Medical Marijuana for Migraine
Despite immense curiosity among people with migraine, most information on using medical marijuana for acute or preventive migraine treatment is anecdotal. Here are some frequently asked questions about marijuana for migraine with answers based on current medical understanding.
Does marijuana work for migraine?
Researching medical marijuana is difficult legally, so there have been no high-quality blinded studies on its use for migraine. Almost everything you hear about marijuana’s use for migraine is anecdotal or comes from a small number of rat studies. Given the multiple ways marijuana and cannabinoinds, chemical compounds found in marijuana could work for migraine, researchers believe a potential benefit is plausible.1,2 The multiple headache specialists I have discussed this with have said that about half their patients get migraine relief from marijuana and the other half say it makes their attacks worse. This is what anecdotes from patients I’ve spoken with also indicate. Marijuana is widely regarded as a treatment for nausea (some synthetic cannabinoids have received FDA approval for this purpose)3, which could provide symptomatic migraine relief.
What kind of marijuana is best for migraine?
Sativa and indica are the two species of marijuana most widely available. Within these species (or a hybrid of the two), there are hundreds, if not thousands, of different strains. Strains are cultivated to have different effects (for recreational marijuana, this could be a “body high,” “head high” or high THC content) and treat different symptoms. Despite marijuana being sold only as medicine in 21 U.S. states, most current strains were developed to deliver the biggest high.4
If you tried marijuana for migraine and it was ineffective, the problem may have been the strain you tried (or it could simply not be effective for you). Dispensary employees should be able to talk you through the different strains they carry and which are most likely to be useful for your symptoms, though the knowledge of employees varies widely from one dispensary to the next. You can also look up strains on the website Leafly, which catalogs the positive and negative effects on each strain based on user feedback (like Yelp for marijuana). To find specific strains, you can search by condition or symptom, including migraine, headache, nausea, insomnia and anxiety. Not every strain will be available at every dispensary and even the same strain can have variations depending on the growing conditions of that particular crop.
What is the dosing for marijuana to treat migraine?
There are no guidelines for marijuana use for migraine, but caution is recommended. As with pretty much all medications, the goal is to find the lowest effective dose. Given that, for acute treatment, it's best to start with a very small amount and watch your symptoms carefully to see if they improve, worsen or remain the same. Then you can use more if you decide it is necessary. Depending on how much you use, there’s a chance you’re not treating the migraine, but are getting so high you don’t notice it. Only you can decide if that’s a wise long-term strategy for you. Some people report using marijuana as a migraine preventive, though typical dosage seems to vary widely. Jessica Catalano, who has recently published a medical marijuana cookbook, reports using 25 to 40 mg of an edible nightly as a migraine preventive.5
Can marijuana cause rebound (medication overuse) headache?
Again, this hasn’t been studied. When it comes up at conferences, physicians say they’ve seen patients with rebound headaches from marijuana and they treat it the same way as opioids. Opioids should not be taken more than 10 times a month. It’s recommended to follow that guideline for marijuana and to use as little as possible each time.
What's the best way to take medical marijuana?
Much like oral triptans vs. injected triptans, the delivery method you use for marijuana can influence its efficacy. Smoking gets the marijuana into your system quickly and it won’t take long before you can assess whether you need more. There are risks with smoking anything, though a large, 20-year study on lung function and smoking found marijuana to be less damaging that tobacco.6 (Vaporizers also get the drug in your system quickly and may be less harmful to lungs than smoking.7).
Eating marijuana delays how quickly it takes effect. Delayed stomach emptying, a migraine symptom, could mean you don’t absorb as much of the drug as you need. If you vomit during your migraine attacks, you may not get much of the drug in your system at all. (A friend who used Marinol for chemo nausea told me the effects varied dramatically. Sometimes it was really helpful, other times not at all. She said the efficacy seemed to depend on how long it had been since she’d eaten and how efficient her digestive tract was that day.)
What other questions do you have?
These are the top questions on marijuana and migraine, but you very likely have more. Please leave them in the comments and I’ll do my best to answer them in a future post.
How much has your migraine disease changed or evolved over time?