Evidence Review: Marijuana and Migraines

HISTORICAL PERSPECTIVES

If you use marijuana to treat migraines, you’re definitely not alone- over the years it’s been one of the most common indications patients have sought out medical marijuana and I’ve talked to countless patients that credit cannabis with effectively controlling their headaches. Compared to some other medical conditions that cannabis is often used for, we actually have quite a few concrete details about why cannabis is effective for migraines.

Marijuana has been used to treat migraines for hundreds of years. Some of the earliest medical texts, in 10th century Persia, described utilization of cannabis extracts for treatment of headaches (1). Cannabis enjoyed a period of relatively widespread use in European and American medicine from 1840-1940, before prevailing attitudes about the plant changed.

American neurologists in the 19th century were quite fond of cannabis as a treatment for migraine. In 1878, the president of the New York Neurological Society gave a speech, stating

“Briefly stated my thesis is THAT BY THE LONG-CONTINUED USE OF CANNABIS INDICA, MIGRAINE OR SICK-HEADACHE MAY BE CURED, MUCH RELIEVED, OR MITIGATED IN SEVERITY.”

-Edouard C. Seguin, the President of the New York NeurologicalSociety

I think that’s an incredible perspective- for most of our adult lives now, cannabis has been a fringe medication, and the predominant attitude for our generation’s lifetime has been one of restriction. However, over 100 years ago, a well-known physician was delivering a speech to other physicians talking about how useful marijuana was.

THE DATA

Migraine is a commonly-cited reason that patients choose cannabis. Personally, I feel that migraine is one of the stronger indications for medical marijuana- compared to some other commonly-cited indications (such as depression or anxiety), the data is more generally positive with less caveats.

We even have a hypothesis as to why marijuana is effective for migraines, which is uncommon amongst medical conditions.

High-quality research on any marijuana topic remains pretty sparse due to the current political climate. Marijuana remains illegal in the United States, after all. However, as a form of chronic pain, migraines have enjoyed a bit more scholarship than most other topics. Chronic pain, and the endocannabinoid system, are among the most well-researched topics in medical marijuana.

One of the ways that we can demonstrate that marijuana is effective for migraines is by showing that marijuana patients with migraines stop using migraine medicine. Recent scholarship has demonstrated that marijuana users are able to reduce the amount of opiates and other medications utilized for migraine treatment (2).

Migraine sufferers can additionally point to at least one American study, conducted in 2016 (3) that shows a statistically significant, and impressively large effect on migraine frequency. In this study, patients at an American dispensary were questioned about their pattern of headaches, and were asked to document their average number of headaches per month over a four-year period.

This study showed that patients with migraines decreased from 10.4 to 4.6 headaches per month with the use of cannabis! That’s pretty incredible.

BUT WHY DOES IT WORK?

We don’t know with 100% certainty what causes migraines. For a long time, it was theorized that migraines were caused by issues with blood vessels in the brain. Medical researchers suspected this because some migraine patients would have stroke-like symptoms, like an arm or leg that became numb or weak. Strokes have a clear vascular origin, and because of the similarities in presentation, migraines were felt to originate primarily from the vascular system as well.

There is a growing body of evidence that suggests that migraines are correlated with endocannabinoid deficiency (4,5). Endocannabinoids, in short, are chemicals that we all naturally make, and are theorized to be deeply involved in pain responses. Having a decreased amount of circulating endocannabinoids is suggested to be part of the cause of numerous chronic pain-related conditions.

How do we know that? It’s been tested in different studies! Researchers have gone as far as placing needles in patients’ backs (both with and without migraines) to determine their endocannabinoid levels! The endocannabinoids we know the most about are N-arachidonoylethanolamide (anandamide, AEA), palmitoylethanolamide (PEA), and 2-arachidonoylglycerol (2-AG). A study performed in 2006 (6) showed that patients with migraines and patients without migraines have significantly different levels of all three endocannabinoids. An enzyme that degrades AEA is being looked at as a prospective treatment for migraines- by blocking its breakdown, we can increase AEA levels and possibly treat migraines!

Increasing amounts of endocannabinoid are theorized to have a positive effect on pain, and especially migrainous pain. Two large and recent publications (7, 8) document this. The easiest way to increase your endocannabinoid levels? You guessed it-medical marijuana.

Dr. Wong

Citations: 

  1. Russo, E. (2001). Hemp for Headache. Journal of Cannabis Therapeutics, 1(2), 21–92. doi: 10.1300/j175v01n02_04

  2. Baron, E. P., Lucas, P., Eades, J., & Hogue, O. (2018). 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). doi: 10.1186/s10194-018-0862-2

  3. Rhyne, D. N., Anderson, S. L., Gedde, M., & Borgelt, L. M. (2016). Effects of Medical Marijuana on Migraine Headache Frequency in an Adult Population. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 36(5), 505–510. doi: 10.1002/phar.1673

  4. Baron, E. P. (2015). 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), 885–916. doi: 10.1111/head.12570

  5. Russo EB (2004). Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinol Lett 25: 31–39.

  6. Sarchielli, P., Pini, L. A., Coppola, F., Rossi, C., Baldi, A., Mancini, M. L., & Calabresi, P. (2006). Endocannabinoids in Chronic Migraine: CSF Findings Suggest a System Failure. Neuropsychopharmacology, 32(6), 1384–1390. doi: 10.1038/sj.npp.1301246

  7. Russo, E. B. (2016). Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis and Cannabinoid Research, 1(1), 154–165. doi: 10.1089/can.2016.0009

  8. Greco, R., Demartini, C., Zanaboni, A. M., Piomelli, D., & Tassorelli, C. (2018). Endocannabinoid System and Migraine Pain: An Update. Frontiers in Neuroscience, 12. doi: 10.3389/fnins.2018.00172