7 Surprising Reasons for Cannabis in Migraine Headaches
Jul 28, 21
Migraine is a type of debilitating headache with two primary classes: common migraine headache occurring with nausea, vomiting, and sensitivity to sensory stimuli; and classical migraine headache preceded by an aura of warning symptoms such as visual disturbances. Other less common migraines include abdominal, ocular, and chronic migraines.
Common tension headaches affect up to 80 percent of the population. The many causes of tension headaches include lack of dehydration, lack of sleep, poor posture, and emotional stress. Cluster and thunderclap headaches, while severe in intensity, are not considered migraines. Read on to explore these 7 reasons for using cannabis for migraine headaches...
1. As Effective As A Prophylaxis
Prophylaxis simply means; measures designed to preserve health; treatment given or action to prevent dis-ease. Cannabis is just as effective as a prophylaxis for reducing the frequency of migraine in many patients. A 2016 chart review of Colorado patients with migraine noted that 39.7 percent of these patients reported positive benefits for their migraines, with nearly 20 percent successfully reducing the frequency or preventing headaches, and over 11 percent crediting cannabis with aborting headaches.
2. Relieves Pain from Cluster Headaches
Cluster headache or histamine headache is often considered the most painful form of headache, and true to its name comes in clusters of short, very intense headaches. While the mechanism is not completely understood, it appears to involve the hypothalamus. The hypothalamus has a very high density of cannabinoid receptors, which may help explain why cannabinoids can be of value in treating cluster headaches. In an extremely well thought out and interesting 2015 review of medical cannabis and headache, Dr Eric Baron of the Cleveland Clinic cites several cases that support his opinion that cluster headache can be helped by cannabis.
What gets rid of migraines fast?
In one case report, a 19-year old male who was unresponsive to pharmaceutical medications for his headaches revealed that smoking marijuana at the onset of a cluster headache would abort the headache completely within five minutes. Given this result, his doctor prescribed dronabinol medication at 5 mg, which is a synthetic version of THC. Dronabinol, taken at the onset of a cluster headache, consistently provided complete and rapid relief within 5 to 15 minutes.  Cannabis has also proven to be successful in treating the symptoms of many common tension headaches. Because of the potentially serious adverse effects when using cannabis with adolescents and children, caution is advised before using cannabis to treat the headaches in younger people.
3. Helps Correct ECS Deficiencies
Italian researchers, Greco and Tassorelli, published a thorough review of cannabinoids and migraine in their book, Cannabinoids in Neurologic and Mental Disease. Current thinking about migraine views the headache as a series of steps. The person encounters a migraine generator or trigger: hunger chemicals in a certain food, bright light, sudden anxiety, hormonal change, and so on. This trigger initiates a chemical reaction within the brain; one that may normally stimulate the release of endocannabinoids to restore equilibrium and balance again. But for some unknown reason, migraineurs don’t always release these endocannabinoids and this absence is likely indicative of an endocannabinoid deficiency stemming from endocannabinoid system (ECS) dysfunction; see our article The Endocannabinoid System Explained. It must be noted that endocannabinoid dysfunction has been discovered to be the root cause of many autoimmune diseases such as fibromyalgia and multiple sclerosis, along with other conditions such as endometriosis and PCOS. This doesn’t come as a surprise, since the ECS is the most important system of physiology inside the body responsible for maintaining order and balance across every major bodily system from the reproductive, cardiovascular, and lymphatic, to the circulatory, and respiratory systems. If the ECS is dysfunctional, eventually other areas of the body will fall into dysfunction also. Dysfunction of the ECS leads to an imbalance or lack of sufficient endocannabinoids in circulation to allow for normal healthy functioning. Without endocannabinoids to normalize communication, the trigger causes pain-sensing cells in the brain stem to release neuropeptides, which causes other sensitive pain-sensing cells to releasing more neuropeptides, starting a cascade. This flood of chemicals creates abnormal dilation of blood vessels on the brain’s surface. This jump in pressure increases swelling in the surrounding tissue, causing pain levels to skyrocket. There appears to be gender differences in migraine with female patients showing increased CB1 cannabinoid receptor binding between headaches, especially in areas of the brain that regulate pain, supporting the idea of endocannabinoid deficiency in migraine.  It has been noted that migraine tends to happen in 70 percent of cyclical vomiting, a syndrome that has been linked to heavy cannabis use,  and as you'll read further, cannabis is biphasic; meaning, it can help prevent migraines from happening at low doses, and actually bring them on at high doses, where chronic long term use can exacerbate it.
4. Used for Thousands of Years
Cannabis has been used for the prevention and relief of migraine headaches for over a thousand years in Indian, Chinese, Egyptian, Greek, Roman, and Islamic medicine.  The earliest use of cannabis in migraine treatment dates back to the ninth-century Persia and recommends inserting cannabis juice into the patient’s nose, thus avoiding its rejection by vomiting. A 12th century herbalist and abbess, Hildegard von Bingen, wrote of cannabis in her Physica, “Whoever has an empty brain and head pains may eat it and the head pains will be reduced.” 
5. It Was The Drug of Choice
Oral cannabis extracts became Western medicine’s drug of choice for migraine from the mid-19th century until the early 1940s (until it's more recent resurgence). From the 1870s onward, prestigious medical journals, including the Journal of the American Medical Association, The Lancet, and Merck’s Archive, all printed articles recommending cannabis in migraine treatment. The 1912 Merck Manual entry on migraine gives cannabis as the sole medicinal option. A 1919 Eli Lilly catalogue lists, “Cannabis Indica, Extract” as a treatment for migraine and neuralgia at doses up to 1 gram.
By the 1930s, physicians began to complain about the wide variance in potency found in pharmaceutical cannabis extracts. This inconsistent level of quality and the first marijuana laws encouraged the removal of cannabis from the Western pharmacopeia in 1941. The final appearance of cannabis as an established treatment for migraine in the West appears in a 1942 issue of the Journal of the American Medical Association.  Cannabis continued to be a common treatment for migraine headaches in India, China, and Southeast Asia.
6. Helps Prevent Migraines
In the 1990s, Dr Ethan Russo attempted to gain permission from the National Institutes of Health (NIH) to conduct clinical trial studies with cannabis on migraine patients, but the National Institutes of Drug Abuse (NIDA) blocked the study. In 2004, Russo published a hypothesis that a deficiency of endocannabinoids in some patients underlies the pathophysiology of migraine, fibromyalgia, and irritable bowel syndrome (among many other autoimmune conditions), thus coining the term Clinical Endocannabinoid Deficiency (CECD).  In 2016 he produced a follow-up paper that reviewed the evidence about CECD, including migraine, that has accumulated since his first paper.  Subsequent research has provided sufficient data and evidence to support Dr Russo’s findings of a Clinical Endocannabinoid Deficiency.
Medical disclaimer: the information contained in this article is for informational purposes only and does not constitute medical advice. Prior to making changes to your lifestyle or treatment plan, consult with a licenced medical professional on the long term effects of cannabis, tetrahydrocannabinol (THC), and cannabidiol (CBD) on migraine frequency and chronic pain relief. Medical cannabis users can run the risk of medication overuse headache if they do not take care to keep the dose low, and start low and slow. For further information and news, visit the health section of our blog.
7. Relief Without Psychoactivity
There are two main approaches when dosing cannabis for migraine: prophylactic and symptomatic. Prophylaxis is intended to reduce the frequency and intensity of the headaches; meaning, its a preventative measure. The symptomatic approach relieves pain and nausea associated with chronic migraine after its onset; meaning, you dose cannabis when you first feel the inital symptoms of migraine coming on.
The prophylaxis approach is intended to supplement (top up) the body's own (lack of) endogenous cannabinoids with its plant-based equivalents from cannabis. Patients consume a small daily dose of cannabis, often below 2.5 mg of THC or its equivalent, which produces little or no intoxication. This prophylactic dose appears to be most effective if taken upon rising or mid afternoon, depending on whether the patient has noted a pattern for the occurence of headaches. Many cannabinoids, including THC, are biphasic, so while a small THC dose could relieve anxiety and reduce headache frequency, a large dose may trigger anxiety and precipitate a headache.
Symptomatic relief is most effective taken early in the migraine’s progression. Sublingual administration under the tongue, smoking, or vaporizing of up to 12.5 mg of THC can be helpful if the migraine patient is already vomiting. With a migraine that has progressed in severity, doses of up to 25 mg of THC with a CBD buffer of 10 mg and a terpene entourage of limonene and myrcene can be of value for helping to sedate the patient and reduce extreme nausea. The addition of CBD to the THC dose can reduce the intensity of THC psychoactivity. Remember that cannabis dosage has a “sweet spot” for pain relief treatments, so avoiding overmedication is of utmost importance when it comes to successfully managing symptoms of migraine and preventing a medication overuse headache.
Dosage for common tension headaches would ideally follow the sweet spot approach. For tension headaches, 2.5 to 5 mg of THC will likely prove effective. An additional 2.5 mg of CBD can help. Interestingly, CBD when dosed alone can result in mild headache in some people.
Reduce Migraine Occurrence
People often note that a small dose of oral cannabis can be rather effective in reducing migraine occurrence. These oral doses can be administered sublingually for faster onset, or swallowed for slower release of THC. Caution must be exercised with oral cannabis to avoid overdose. Problems with finding the correct oral dose for migraines can be an issue. If using an edible cannabis product from a dispensary, initially choose a product that contains less than 5 mg of THC and start by eating half of the product.
Both smoked and vaporized cannabis can be effective. Migraine patients have found that administering cannabis at the onset of the aura phase can sometimes halt the headaches progression and limit the visual disturbances.
What strain is best for migraines?
The following high-THC strains seem effective for their combination of anti-inflammatory, sedative, and analgesic effects: caryophyllene-dominant with myrcene and limonene varieties, such as Gorilla Glue #4, or myrcene-dominant varietals with ocimene and limonene, such as Purple Haze. for low-dose migraine prophylaxis, a very small dose of myrcene-ocimene Skunk or a myrcene-pinene Purps or Blue Dream. For acute pain and nausea, myrcene-dominant Purps.
For more information, read our other article on Migraine.
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6. M. Fishbein, “Migraine Associated with Menstruation,” Journal of the American Medical Association 237, no. 326 (1942)