Migraines affect a significant amount of the population and can cause debilitating pain and nausea. Many people find that over the counter, and even prescription medications are ineffective for managing the symptoms of migraines. CBD, one of the most common cannabinoids found in cannabis, has been extensively researched as a potent pain reliever, making it an appealing choice for migraine and headache sufferers. But does it work?
CBD, or cannabidiol, belongs to a class of compounds known as cannabinoids. These compounds are found in cannabis plants and interact with a system of receptors in our brains known as the endocannabinoid system. Another well-known cannabinoid is THC, which is responsible for the euphoric high typically associated with ingesting marijuana. Unlike THC, CBD doesn’t have psychoactive effects. Instead, it appears to reduce anxiety and decrease the sensation of pain. This has made CBD an appealing research subject for chronic pain management.
To understand how CBD works, you first need to understand the endocannabinoid system. The endocannabinoid system is a signaling system that responds to stress from the peripheral and central nervous systems. Endocannabinoids are compounds produced by the body which bind to special receptors found in cells. When a compound binds to a receptor, it triggers several processes that cause cells to behave in a certain way.
There are two main endocannabinoids produced in the body: CB1 and CB2. CB1 receptors are located in the brain and in the peripheral and central nervous systems. CB1 receptors are also responsible for mediating the behavioral and psychotropic effects of cannabinoids that are responsible for the high you get when ingesting THC. CB2 receptors are found mostly in peripheral tissues and in the immune system. They are responsible for mediating and controlling the inflammation response that occurs in the body due to stress.
These two receptors can work independently or synergistically in the body. The endocannabinoid system affects most organ systems in the body in some way. The main function of the system is to manage pain and inflammation through a wide range of biological pathways.
Cannabinoids, such as CBD or THC, can also bind to the CB1 and CB2 receptors. THC, in particular, binds strongly to CB1 receptors, which is why it causes a feeling of well-being and other psychotropic effects. While most studies on cannabinoids have focused on THC and CBD, there is a growing body of literature that suggests that other, lesser-known compounds in cannabis play significant roles in improving the action of these cannabinoids. These ‘cannabis entourage effects’ suggest that using only CBD or only THC diminishes the efficacy of the treatment and that a full-spectrum cannabinoid extract may be more effective at treating pain.
One popular hypothesis around the cause of migraines is the Clinical Endocannabinoid Deficiency (CECD) hypothesis. The CECD hypothesis suggests that there is a correlation between endocannabinoid deficiency and pain. The hypothesis is supported by the fact that many treatment-resistant syndromes, like fibromyalgia, irritable bowel disorder, and migraines all share genetic overlap, and people who suffer from one frequently suffer from the others as well. Having an endocannabinoid deficiency means that you will be more prone to suffer from inflammation and pain, and using cannabinoids like THC or CBD can alleviate this pain.
Currently, there are no cannabis-based medications approved for the treatment of migraines or headaches. While there is a growing consensus that cannabinoids are effective at managing chronic pain, there still needs to be more research into the efficacy, dose, route of administration, and potential side-effects before the FDA or other regulatory bodies will approve them for general use. The issue is made worse by the fact that some studies focus exclusively on CBD, or THC, or even synthetic THC alternatives.
To date, there has only been one clinical study conducted on the safety and efficacy of a synthetic THC analog, dronabinol. The study was a multicentre, double-blind, placebo-controlled investigation sponsored by Solvay Pharmaceuticals into the efficacy of dronabinol for migraines. Despite completing the study in 2015, the researchers have not yet published their results, suggesting that their findings were inconclusive or negative.
The several studies that looked into the effect of THC, CBD, or both on migraines have looked at self-reported data instead of carefully designed trials. A 2016 retrospective study by Rhyne et al. took data from two medical specialty clinics in Colorado and evaluated 121 adult patients with migraine headaches. The study found that migraine headache frequency decreased from 10.4 to 4.6 headaches per month, with the use of marijuana. Almost 40% of the patients reported positive effects of either having reduced instances of migraines or being able to stop migraine headaches from getting worse. 12% of patients reported a negative effect, particularly sleepiness and difficulty controlling their dose and timing. The study does have several shortcomings, most notably issues with follow-up visits and patient issues with controlling their dosage. Moreover, the researchers were not able to document the strains or dosages used by the patients, a fact that further highlights the need for larger-scale, formal clinical trials.
There have also been two smaller trials that looked at the effect of cannabinoids on headache pain that included a control group. The first was a double-blind, active-controlled crossover trial on 30 patients with medication overuse headaches that had failed at least three detoxification attempts. The study divided patients into two groups, one that received 400 mg ibuprofen and the other that received 0.5 mg THC-analog, nabilone daily for eight weeks. After a one-week washout, the groups then swapped their treatments for another eight weeks. The results showed that the nabilone treatment was more effective in reducing pain intensity, level of medication dependency, and daily analgesic intake. It also improved the patients’ quality of life. However, the study did have several limitations, including the possibility that the group coming off of ibuprofen saw results from the cessation of the drug rather than from the nabilone itself.
The second large trial was conducted in the EU, where it looked at the potential use of cannabinoids as both a preventative and a treatment for chronic migraine and chronic cluster headaches. The first phase involved working out the correct dose of the two treatments, one which contained 19% THC, while the other contained a mixture of 0.4% THC and 9% CBD. The 48 volunteers started on a very low dose and worked their way up to 200 mg, which appeared to be effective. The researchers used this dose in the second phase of the trial.
The second phase of the trial included 79 chronic migraine sufferers and 48 chronic cluster headache sufferers. Each individual in the migraine group was assigned either amitriptyline or 200 mg THC + CBD per day for three months. The chronic cluster headache group sufferers received either verapamil or 200 mg THC + CBD daily for one month. Every individual in the study was allowed to use 200 mg of THC + CBD in the event of an acute attack. In the migraine group, the cannabinoid group showed a 40.4% improvement, while the amitriptyline group showed a 40.1% improvement. In the event of acute attacks, the cannabinoid dose helped reduce pain intensity in 43.5% of the cases in migraine patients.
Interestingly, the cannabinoid dose also helped reduce the intensity of pain in chronic cluster headache sufferers, but only if they had a childhood history of migraines. If they didn’t, the treatment proved ineffective. These results show that cannabinoids are approximately as effective as current drugs on the market in preventing and treating migraines and headaches.
There is a lot of evidence that suggests that both CBD and THC can help reduce and manage chronic pain. Both of these cannabinoids bind to receptors in the brain responsible for the sensation and reduction of pain. While many studies confirm the link with chronic pain reduction and CBD/THC, fewer have looked at the impact of these compounds on headaches and migraines. Most studies have looked at existing cases or gotten information from medical marijuana clinics, and these studies suggest that marijuana may be effective for treating chronic migraines and headaches. Small scale studies show that using CBD for headaches is approximately as effective as traditional over-the-counter or prescription medications.
As more studies delve deeper into the question of whether CBD can help decrease the pain or frequency of migraines, a clearer picture of the efficacy of CBD will emerge. For now, there is a good theoretical foundation for believing that it helps with migraine pain, but the truth of the matter is still unclear.