for figuring out the right dose to start with, and how to dial it effectively.

With that said, it’s important to note that many people who are prone to migraines tend to be more sensitive to chemicals. For this reason, we recommend starting slightly below the lowest recommended dosage for your weight and build up slowly from there.

CBD Dosage Calculator

Embed this map on your site

Copy and paste the code below

How Long Should I Use CBD Oil for Migraines?

The key to using CBD oil effectively for migraines is to use it regularly over long periods of time, in addition to your routine prescriptions.

By taking small doses of the oil throughout the day – usually once in the morning and once in the evening — you’ll be able to improve your body’s natural ability to maintain neurovascular balance and avoid spiraling out of control into a debilitating migraine attack.

Many people taking CBD oil for this will increase the dose when they feel a migraine attack coming on to stop it in its tracks or reduce its overall severity.

For example, a migraine sufferer might take 5 mg worth of CBD in the morning and 5 mg in the evenings most days. When they feel a migraine coming on, they take another 5 mg every 2 or 3 hours until it subsides. However, you should also keep taking your prescription medications for prevention and treatment.

What are Migraines?

Migraines are a type of severe, recurring headache accompanied by at least one, or various, physical symptoms such as nausea, vomiting, and sensitivity to light or sound.

In many cases, these headaches only affect one side of the head and cause throbbing pain. They may also be agitated by movement, and are of enough intensity to interfere with daily function.

Migraines typically last 4-8 hours (typically all day), but can last as long as three days (72 hours).

Along with headaches, migraine sufferers also commonly experience other symptoms such as nausea, sensitivity to light, sound, and smells, as well as visual disturbances.

Four Phases of Migraine Headaches

Migraines tend to have distinct phases. These aren’t always present, and they can vary a lot from one episode to the next.

Phase 1: Prodromal Phase

This phase can begin either days, hours, or minutes before a migraine attack — it’s a common warning sign that a migraine is soon to ensue.

It may involve a wide variety of symptoms that appear before the actual headache. People with chronic migraines tend to learn what their triggers and early symptoms usually are. These feelings should prompt people to take their preventive medications.

Some common symptoms of the prodromal phase include:

Phase 2: Aura Phase

During the aura phase, people experience strange changes in their vision and/or perception. It can change the way colors look, how we interpret smell and taste and can alter our mood dramatically.

The aura phase typically lasts about 1 to 2 hours.

For most people who experience regular migraines, this is the most reliable indication that they are about to have an episode. Some people can even estimate how severe their migraine will be from the severity of the aura phase.

Symptoms of the aura phase can include:

  • Vision disturbances
  • Changes in perception of taste, light, smell, sound, and touch
  • Speech or language problems
  • A spinning sensation
  • Muscle weakness
  • Auditory or visual hallucinations
  • Paranoia
  • Fatigue
Phase 3: Pain (Headache) Phase

This is the main phase we think of when we talk about migraines.

This phase can vary a lot in severity and is usually very unpredictable, even in people who have regular episodes of migraine headaches.

In most cases, migraine headaches only affect one side of the head but can affect both sides equally as well. Some people feel the pain at the front of the head, others at the back, and some in the center.

However, if you suddenly experience the worst headache of your life that feels like a clap of thunder all over your head, or have had a migraine for over 72 hours, please go to your nearest emergency department right away.

Symptoms of the pain phase include:

Phase 4: Postdrome Phase

The postdrome phase happens after a migraine has settled.

Many people who experience these say they resemble a hangover but can last for several days. Some will even feel pressure or low-grade pain in the places where most of their migraine affected.

It can leave people feeling fatigued and depressed for a few days after the event.

In some cases, people may find that during this phase they feel unusually refreshed and clear-headed. Some reports even suggest a euphoric state for as long as a week after the event.

What Causes Migraine Headaches?

Migraine headaches tend to be very elusive to researchers. They’re hard to predict and even harder to trace back to any particular cause. Migraine headaches tend to be very elusive, however, researchers today have a better understanding of the basis of migraines.

From stress and hormone levels to allergies and chemical exposure — these are all considered factors and potential causes for migraines but can vary a lot from one person to the next.

Common Migraine Triggers
  1. Mental — Stress, emotional upset
  2. Endogenous — Hormonal changes, fasting, fatigue, sleep disturbances
  3. Exogenous — Certain foods (chocolate, wine, aged cheese, etc.), alcohol, smoke, allergens, nitrates, oral contraceptives, glutamate, tyramine
  4. Other — Weather, bright colors, odors, temperature changes, altitude

One of the main factors new research is investigating is hormone levels.

This is because migraines are more common in young boys just before puberty and 2 or 3 times more likely in women than men. Additionally, migraines tend to decrease during pregnancy and menopause.

All of these factors can be traced back to fluctuations in hormone levels, though scientists still don’t know exactly how this works, but there are several strong theories as we’ve listed below.

There are several prominent theories at play [14] which are most likely the actual causes of hormone-related migraines including:

  1. Serotonin/platelet theory
  2. Sensitization of peripheral and central brain areas from inflammation
  3. Muscular spasms of the veins and arteries

Let’s cover some of the main ones now and how they’re correlated with CBD.

1. Serotonin & Platelet Theory

Serotonin is a neurotransmitter and has many roles in the body. It regulates much of our emotion, sexual function, hormone balance, and memory.

One of the leading theories for the cause of migraines is an excessive release of serotonin from platelet triggers.

What does this mean?

A platelet is a type of cell that floats around in the bloodstream and plays an important role in the way we monitor and control coagulation and inflammation in the body — among other things. One of the ways we do this is by releasing small amounts of serotonin.

In some cases, these platelets can overreact to the situation and dump large amounts of serotonin into the bloodstream, causing blood vessels to widen and lose pressure. This essentially causes regions located near the area to go into shock [1].

When this happens in the blood vessels of the brain, it can cause the widening of blood vessels and release of inflammatory signals causing symptoms such as severe pain, disorientation, and hypersensitivity to stimuli like sight and smell.

What this means: If we can stop the excessive release of serotonin from the platelet cells, we may be able to stop or prevent migraine headaches.

2. Inflammation (Sensitization)

We need inflammation to stay healthy.

It’s our bodies’ way to trap and destroy invading bacteria and viruses. Inflammation promotes healing and prevents further damage to the body by causing pain and redness which reminds us to be careful with that part of the body.

Unfortunately, inflammation can go out of control causing many different health problems for the body.

One such problem is migraine headaches.

A protein found inside the cells, known as nuclear factor kappa B (NF-kB for short) is responsible for regulating the creation of inflammatory compounds in the cells.

NF-kB is a major driving factor behind migraine headaches. When this protein goes out of balance, it can cause an overabundance of inflammatory messengers called cytokines (IL-1B, IL-6, and TNF-a). These messengers then trigger a wave of inflammation and pain in the nervous system. [2].

Since these messengers are short-lived, the problem usually subsides within several hours, causing the migraine to typically last all day, and before gradually disappearing.

This cause is especially common in people who tend to be over-reactive to foods and other allergens. People who suffer from asthma and hay fever are also at a higher risk for migraines caused by this effect.

What this means: If we can stop the overactivation of NF-kB, we may be able to prevent migraines.

3. Muscular Spasms of the Veins and Arteries

All of our arteries have a thin layer of muscle lining them.

These muscles are designed to expand and contract to control our blood pressure and to allow us to shunt blood into vital organs such as the brain when need be.

A good example of when do this is when we’re out in the cold.

To preserve the core body temperature, the blood vessels in our hands, feet, and nose will tighten to slow blood flow in the area. This helps to keep the warm blood closer to the internal organs.

There are other reasons for shunting blood as well, such as after a meal when we need more blood flow to the digestive organs or after a traumatic injury where we need to bring fresh oxygen and nutrients to the damaged site.

This system is especially sensitive in the delicate regions of the brain.

When the trigeminal ganglion is activated by the cortical spreading depression, it releases pro-inflammatory molecules onto] the muscles controlling its blood vessels that can widen and spasm, causing severe migraine headaches.

What this means: If we can stop excessive vascular spasms among the arteries feeding the brain, we can stop migraines.

How Are Migraine Headaches Treated?

Treating migraines focuses on both prevention as well as treatment, but still involves a lot of trial and error, as well as time due to everyone’s unique chemistry.

This is because the medications used to address any of the three causes of migraines are different, and it takes up to 6 weeks for a medication to build up enough to have any effect.

Most of the drugs for migraines have about a >50% chance of working after several weeks. If one medication doesn’t work, doctors will usually move on to another one. If your migraines happen 15 or more days per month, then scalp botox injections are also an effective new, insurance-covered prevention option.

Most people who suffer migraines will use [their preventive medications and prescriptions. However, milder migraine sufferers may use] over the counter pain medications such as Excedrin, Tylenol, Ibuprofen, and Aspirin, however, this only helps curb the intensity of mild episodes. They do little for actually clearing up a migraine and are rarely strong enough to completely alleviate symptoms. Most often they’re used in conjunction with routine prescription medication.

Treatment Options for Migraine Headaches:

Most of these medications come with a long list of negative side effects such as ulcers, heart vessel spasms, kidney damage. Unfortunately for some people, there is only minimal relief available from migraine headaches.

For this reason, many people who suffer recurrent migraines are turning for help from a different source of medicine. It’s important to note that many medications interact with CBD and other alternative treatments.

Herbal Medicine for Migraines

There are obvious benefits to conventional medicine over plant-based medicine. However, this is not the case for migraine headaches.

There are many herbs with well-established benefits of treating and preventing migraine headaches.

Feverfew, for example, is a small plant in the daisy family that offers direct improvements on all three processes thought to be causing migraine headaches [15].

Another plant that has shown significant potential in addressing the causes and symptoms of migraine headaches is the cannabis plant.

Plants such as these often contain dozens, if not hundreds of different chemicals. Unlike pharmaceuticals, this makes it difficult to characterize each compound’s precise effects, giving them the added benefit of providing what we could call a multifaceted approach to treatment.

This means that the series of chemicals contained in cannabis may possibly offer similar benefits for a medical condition, but do it through different mechanisms.

For example, the cannabis plant contains as many as 80 different cannabinoids and well over 100 different terpenes in its leaves and resin.

Some of these cannabinoids help to stop arterial spasms, others stabilize immune cells and more.

By providing multiple therapeutic avenues for a particular condition, and by sharing many common underlying mechanisms, cannabis could potentially stand a better chance of fixing the problem.

This is a common technique oncologists use to fight cancer. By using a cocktail of chemotherapeutic drugs, each with slightly different modes of action, they get a far greater chance of choosing the right one and curing their patient’s cancer.

Key Takeaways: Can CBD Oil Help With Migraines?

Migraines are many things— common, debilitating, and mysterious.

Doctors and neuroscientists still don’t have a definitive explanation for what causes them or how to stop them.

There are, however, a lot of promising theories that we can start with when looking for treatments for the condition. From what is known, there are common pathways that CBD may also act upon to help.

CBD oil has recently been on the rise as a new and potentially effective migraine treatment and prevention method. It works through several different yet related pathways to resist the processes driving migraine headaches.

It’s likely that we’ll see this use of CBD and CBD oil become a standard adjunctive treatment for the condition in the next few years as more research sheds light on the incredible benefits of this humble plant extract.

Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Cannabis has been long used since ancient times for both medical and recreational use. Past research has shown that cannabis can be indicated for symptom management disorders, including cancer, chronic pain, headaches, migraines, and psychological disorders (anxiety, depression, and post-traumatic stress disorder). Active ingredients in cannabis that modulate patients’ perceptions of their conditions include Δ 9 ‐tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes. These compounds work to produce effects within the endocannabinoid system to decrease nociception and decrease symptom frequency. Research within the United States of America is limited to date due to cannabis being classified as a schedule one drug per the Drug Enforcement Agency. Few anecdotal studies have found a limited relationship between cannabis use and migraine frequency. The purpose of the review article is to document the validity of how medical cannabis can be utilized as an alternative therapy for migraine management. Thirty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: “Cannabis,” “Medical Marijuana,” “Headache,” “Cannabis and Migraine,” “Cannabis and Headache.” This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.

Introduction and background

Cannabis has a rooted history for both medical and recreational use. Cannabis has been used since ancient times to manage various conditions, including acute pain, anxiety, cancer pain, chronic pain, depression, headaches, and migraines [1]. It exists in forms that include: Cannabis indica, Cannabis ruderalis, and Cannabis sativa of which contain 400 compounds [2]. Important compounds of interest include Δ 9 ‐tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes [2]. THC and CBD are the major components of different medical cannabis formulations [2]. Both CBD and THC stimulate cannabinoid (CB) receptors throughout the human body, constituting the endocannabinoid system [2]. The endocannabinoid system consists of CB1 (central/peripheral nervous system) and CB2 (peripheral/immune tissues) receptors [2]. CB1 receptor activation leads to decreased neurotransmission of dopamine, γ-aminobutyric acid (GABA), and glutamate. On the other hand, CB2 receptor activation leads to analgesia and decreased immune system function [2-4].

In migraines, current theory suggests that the CB system mitigates migraine through several pathways (glutamine, inflammatory, opiate, and serotonin) both centrally and peripherally [4]. Anandamide (AEA) potentiates 5-HT1A and inhibits 5-HT2A receptors supporting therapeutic efficacy in acute and preventive migraine treatment; it is active in the periaqueductal gray matter, a migraine generator. Cannabinoids also demonstrate dopamine-blocking and anti-inflammatory effects [5]. Furthermore, cannabinoids may have a specific prophylactic effect in migraines due to their ability to inhibit platelet serotonin release and peripheral vasoconstrictor effect [6]. In addition, CB1 receptors reduce nociperception via a serotonin-mediated pathway, whereas CB2 receptors act to produce analgesia without developing tolerance or side effects [4]. Current research suggests that the endocannabinoid system plays a role in migraine mitigation, but updated research is lacking within the United States of America (USA) [7,8].

Cannabis is classified as a Schedule I drug, per the Controlled Substances Act and the Drug Enforcement Agency, indicating that it has a high potential for abuse, and medical use is prohibited [9,10]. However, state governments have utilized their powers and legalized cannabis for medical and/or legal use within the last several years. California was the first state to legalize medical cannabis back in 1996 [9]. Still, to date, 36 states and four USA territories deem this compound for medical use, with 18 states, two territories, and the District of Colombia allowing it for recreational use [9]. Medical societies have even incorporated cannabis use in medical management. For example, the Canadian Pain Society recommended back in 2014 that cannabis be utilized as third-line therapy for chronic pain management [11]. Chronic pain is often a common reason for a patient to register with a medical cannabis state registry [12]. Other uses for medical cannabis include symptom management of Alzheimer’s disease, amyotrophic lateral sclerosis, migraines, multiple sclerosis, and seizures [4,13,14]. To utilize medical cannabis, an individual must establish care with a medical cannabis physician and have a qualifying or similar diagnosis [15]. Florida, for example, requires that a patient have a qualifying medical condition that includes, amyotrophic lateral sclerosis, cancer, chronic nonmalignant pain, Crohn’s disease, epilepsy, glaucoma, human immunodeficiency virus disease/acquired immunodeficiency disease syndrome, multiple sclerosis, Parkinson’s disease, post-traumatic stress disorder, and terminal condition [12,15]. In addition, as defined per Florida amendment 2, similar conditions include disorders (alcoholism, anxiety, depression, diabetes, and endometriosis) that have symptoms that are common to the above qualifying conditions [12]. Once a physician determines patient eligibility for medical cannabis use, a patient can access medical cannabis products for seven months [12].

Medical research for medical cannabis use is sparse, given the lack of randomized control studies. Current literature is limited to case reports, case series, cell phone survey applications, and retrospective analyses. In addition, few studies document the improvement of migraine symptoms with medical cannabis use. However, two prospective trials done by Robins et al. and Aviram et al. have noted migraine improvement within their studies [16,17]. Also, there are limited studies that qualify or quantify an ideal dosage and method of cannabis use. Hence, with minimal research studies on the effectiveness of medical cannabis on different medical conditions, review papers are essential to summarize how this compound can be effective in headache and migraine management.

This paper aims to determine if medical cannabis can be utilized as an alternative treatment for headache and migraine management. It emphasizes how medical cannabis can reduce headaches and migraine duration and frequency, highlights different forms and ideal doses used for clinical effectiveness. After an extensive literature search using PubMed and Google scholar databases, 34 relevant articles were found to review the efficacy of medical marijuana use on migraines and headaches. Keywords used were “Cannabis,” “Medical Marijuana,” “headache,” “Cannabis and Migraine,” “Cannabis and Headache.” The articles were thoroughly screened by reviewing each article with titles, abstracts, and content of the full articles. We included the studies published between 1987 and 2020, human studies in the English language, including adults 18 years and older, whereas articles involving children less than 17 years and pregnant females were excluded from this study.

Review

Cannabinoids, similar to other analgesics and recreational drugs, act on the brain’s reward system, especially on cannabinoid one receptor localized at the same place as opioid receptors on nucleus accumbens and functions by overlapping the antinociceptive pathways [18]. Articles included in our study focused on identifying the cannabis treatment in migraines and headaches. These articles also analyzed the preferred cannabis forms and their substitution for medications. During the extensive search of the literature, we came across three main questions for which the studies are conducted and directed: (i) Is medical cannabis effective on headaches and migraines? (ii) What forms of medical cannabis do people prefer? (iii) What is an ideal dose for the “preferred form?”

Medical cannabis and its potential role in headaches and migraines

Several studies have reported both the benefits and effectiveness of medical cannabis use. A prospective clinical trial done in 2020 by Aviram et al. focused on 68 patients who smoked or vaped MC inflorescences evaluated the differences in total MC monthly dose between responders and non‐responders [17]. This study focused on the associations between phytocannabinoid treatment and migraine frequency [17]. The study also reported better migraine symptom reduction, less negative headache impact, better sleep quality, and decreased medication consumption [17]. In 2019, Cuttler et al., in their survey study from a Canadian data application (Strainprint), focused on the inhaled cannabis usage and their effect of reduction in migraine severity and frequency along with the factors affecting the dosage used [19]. Survey results demonstrated that headaches were reduced by 47.3% and migraines by 49.6% [19]. A higher proportion of males (90.9%) compared to females (89.1%) reported a more favorable reduction with headaches, whereas females (88.6) compared to males (87.3%) reported a more favorable reduction with migraines [19]. It also investigated the tolerance development with prolonged cannabis use [19]. Lack of a control group and sampling bias were limitations of this study [19]. In 2018, Baron et al. did a literature review of cannabinoid usage to treat migraines, facial pain, and chronic pain and their medicinal benefits [20]. The study shows the significant advantage of medical marijuana in improving nausea and vomiting associated with migraines [20]. Later in 2018, he and his team conducted another survey and identified different patterns of medical marijuana treatment in migraine headaches [20]. Rhyne et al., in 2016, did a retrospective study from medical record reviews, analyzed the frequency of headaches with medical marijuana as a primary goal, and focused on the type, dosage use, previous migraine therapies used, and patient-reported data as secondary outcomes [21]. They showed a significant reduction in migraine frequency with medical marijuana [21]. Leroux et al. conducted a survey and demonstrated that the prevalence of cannabis use is higher in patients with cluster headaches than in the general population [22]. The study included 139 patients from two hospitals in France and attempted to investigate the frequency of cannabis use among cluster headache sufferers and its effects on attacks [22]. Medical cannabis was found to have unpredictable effects in 1/2 of all the patients with cluster headaches, a modest effect in 1/4 of all patients, and eliminate an attack in 1/8 of patients [22]. Due to cannabis’s variable responses, the survey concluded that cannabis should not be used as a therapeutic option for managing cluster headache attacks [22]. Bagshaw et al. in 2002 provided a literature review with a summary of recommendations of when medical cannabis can be used in the palliative care setting [23]. The literature review focused on symptoms in palliative care not limited to nausea, migraines, muscle spasticity, and seizures [23]. This review found that oral THC was superior to placebo for managing symptoms. THC use, however, was found to be limited due to dose-dependent psychosis and psychotropic effects [23]. Pini et al., in their randomized controlled trial (RCT) study, evaluated the efficacy and safety of nabilone in reducing pain and frequency of headache, the number of analgesic intake, and in increasing the quality of life of patients with long-standing intractable medication overuse headache [24].

Despite mixed findings regarding the effectiveness of medical cannabis on both headaches and migraines, there is a consensus for the indication of medical marijuana therapy when first and second-line treatment fails. Current ethnobotanical and anecdotal references mention efficacy. Biochemical studies of THC and anandamide have provided a scientific basis for both symptomatic and prophylactic treatment of migraine [25]. Dronabinol and nabilone, synthetic cannabinoids, have been shown to act in place of first-line therapy for cluster headaches (triptans, verapamil) and can effectively control pain [16,26]. Non-synthetic cannabis (oral, inhaled, sublingual, edible, topical) can be indicated for managing headache and migraine symptoms, but it is dose-dependent [22,23]. Adverse reactions to medical cannabis use can include dizziness, dry mouth or eyes, nausea, vomiting, and psychosis [26]. Despite such side effects, patients have an overall favorable view of using medical cannabis along with or in place of medications, as it was reported to decrease the frequency and duration of migraines.

Different forms of medical cannabis and patients preference

Several studies have reported preferred forms of medical cannabis for the treatment of migraines and headaches. Salazar et al. conducted a cross-sectional survey to assess self-reported reasons for recreational and medical cannabis users in the southeastern United States [27]. From the survey, 50 participants (11.6%) reported medical cannabis use, 180 participants (41.7%) reported recreational use, and 202 participants (46.8%) reported combined usage [27]. The reported primary method of use was smoking, followed by vaporization (5.6%) and “dabs” (2.8%) [27]. Participants were asked about their cannabis use, frequency, amount, and methods to use it [27]. The survey’s results showed that 35.5% of the patients used it for headaches and migraines [27]. The effect of medicinal cannabis on headaches and other conditions had a mean score of 3.6/5, which meant an 86% efficacy in pain relief [27]. The dried Cannabis flower may be an effective medication for the treatment of migraine- and headache-related pain, but the effectiveness differs according to characteristics of the Cannabis plant, the combustion methods, and the age and gender of the patient [28]. Many patients were able to replace their pain meds with medicinal cannabis in a survey reported by Nicolodi et al. [29]. Limitations of this study include relying upon self-reported data along with a lack of diagnosis verification [29]. Boehnke et al., in 2019, conducted an online survey consisting of 1321 patients on medicinal cannabis use [30]. This survey analyzes cannabis use patterns among chronic pain patients [30]. More females, 59.1%, participated in the survey in comparison to male patients [30]. Males use smoke and vaporize form more, whereas females rank edible, tincture (oil-based), and topical cannabis as preferred first-line methods and also products that consist of low THC to high CBD in a “ratio” [30]. Piper et al., in 2017, conducted an online survey to evaluate the effects of medical cannabis usage by substituting opioids or other psychoactive medications and evaluated the communication about the usage of the patients with their physician [31]. This survey included 52.9% female and 47.1% male patients [31]. The results show that 76.7% reported a gradual decrease in opiate use [31]. Approximately, two-thirds of patients reduced anti-anxiety, migraine medications, antidepressants, and alcohol following MC usage [31]. Preferred delivery methods include joints (48.5%), vaporization (22.3%), edibles (14.3%), tinctures (10.8%), concentrates (3.4%), and topical (0.7%) methods [31]. This survey is limited as it did not examine “combination” medication use (antidepressant + sleep aid), and the data were designed to be interpretable by the general population [31]. Rhyne et al., in 2016, conducted a retrospective, observational review of patients in Colorado [21]. Patients between the ages of 18 and 89 years old with a diagnosis of migraines were included in the study [21]. Factors such as sex, the duration of migraines, medical history, past migraine treatment, number of migraines experienced per month, how often and how much cannabis was used were self-reported by the patient [21]. It was reported that out of 82, 20 patients used at least two forms of cannabis [21]. The study has shown different forms of cannabis used to treat migraines [21].

After reviewing the literature, it is found that the primary method for cannabis use was smoking, followed by vaporization (5.6%) and dabs (2.8%) [27]. Patients with headaches were 2.7 times more likely to prefer a hybrid (Cannabis sativa + Cannabis indica) strain than chronic pain patients [20]. Females preferred to rank edible, tincture (oil-based), and topical cannabis as preferred first-line methods for chronic pain like arthritis and migraine [30]. Also, analysis of Strainprint responses reveals that inhalation methods like smoking, vaping, concentrates, dabs (79.4% of headache data and 82.8% of migraine data) were primary methods used by the patients [19].

Cannabis ideal dose and preferred forms

While medical cannabis exists in different forms, there is variability in the ideal dosage for medical cannabis use. Several studies done to determine the “ideal” dosage are described here. Ogborne et al., in 2000, interviewed 50 medical cannabis users recruited via advertisements in newspapers and job boards [26]. The participants were using medical cannabis for various reasons such as HIV, cramps, depression, pain, and migraines [26]. Almost all of the participants smoked cannabis approximately two to three times a day [26]. Baron et al., in 2018, in their electronic survey for the use of medical cannabis in a patient with headache, showed a pattern of cannabis use, including frequency, quantity, and strains [20]. In the ID Migraine™ questionnaire, hybrid strains of cannabis, of which “OG Shark,” a high THC/THCA, low CBD/CBDA, and strains with predominant terpenes β-caryophyllene and β-myrcene, were most preferred in the headache and migraine groups [20]. In the study trial, patients were intervened with 19% THC or THC+ 9% CBD [20]. It was found that a dose of 200 mg effectively reduced the intensity of migraine pain by 55% [20]. In another phase, 25 mg of amitriptyline or THC+CBD 200 mg per day was given prophylactically for three months in chronic migraine patients [20]; also, THC + CBD 200 mg was required for the acute attack [20]. The study concluded that THC + CBD 200 mg had a 40.4% improvement over amitriptyline use (40.1%) [20]. A similar study was done for the cluster headache, but it did not benefit as abortive treatment [20]. Sexton et al., in 2016, did an online survey that sought to collect epidemiological data to start a discussion on medico-legal recommendations, report patient outcomes, and inform the medical practice of medical cannabis users [32]. Many medical professionals (59.8%) used cannabis as an alternative treatment for their patients, reducing the symptoms by 86% [32]. This study also included the route and dosage of medical marijuana usage, where 84.1% of the participants had inhalation as the most common route, and 60.8% of the participants reported one to five hits usage per session [32]. Concerning the dosage of cannabis, 12.3% of respondents used less than 1 g/week, 20.3% reported using 1-2 g/week, 31.8% reported using 3-5 g/week, 26.1% reported using 7 g/week, 6% using 28 g/week, and 3.4% using more than 28 g/week [32]. The survey was limited due to self-reported results, placebo effects, recall bias, and how efficacy was reported [32]. In this situation, the amount utilized per week ranges from 1 to 28 g [26,32]. Frequency is also a concern, as patients vary from “1-10 hits per day” or 2-3 times per day depending on the convention used [26,32].

Finding an ideal dosage of a medical cannabis product can be difficult due to its variation among users. Every study mentioned the different doses and forms used by patients for different causes. Some studies have shown that THC +CBD had a good outcome when used as prophylactic or when given in acute attack [20]. Combination studies of Amitriptyline and THC or Amitriptyline and CBD should be done in order to find the improvement in efficacy and dose reduction of Amitriptyline for abortive as well as curative treatment. Also, more research should aim in doing controlled studies about the route and dose of THC/CBD for migraine and headache patients.

As with all research, limitations exist that prevent a quality analysis. This literature review is limited by the number of articles that were selected to begin. The use of cannabis with other recreational drugs was not excluded from the studies. Also, the selected studies had their own limitations as the articles were surveys collected, online surveys, a small sample size, and very few controlled trials. The lack of standardization may affect the quality of our results. Despite the limitations of the above studies, medical cannabis is an effective alternative treatment for managing headache and migraine symptoms. Our review article shows that cannabis use is picking up in patients with chronic pain and can be expected to continue to rise upwards in the face of increasing societal awareness and availability of legal cannabis [33]. Careful questioning and discussing with the patients about the use of marijuana, its risks, and benefits should be documented and researched. More information about the doses, frequency, methods, and forms of marijuana consumed, as well as alcohol use, illicit drug, and prescription drug use, should be explored to form the definitive treatment goal for migraine and headache patients [34].

Conclusions

The review article shows encouraging data on medicinal cannabis’s therapeutic effects on alleviating migraines in all of the studies reviewed. Beneficial long-term and short-term effects of medicinal cannabis were reported. It was effective in decreasing daily analgesic intake, dependence, and level of pain intensity. Some patients experienced a prolonged and persistent improvement in their health and well-being (both physically and mentally) after long-term use of medicinal cannabis. Overall, patients reported more positive effects rather than adverse effects with medical cannabis use. Chronic pain and mental health are the two reasons where medical cannabis is used often. It is found that some medical providers are hesitant to recommend medical cannabis due to a lack of current evidence, medical professional training, and a lack of uniform medical cannabis use guidelines. The therapeutic benefits of cannabis should be studied widely with intensive research trials supervised and controlled by authorities for safety and quality effectiveness. Further research should be performed once cannabis becomes legalized to determine a favorable delivery method, dose, and strain for migraine and chronic headache management and possible long-term effects of medical cannabis use. While medical cannabis is in a “disorganized realm” at the moment due to a lack of substantial research and medical provider education and patient education, this field is evolving and expanding to provide up-to-date research for both patient and doctor.

Acknowledgments

The authors would like to acknowledge Dr. Marcos A. Sanchez-Gonzalez for his constant support throughout the course of the manuscript. In addition, the authors appreciate the support of Dr. Marie-Pierre Belizaire, Dr. Madiha Zaidi, Prathima Guntipalli, and Rahima Taugir. Finally, the authors would like to thank the reviewers for their constructive feedback.

Notes

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

Footnotes

The authors have declared that no competing interests exist.

References

1. Medical reasons for marijuana use, forms of use, and patient perception of physician attitudes among the US population. Azcarate PM, Zhang AJ, Keyhani S, Steigerwald S, Ishida JH, Cohen BE. J Gen Intern Med. 2020; 35 :1979–1986. [PMC free article] [PubMed] [Google Scholar]

2. Medicinal properties of cannabinoids, terpenes, and flavonoids in cannabis, and benefits in migraine, headache, and pain: an update on current evidence and cannabis science. Baron EP. https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.13345. Headache. 2018; 58 :1139–1186. [PubMed] [Google Scholar]

3. Cannabidiol, unlike synthetic cannabinoids, triggers activation of RBL-2H3 mast cells. Giudice ED, Rinaldi L, Passarotto M, et al. https://jlb.onlinelibrary.wiley.com/doi/full/10.1189/jlb.1206738. J Leukoc Biol. 2007; 81 :1512–1522. [PubMed] [Google Scholar]

4. Cannabis and neuropsychiatric disorders: an updated review. Chayasirisobhon S. https://pubmed.ncbi.nlm.nih.gov/31867704/ Acta Neurol Taiwan. 2019; 28(2) :27–39. [PubMed] [Google Scholar]

5. Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Russo EB. https://pubmed.ncbi.nlm.nih.gov/18404144/ Neuro Endocrinol Lett. 2008; 29 :192–200. [PubMed] [Google Scholar]

7. Endocannabinoid system and migraine pain: an update. Greco R, Demartini C, Zanaboni AM, Piomelli D, Tassorelli C. Front Neurosci. 2018; 12 :172. [PMC free article] [PubMed] [Google Scholar]

8. Practical considerations of hypotheses and evidence in cannabis pharmacotherapy: refining expectations of clinical endocannabinoid deficiency. Cogan PS. J Diet Suppl. 2020; 17 :608–624. [PubMed] [Google Scholar]

10. Cannabis guidelines. Kennedy Sheldon L. https://pubmed.ncbi.nlm.nih.gov/28738036/ Clin J Oncol Nurs. 2017; 21 :409. [PubMed] [Google Scholar]

11. Practical strategies using medical cannabis to reduce harms associated with long term opioid use in chronic pain. MacCallum CA, Eadie L, Barr AM, Boivin M, Lu S. Front Pharmacol. 2021; 12 :633168. [PMC free article] [PubMed] [Google Scholar]

12. Compassionate Medical Cannabis Act of 2014. [Aug;2021 ];Florida senate. (2014. https://www.flsenate.gov/Session/Bill/2014/1030 Compassionate Medical Cannabis Act of. 2014

13. Cannabinoids in health and disease. Kogan NM, Mechoulam R. Dialogues Clin Neurosci. 2007; 9 :413–430. [PMC free article] [PubMed] [Google Scholar]

14. Medical cannabis: do the benefits outweigh the risks? Gupta S, Phalen T, Gupta S. https://www.mdedge.com/psychiatry/article/155158/medical-marijuana-do-benefits-outweigh-risks Current Psychiatry. 2018; 17 :34–41. [Google Scholar]

15. Weighing the benefits and risks of medical marijuana use: a brief review. [Oct;2020 ];Karst A. http://10.3390/pharmacy6040128 Pharmacy (Basel) 2018 6 :128. [PMC free article] [PubMed] [Google Scholar]

16. Cluster attacks responsive to recreational cannabis and dronabinol. Robbins MS, Tarshish S, Solomon S, Grosberg BM. Headache. 2009; 49 :914–916. [PubMed] [Google Scholar]

17. Migraine frequency decrease following prolonged medical cannabis treatment: a cross-sectional study. Aviram J, Vysotski Y, Berman P, Lewitus GM, Eisenberg E, Meiri D. https://www.mdpi.com/2076-3425/10/6/360 Brain Sci. 2020; 10 :360. [PMC free article] [PubMed] [Google Scholar]

18. Psychoactive substances as a last resort – a qualitative study of self-treatment of migraine and cluster headaches. Andersson M, Persson M, Kjellgren A. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0186-6. Harm Reduct J. 2017; 14 :60. [PMC free article] [PubMed] [Google Scholar]

19. Short- and long-term effects of cannabis on headache and migraine. Cuttler C, Spradlin A, Cleveland MJ, Craft RM. https://www.sciencedirect.com/science/article/pii/S152659001930848X. J Pain. 2020; 21 :722–730. [PubMed] [Google Scholar]

20. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort. Baron EP, Lucas P, Eades J, Hogue O. J Headache Pain. 2018; 19 :37. [PMC free article] [PubMed] [Google Scholar]

21. Effects of medical cannabis on migraine headache frequency in an adult population. Rhyne DN, Anderson SL, Gedde M, Borgelt LM. Pharmacotherapy. 2016; 36 :505–510. [PubMed] [Google Scholar]

22. Use of cannabis among 139 cluster headache sufferers. Leroux E, Taifas I, Valade D, Donnet A, Chagnon M, Ducros A. Cephalalgia. 2013; 33 :208–213. [PubMed] [Google Scholar]

23. Medical efficacy of cannabinoids and cannabis: a comprehensive review of the literature. Bagshaw SM, Hagen NA. https://journals.sagepub.com/doi/abs/10.1177/082585970201800207. J Palliat Care. 2002; 18 :111–122. [PubMed] [Google Scholar]

24. Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial. Pini LA, Guerzoni S, Cainazzo MM, et al. J Headache Pain. 2012; 13 :677–684. [PMC free article] [PubMed] [Google Scholar]

25. Cannabis for migraine treatment: the once and future prescription? An historical and scientific review. Russo E. Pain. 1998; 76 :3–8. [PubMed] [Google Scholar]

26. Who is using cannabis as a medicine and why: an exploratory study. Ogborne AC, Smart RG, Weber T, Birchmore-Timney C. J Psychoactive Drugs. 2000; 32 :435–443. [PubMed] [Google Scholar]

27. Medical cannabis use among adults in the Southeastern United States. Salazar CA, Tomko RL, Akbar SA, Squeglia LM, McClure EA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388700/ Cannabis. 2019; 2 :53–65. [PMC free article] [PubMed] [Google Scholar]

28. Alleviative effects of Cannabis flower on migraine and headache. Stith SS, Diviant JP, Brockelman F, Keeling K, Hall B, Lucern S, Vigil JM. https://www.sciencedirect.com/science/article/abs/pii/S2095496420300741. J Integr Med. 2020; 18 :416–424. [PubMed] [Google Scholar]

30. Cannabis use preferences and decision-making among a cross-sectional cohort of medical cannabis patients with chronic pain. Boehnke KF, Scott JR, Litinas E, Sisley S, Clauw DJ, Goesling J, Williams DA. J Pain. 2019; 20 :1362–1372. [PubMed] [Google Scholar]

31. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. Piper BJ, DeKeuster RM, Beals ML, et al. J Psychopharmacol. 2017; 31 :569–575. [PubMed] [Google Scholar]

32. A cross-sectional survey of medical cannabis users: patterns of use and perceived efficacy. Sexton M, Cuttler C, Finnell JS, Mischley LK. Cannabis Cannabinoid Res. 2016; 1 :131–138. [PMC free article] [PubMed] [Google Scholar]

33. Cannabis use in hospitalized patients with chronic pain. Orhurhu V, Urits I, Olusunmade M, et al. Adv Ther. 2020; 37 :3571–3583. [PMC free article] [PubMed] [Google Scholar]

34. An analysis of applicants presenting to a medical marijuana specialty practice in California. Nunberg H, Kilmer B, Pacula RL, Burgdorf J. J Drug Policy Anal. 2011; 4 [PMC free article] [PubMed] [Google Scholar]

See also  How to determine dosage for cbd oil