What's In Your Toolbox? - Migraine and Cannabinoids

It is interesting that with the rise in migraine research and FDA approval of multiple new treatments, there is a corresponding rise in interest in alternative treatments. Possibly seen most clearly in the area of cannabinoids, there is a growing awareness of the need for options that work but which also have few or no side effects.

Managing migraine treatment expectations

The excitement about the possibilities is understandable. However, that excitement needs to go hand in hand with science, awareness of what we do and don’t know, and realism. There is no ‘cure’ for migraine, and sadly utilizing cannabinoids does not change that. That doesn’t mean that they don’t have a viable role to play, though, and for many cannabinoid treatment is an option they’ve either already embraced or are considering adding to their migraine toolbox.

What does research say about cannabinoids and migraine?

While there is a lack of extensive, double-blind studies specifically looking at the impact of cannabinoids on migraine, there are some studies of interest. One study concluded that the endocannabinoid system in people with chronic migraine may be dysfunctional and that activation of that system could offer a promising option in migraine treatment.¹ A second article states that cannabinoids “present a promising class of compounds for both acute and prophylactic treatment of migraine pain… research on (endo)cannabinoids has become pertinent once again.”² In addition, there is at least one clinical trial slated to begin in 2021 that specifically looks at CBD for the preventive use of migraine.³

Managing expectations on cannabinoid use for migraine

As we wait for more clinical trials, it is important to have realistic expectations. For some people, cannabinoids appear to reduce pain levels. For others, there doesn’t appear to be so much a pain reduction as a reduction of the perception of that pain. Some patients anecdotally report that they have found at least partial success in aborting migraine attacks. Others only find preventive help through daily dosing. There are also some who have not found success as either an abortive or preventive treatment. It is too early to know whether some people will respond while others will not, or if it is a matter of finding the right dose, brand, ratio, and formulation for each person. In the meantime, if this is a journey you are considering, it is important to know some of the challenges that lie ahead so that you can be informed.

Cannibinoids are like the wild west in the U.S.

There are some countries that have legalized and regulated cannabinoids, including testing. However, in the USA there is a lack of FDA regulation which makes it like the “wild west” when exploring this terrain here. There are countless options of both marijuana-based CBD and hemp-based CBD brands. While a few brands have been independently analyzed for cannabinoid/terpene profiles, harmful pesticides, and heavy metals, most have not. There is no standard for laboratory conditions, purity, ingredient contents, and many brands rely on anecdotal patient reviews rather than evidence-based information.

A variety of cannabinoid choices

Even within the same brand patients are often faced with a dizzying array of options. How does an individual decide between full-spectrum, broad-spectrum, and isolate? What is the difference between edibles, capsules, topicals, tinctures, and vaping? What is the best ratio of CBD to THC? Is it important to have a formulation that includes various terpenes? The questions are endless, and the process is really one of trial and error. Even with anecdotal advice from other patients, which often gives a much-needed starting point, the journey is more of a marathon than a sprint. Migraine Buds, a website dedicated specifically to the use of cannabinoids for migraine, states: “Medicating with cannabis is a continual process of trial and error. Each person’s metabolism and neurotransmitters react differently, so what works for one person may not work for another. It is very hard to predict what will work for you.”⁴

The expense of trying cannabinoids for migraine

Cannabinoid products are not currently covered by insurance for migraine and are generally very expensive. With at least one clinical trial expected to start sometime during 2021 there is hope that this may change, but it is going to take some time. As a result, the cost of trying various cannabinoid products to see if they work and are tolerable can be very expensive. For those who quickly find a variation that helps reduce the frequency or severity of attacks, or even aborts attacks, the cost can be well worth it. For those who have a longer explorative journey or who never end up getting relief, the expense can sometimes be daunting.

Interaction with migraine medications

Cannabinoids such as CBD and THC can affect drug metabolism by impacting the CYP enzymes. As a result, some medications may end up having a reduced effect while others may have an immediate increased effect, both of which can be very concerning. As one recent article states, “There are numerous in-vitro and in-vivo studies indicating that cannabinoids may act on P450 isoenzymes to affect the metabolism of various drugs.”⁵ The article itself gives a wonderful overview of the concerns regarding possible interactions of cannabinoids with medications and makes great reading for anyone who is interested in learning more.

The early stages of migraine and cannabinoid research

As with everything else to do with cannabinoids, research and understanding are still at a very early stage, even though there is documentation of usage for migraine as early as 1839! Right now there is a huge need for research and clinical trials, and this is emphasized by the fact that at least two of the new abortive migraine medications FDA approved in 2020 have warnings about the concomitant use of CYP inhibitors and inducers.^6,7

The importance of talking to doctors

When it comes to use of CBD-based products there may be an understandable reluctance for some patients to share any potential use with their doctors. However, this article highlights the importance of informing our doctors about everything we take to help manage pain. That includes both prescription medications and over-the-counter options. By doing this, we can be informed about any potential contraindications or necessary dosage changes to our medications.

Where to start if interested in cannabinoids for migraine

If you’re interested in trying cannabinoids for migraine then you are likely wondering where to start, so here are just a few ideas:

• Educate yourself and consider joining an online group such as Migraine Buds Chat.
• Realize that this process is trial and error and is often more of a marathon than a sprint.
• Look for brands that have been independently tested for cannabinoids, terpenes, and harmful chemicals.
• Avoid brands that make unrealistic or unsubstantiated health claims.
• Start with a low dose full-spectrum CBD product. Give it some time to see if it helps and what any potential side effects may be. Then slowly increase until you reach a dosage that is helpful to you. If it's not helping, consider trying a new brand/product strain.
• Most of all, PLEASE make sure that the doctor that treats your migraine knows what you are taking. Informed decisions about medications and dosing are essential.

We want to hear from you

We’d love to hear if you have tried cannabinoids for migraine, and if so, whether you found something that helped? If you have not tried them but are interested, let us know why you are considering this. Finally, is this a discussion that you feel comfortable starting with your doctor?