Migraine – Research on cannabinoids
A migraine is a type of headache characterized by palpitations and throbbing in an isolated area of the brain 8. The pain can be so intense that it causes nausea, vomiting and sensitivity to light and sound 7. The International Headache Society distinguishes a migraine according to the intensity of the pain and frequency of attacks (at least five, lasting between 4 and 72 hours, if untreated) 8. It is common for those who suffer from migraines to see auras, the which may include visual disturbances such as glare, zigzag lines, or partial loss of vision due to compression of the optic nerve. Migraines usually appear during childhood, adolescence or adulthood, being three times more common in women than in men 7.
While the pathophysiology of migraines is not yet fully understood, research suggests that they are the result of neurological abnormalities caused by genetic mutations in the brain 8. This fluctuation in neural activity appears to activate the trigeminovascular system, which includes the nervous and vascular system in the meninges, and the associated inflammatory response causes pain 8. Genetics are likely involved in the causes of migraines 7.
Representation of a scintillating scotoma common in migraines
To date, migraines have no cure and the focus of treatment is on preventing attacks and relieving symptoms as soon as one occurs. Efforts to prevent migraines include medications, stress management, physical activity, nutritional adjustments, adequate hydration, consistent amounts of sleep, and avoiding behaviors known to trigger attacks. When a migraine occurs, the focus becomes the administration of analgesics 7.
Discoveries: effects of cannabis on migraines
Cannabis has been used to treat migraines for centuries. Between 1874 and 1942, it was one of the most used medicines by general practitioners 7,12.
Research suggests that the effectiveness of cannabis in relieving migraines may be attributed to the cannabinoids found in the plant, including CBD, or cannabidiol, and THC, tetrahydrocannabinol. Both CBD and THC activate the CB1 and CB2 receptors of the body’s endocannabinoid system, inhibiting responses from the trigeminovascular system and restricting the inflammation that causes migraine pain 1,2,5.
A January 2016 study found that marijuana is effective in decreasing migraine frequency. In this first-of-its-kind study – due to previous federal regulation – researchers found that 103 of 121 participants diagnosed with migraines saw a reduction in the frequency of attacks, from an average of 10.4 to 4.6 per month 10.
Additionally, other studies suggest that cannabis is an effective pain reliever in conditions related to chronic neuropathic pain that is resistant to other pain relief treatments 3. Findings from one study even suggest that a dysfunction in the endocannabinoid system may contribute to the development of migraines. Researchers then came to the conclusion that the activation of CB1 and CB2 receptors could correct this dysfunction and be useful in treating migraine pain 6.
Regardless of medical recommendations, due to the effectiveness of cannabinoids in migraines, even in places where medicinal cannabis remains illegal, the use of the plant by patients suffering from condition 7 is very common.
“The Headache”, by George Cruikshank (1792-1878)
Recent studies on the effects of cannabis on migraines
- Medical marijuana reduces the frequency of migraines in 103 of 121 patients. Effects of medical marijuana on the frequency of migraine-associated headaches in a group of adults.
http://onlinelibrary.wiley.com/wol1/doi/10.1002/phar.1673/full
- A review of studies examining the effects of cannabis on migraine pain suggests that marijuana may play a role in treating the condition. Comprehensive Review of Medical Marijuana, Cannabinoids, and Therapeutic Implications in Medication and Headaches: What a Long and Strange Trip.
http://onlinelibrary.wiley.com/wol1/doi/10.1111/head.12570/full
- Marijuana-like medication caused rats with experimentally induced migraines to experience less pain than rats that were not medicated. Activation of CB2 receptors as a potentially therapeutic target for migraine: evaluation in an animal model.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995520/
References:
- Akerman, S., Holland, P.R., Lasalandra, M.P. and Goadsby, P.J. (2013, September). Endocannabinoids in the brainstem modulate dural trigeminovascular nociceptive traffic via CB1 and “triptan” receptors: implications in migraine. Journal of Neuroscience, 33(37), 14869-77. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771033/. - Baron, E.P. (2015, June). Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It’s Been. Headache, 55(6), 885-916. Retrieved from
http://onlinelibrary.wiley.com/wol1/doi/10.1111/head.12570/full. - Boychuk, D.G., Goddard, G., Mauro, G. and Orellana, M.F. (2015, Winter). The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. Journal of Oral & Facial Pain and Headache, 29(1), 7-14. Retrieved from
https://goo.gl/R28LWD. - Greco, R., Gasperi, V., Maccarrone, M., and Tassorelli, C. (2010, July). The endocannabinoid system and migraine. Experimental Neurology, 224(1), 85-91. Retrieved from
http://www.sciencedirect.com/science/article/pii/S0014488610001159. - Greco, R., Mangione, A.S., Sandrini, G., Nappi, G. and Tassorelli, C. (2014, March). Activation of CB2 receptors as a potential therapeutic target for migraine: evaluation in an animal model. The Journal of Headache and Pain, 15, 14. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995520/. - Greco, R., Mangione, A.S., Sandrini, G., Maccarrone, M., Nappi, G. and Tassorelli, C. (2011). Effects of anandamide in migraine: data from an animal model. The Journal of Headache and Pain, 12(2), 177-83. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072518/. - McGeeney, B.E. (2013). Cannabinoids and hallucinogens for headache. Headache, 53(3), 447-58. Retrieved from
http://onlinelibrary.wiley.com/wol1/doi/10.1111/head.12025/full. - Migraine (2013, June 4). Mayo Clinic. Retrieved from
http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/definition/con-20026358. - NINDS Migraine Information Page. (n.d.) National Institute of Neurological Disorders and Stroke. Retrieved from
http://www.ninds.nih.gov/disorders/migraine/migraine.htm. - Rhyne, D.N., Anderson, S.L., Gedde, M., and Borgelt, L.M. (2016, January 9). Effects of Medical Marijuana on Migraine Headache Frequency in an Adult Population. Pharmacotherapy, doi: 10.1002/phar.1673. Retrieved from
http://onlinelibrary.wiley.com/wol1/doi/10.1002/phar.1673/full. - Russo, E.B. (1998, May). Cannabis for migraine treatment: the once and future prescription? An historical and scientific review. Pain, 76(1-2), 3-8. Retrieved from
http://journals.lww.com/pain/pages/articleviewer.aspx?year=1998&issue=05000&article=00002&type=abstract. - Russo, E.B. (2008, February). Cannabinoids in the management of difficult to treat pain. Therapeutics and Clinical Risk Management, 4(1), 245-259. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/. - Russo, E.B. (2001). Hemp for Headache: An In-Depth Historical and Scientific Review of Cannabis in Migraine Treatment. Journal of Cannabis Therapeutics, 1(2), Retrieved from hemp_for_headache.pdf.
- Russo, E.B. (2008, April). Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Benefits of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions. Neuroendocrinology Letters, 29(2), 192-200. Retrieved from
http://cannabisclinicians.org/wp-content/uploads/2014/07/Russo-Clinical-endocannabinoid-deficiency.pdf. - Smith, S.C., and Wagner, M.S. (2014). Clinical endocannabinoid deficiency (CECD) revisited: Can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions. Neuroendocrinology Letters, 35(3), 198-201. Retrieved from
http://www.nel.edu/archive_issues/o/35_3/35_3_Smith_198-201.pdf