Dear Nurse Susan,

I have been plagued with migraines for the last 20 years. I have tried everything and sometimes it helps, but most of the time it doesn’t. I’ve never tried cannabis and I’m a little bit afraid, but willing to put up with the high if it will ease my pain. I figure I can’t function with the pain, so what does it matter if I get high? Thanks for your help.

-Splitting Headache

Dear Splitting Headache,

You are not alone; migraine is an extremely prevalent headache syndrome affecting 14% of Americans, with a 3:1 female:male ratio with an annual cost of $20 billion. Ethan Russo, MD, a world-renowned cannabis researcher posits that migraines (and many other disorders) are the result of an endocannabinoid deficiency (ECD). The endocannabinoid system interacts with every other system in the body and is responsible for maintaining balance or homeostasis. Here is a link to a short video that explains the endocannabinoid system:

Migraine is a neurovascular disorder with neurogenic inflammation. Researchers have found that endocannabinoid (cannabinoids that we produce in our body) levels were significantly lower in chronic migraine patients. Serotonin levels were also strongly reduced in chronic migraine patients. This information supports the hypothesis that dysfunction of the endocannabinoid system is involved in migraine headaches and the fact that cannabinoid treatment, in the form of cannabis, frequently provided symptomatic benefit.

Significant differences in levels of anandamide (a cannabinoid that we make in our bodies) in cerebrospinal fluid have been documented in migraine patients, and advanced imaging studies have demonstrated below-normal function of ECS in post-traumatic stress disorder. Clinical data have also produced evidence for decreased pain, improved sleep, and other benefits to cannabinoid treatment and adjunctive lifestyle approaches affecting the ECS.

According to Dr. Russo, until recently, only case reports and surveys of use of THC and cannabis and its effects on migraine have been published but a more formal observational trial has been reported from a cannabis-oriented clinic in the state of Colorado. Among 120 adults with migraine for whom cannabis prophylaxis (prevention) was recommended, and of which 67.8% had previously used cannabis, the frequency of headache diminished from 10.4 to 4.6 attacks per month. Overall, 85.1% had decreased migraine frequency, with 39.7% reporting positive effects: prevention of or reduced headache frequency (19.8%) or aborted headache (11.6%) in this selected and uncontrolled population employing a mixture of administration techniques with unanalyzed but presumably high-THC cannabis.

It is worth remembering that cannabis was a mainstay of treatment of migraine in Europe and North America for a century between 1843 and 1943, similarly supporting claims of a high degree of efficacy of cannabis treatment in both acute and prophylactic treatments of migraine. The only thing that changes was the politics around cannabis…..not its’s effectiveness as a treatment.

The best results are usually found with a combination of preventive (ongoing use) and acute (when having an event) use of cannabis. A daily regimen of the lowest possible dose of THC combined with CBD whole-plant medicine (oil, tincture, sublingual spray for THC or CBD) will help prevent the onset of migraines, but when they do appear, treat immediately, as soon as you think a migraine is coming on. When a migraine hits, vaping or smoking is quickest way to ingest the medicine and get results.

So, Splitting Headache, cannabis does have promise for patients suffering from migraines. If you’re not a frequent cannabis user make sure you have something on hand for when the next migraine sneaks up on you. Experiment as needed to find out what works best for you.

Wishing you the best in your efforts to manage the pain of this debilitating and all too common problem,

Nurse Susan

p.s. Here are a few more informative resources

https://www.ncbi.nlm.nih.gov/pubmed/26015168 - Article by Dr. Eric Baron of the Cleveland Clinic (speaker in the above video)

https://www.hellomd.com/health-wellness/5833c3741acf3d000ce08758/how-to-stop-migraines - article