Did you know that before cannabis was prohibited in the United States doctors would prescribe cannabis for migraines?
According to this historical review, doctors actually preferred cannabis over other types of treatments to alleviate symptoms of migraines.
Although research on CBD and migraines is still sparse, there are a number of reasons why CBD may very well be a good treatment for migraines.
Cannabidiol, otherwise known as CBD, is one of many active compounds in the cannabis plant which today is being used as a natural treatment for a range of disorders.
In this article, I’m going to cover a broad range of research in an effort to come to a conclusion about whether CBD is a viable and safe alternative treatment for migraines.
What causes migraines?
Migraines are severe headaches that can last up to 72 hours. Migraines are more severe than typical headaches and can cause sensitivity to light, impaired vision and even nausea and vomiting in some people.
There are a number of painkillers which can help to temporarily alleviate symptoms of migraines, but the problem is that these drugs come with side effects.
According to the American Migraine Association over 36 million Americans are affected by migraines (which is around 12 percent of the population).
The cause of migraines are multifaceted and can be caused by hormonal changes, sleep deprivation, medication, environment, genetics, emotional triggers such as stress, anxiety, depression, and even poor posture.
All of these factors can lead to a migraine, however, the exact cause is still unclear, with the majority of research showing it's caused by alterations of nerves, blood vessels and various chemicals in the brain.
What are the most common medications for migraines?
Common medicine for migraines such as ibuprofen (also known as Advil or Motrin) are non-steroidal anti-inflammatory drugs (NSAIDs). These drugs have anti-inflammatory effects, which is why they help with migraines (which are caused by inflamed tissue in cerebral blood vessels).
The problem with NSAIDs is that research shows daily use can increase the chances of developing chronic kidney conditions such as renal ischemia, (especially for those with underlying kidney issues). NSAIDs are also dangerous for your stomach if taken without food and can increase your chances of developing stomach ulcers.
What is CBD?CBD is a compound naturally found in the flower of cannabis. CBD is both similar and very different from the other compounds in cannabis such as tetrahydrocannabinol (THC), which is the compound responsible for the psychoactive effects cannabis is most well-known for.
Both CBD and THC have therapeutic properties. However, due to the fact that CBD isn't psychoactive, there has been a recent proliferation in its manufacturing and sales.
CBD oil and migraines: What does the research show?
As with a lot of research on CBD and disease, research is scarce, but it is increasing as CBD becomes more widely accepted within society.
Research has made it clear that there is a strong connection between CBD, inflammation, and pain. And so in theory it would make sense that CBD would be able to help reduce pain from migraines.
But does the research support this claim?
A study published in Cannabis and Cannabinoid Research in 2017 looked at the effects of oral cannabis on headaches, comparing the effectiveness of CBD to ibuprofen (one of the most common treatments of headaches), as well as Nabilone, which is a common CBD agonist (a synthetic cannabinoid) used to help with nausea, vomiting and also used to increase one’s appetite.
The study found that at the end of the 6 month period out of the 26 people, participants using the Nabilone-CBD formula experienced greater improvements, as well as an overall improved quality of life over those who were using the ibuprofen mixture.
One key limitation of the study is that researchers were not looking at CBD alone and it was a combination of substances (Nabilone-CBD) that researchers were exploring. However, the fact that those taking the Nabilone-CBD formula noticed greater improvements is a good sign.
One study in 2012 found that CBD was effective at relieving certain types of chronic pain and inflammation, with results showing that CBD can help with inflammatory bowel disease (IBD), rheumatoid arthritis, non-alcoholic fatty liver disease, multiple sclerosis and a range of other inflammatory-based conditions. This research indirectly supports the idea that CBD can help with migraines as the causal mechanisms behind these diseases and migraines share some similarities.
The truth is that we simply don’t enough specific human clinical trials on CBD and migraines alone, and so looking at the wider literature that includes cannabis is the best way to come to some sort of conclusion on the benefits of CBD for migraines.
Opioids vs CBD oil for migraines
Migraine patients are often given opioids such as Oxycontin, Vicodin, Percocet, and a number of other strong and addictive medications prescribed for migraines.
The problem is not that these medications aren't effective (they are), but rather that they are addictive and result in a wide range of adverse side effects.
One study published in 2009 looked at what would happen if patients using opioids for chronic pain switched to CBD for pain relief.
Researchers found that cannabinoids act synergistically with opioids, and to quote them "act as opioid sparing agents". This means that someone using opiods for migraines (or any chronic pain for that matter) can use CBD and opioids together whilst lowering the dose of opioids due to the opioid-sparing effects of CBD.
Some would say that the idea that one can switch from opioids to exclusively CBD and experience similar relief is too optimistic, and yes, this is most likely true in cases of heavy opioid addiction.
However, the prospect of CBD (which is natural and safe) being effective enough to lower an opioid users dose is very good news and something to be excited about.
Cannabis for migraines: Does cannabis or CBD work better?A survey conducted by Pharmacotherapy concluded that cannabis can help to reduce the frequency of migraine headaches.
Participants in the study noted that they experienced a reduction of migraines from an average of 10.4 to 4.6 per month. Although this study didn’t use isolated CBD we can assume that CBD played a role.
One old paper looking at cannabis use and migraines from 1987 showed interesting results. The results of the paper showed that long-term cannabis users began to experience migraines after stopping cannabis use abruptly.
The author suggested that the occurrence of these migraines could indicate that compounds within cannabis help to prevent migraines.
However, I would take this claim with a grain of salt for a number of reasons. A good analogy would with coffee consumption. If someone were to drink coffee for years and then suddenly stop, just because they experience a migraine the day after quitting coffee, this doesn't mean that coffee is a preventative compound for migraines. Instead, the coffee is alleviating temporary withdrawal symptoms which cause a migraine.
It’s vital to look at patients’ migraine status prior to beginning the use of cannabis, which this study didn’t.
This isn’t to say that cannabis doesn’t relieve migraines. However, making this claim from this study alone would involve taking a large leap in logic and making unwarranted assumptions.
One study from the University of Colorado found that 121 people who experienced regular migraines used cannabis on a daily basis to prevent migraine attacks. 40% of participants said the frequency of their migraine headaches were halved. 90% of the participants in the study reported fewer migraines per month after using cannabis, which is impressive.
Another study from Germany found that cannabis helped to decrease migraine intensity by 44% and according to the leader of the research team Dr. Maria Nicolodi, they were “able to demonstrate that cannabis is an alternative to established treatments in migraine prevention”.
Overall it seems that the weight of the research is in favour of cannabis and CBD having a positive effect on migraines. There doesn’t seem to be any examples of cannabis exacerbating migraines other than when a heavy cannabis user stops cold-turkey and experiences expected withdrawal symptoms.
CBD Oil and Migraines: Does it improve symptoms?
More research does need to be done to understand exactly how CBD helps to decrease pain and inflammation, but we do currently have a decent understanding of what’s going on in the body.
When CBD is consumed it works by stimulating cannabinoids receptors that are naturally occurring in the brain and nervous system.
These primary endocannabinoid receptors are called CB1 and CB2. CB2 is the receptor most closely interlinked with inflammation while CB1 is more closely associated with the psychoactive effects and perceptive changes that cannabis induces.
One review looking at cannabinoids and inflammation found that CBD suppressed inflammatory and neuropathic pain through targeting the α3 glycine receptors.
One paper in the Journal of Experimental Neurology states that the endocannabinoids system - the bodies natural system that produces cannabinoids - is involved in the process of pain signaling.
Many inflammatory conditions that CBD helps to treat are speculated to be partially induced by a natural deficiency of endocannabinoids within one's body. This condition is referred to as clinical endocannabinoid deficiency.
By using exogenous cannabinoids (i.e through the consumption of CBD oil) one makes up for their deficiency in endocannabinoids and improves symptoms of conditions such as migraine headaches.
Research has shown that neurotransmitters are closely related to migraines with a paper published in the Journal of Neuroendocrinology showing that the molecule Anandamide (AEA) - an endocannabinoid - can increase or decrease the activity of serotonin receptors, which may be one reason why using cannabinoids can help with migraine relief.
AEA is well known to be active within the periaqueductal gray matter of the brain - a region of the brain known for producing migraines.
The overall potential of CBD as a treatment for migraines may lie in its ability to manipulate AEA levels by inhibiting its uptake, resulting in AE remaining outside cells for longer periods of time and consequently decreasing the potential of the generation of migraines.
How to use CBD for migraines
Currently due to a lack of specific research on CBD and migraines there aren't specific dose recommendations for a person suffering from migraines. In general, for chronic pain - which migraines are categorized under - a dose between 2.5-20 milligrams per day is generally the suggested amount.
Will CBD get you high?
CBD oil will not get you high. THC is the substance in cannabis responsible for psychoactive effects, and while CBD is made from cannabis, it doesn’t actually cause psychoactive effects unless THC is present. In fact, CBD is an antagonist to THC, meaning its presence can neutralize the psychoactive effects of THC.
It should be very clearly labeled on the product you’re using whether it’s psychoactive or not.
Side effects of CBD
CBD has produced very few adverse side effects in clinical trials, but the few that do occur tend to be due to interactions with other drugs.
The reason why adverse effects do occur (again, which are very uncommon) are due to a group of liver enzymes which are known as cytochrome P450 (CYP) involved in metabolizing CBD. These enzymes are used in many common medications to help breakdown the medications compounds.
If you're consuming other medications and you're thinking about using CBD as a method to ease migraine symptoms, then be sure to mention these medications to your medical professional as using CBD could (although it's unlikely) exacerbate side effects of your medication.
There is no doubt that there is a link between CBD, pain, and inflammation, but just how effect CBD is for headaches is still a question that needs to be explored through more extensive randomized human clinical trials.
Based on the current research, it’s safe to say that CBD is most likely beneficial for people with migraines, or any kind of pain for that matter. Furthermore, CBD is safe and has few adverse side effects making it a great alternative to stronger migraine medications.