Scientific information for healthcare professionals
Author : Dr.Elmo Resende, Ph.D | Director of R&D – Piauhy Labs
Migraine is a common neurological disease that causes strong headache, throbbing pain, that can leave a person few days in bed. Migraine headache affects around 12% of the worldwide population, who experience nausea, visual disturbances, irritability, numbness, and tingling, among other symptoms. Migraine common symptoms are strident and still professionals can’t point to specific cause. The trigger of migraine attacks can be hard to define. That is why, migraine treatment may vary from patient to patient – mainly include analgesics and anti-inflammatories. Latest literature about migraine relief includes studies made with medicinal cannabis, which demonstrated improvements in migraine headaches common symptoms. In this article we will explore how migraine relief can be driven by medicinal cannabis.
Migraine is a type of disabling headache (headache), of genetic origin, characterized by a throbbing pain in the side of the head (sometimes on both sides) and accompanied by nausea, vomiting and pain in front of lights and sounds (photophobia and phonophobia).
Migraine can be classified in two main types of headaches: primary and secondary.
Migraine is the primary headache, in which the headache itself is both the illness and the cause of the discomfort. It is a throbbing and disabling pain, with an average duration of 4 to 72 hours and which tends to be accompanied by nausea, vomiting, dizziness, sensitivity to light and sounds, and aura, as mentioned above.
On the other hand, headache, or tension-type headache, is of secondary origin, that is, it is a symptom of some other disease or health condition that the body is manifesting through this discomfort. intense, not throbbing and not sensitive to other stimuli. In addition, it tends to be bilateral (affects both sides of the head), whereas in migraine, the pain is usually located in only one part of the head.
The triggers for migraine attacks vary from individual to individual, and in some there is no specific cause.
Migraines are often caused by hormonal changes, eating out of hours, drinking too much coffee, or doing a lot of physical activity. But for some people, certain types of food such as cheese, chocolate, citrus fruits, sweetener, cold or fatty foods can cause migraine attacks.
As migraine has a defined duration, between four hours to three days, treatment usually boils down to controlling symptoms. But when you know what triggers the attacks, there is greater control and migraines are prevented with medication.
Headache treatment aims to resolve attacks efficiently and quickly, returning the patient to their functional capacity, as well as preventing new attacks or reducing their frequency, duration and intensity. One of the general measures is the identification of precipitating factors in susceptible people, such as the ingestion of certain foods or alcoholic beverages, stress, menstruation, fasting, changes in sleep rhythm and intense efforts or taking certain drugs.
In acute attacks, analgesics and anti-inflammatories are first-line non-specific drugs for headache relief, but they only work in mild or moderate migraine attacks. There are also specific drugs for migraine, such as triptans and ergotamine, which are more effective and act even in the most severe attacks. Cluster headaches, on the other hand, may require other care, including oxygen by mask. Prophylactic (preventive) treatment includes some types of antihypertensives, antiepileptics or antidepressants, and must be prescribed by a doctor.
The use of medicinal cannabis has been commonly discussed for its potential to relieve the symptoms of migraine or headaches, or even lessen the frequency of your symptoms. Some people report using medicinal cannabis for pain and ailments other than headaches, but have reported an experience of improvement in the symptoms of headaches and migraines.
Several studies have reported both the benefits and effectiveness of medical cannabis use for patients with migraine. A prospective clinical trial done in 2020 by Aviram et al. focused on 68 patients who smoked or vaped medical cannabis inflorescences evaluated the differences in total medical cannabis monthly dose between responders and non‐responders. This study focused on the associations between phytocannabinoid treatment and migraine frequency. The final results of this study reported better migraine symptom reduction, less negative headache impact, better sleep quality, and decreased medication consumption. In 2019, another research was made by Cuttler et al., 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. Survey results demonstrated that headaches were reduced by 47.3% and migraines by 49.6% after using medicinal cannabis for patients with migraine. 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. It also investigated the tolerance development with prolonged cannabis use.
In 2018, Baron et al. did a literature review of cannabinoid usage to treat migraines, facial pain, and chronic pain and their medicinal benefits. The study shows the significant advantage of medical marijuana in improving nausea and vomiting associated with migraines. 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. They showed a significant reduction in migraine frequency with medical marijuana. 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. 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. The literature review focused on symptoms in palliative care not limited to nausea, migraines, muscle spasticity, and seizures. This review found that oral THC was superior to placebo for managing symptoms.