Medical cannabis shows promise to treat migraine

• More than 1 billion people around the world have migraine headaches each year.
• Researchers from the University of Arizona published a study that supports medical cannabis as a potential migraine treatment.
• Experts agree there are both pros and cons to medical cannabis use and provide insights into what they would like to see in further research.

Migraine — the severe, recurring headaches often accompanied by other symptoms — affect more than 1 billion people around the world every year.

Migraine headaches are also the second leading cause of disability globally.

Doctors primarily treat migraine with different types of pain medications, all of which have potential side effects. Past research shows two-thirds of people with severe headaches and migraine sometimes delay or avoid taking prescribed medications due to side effects concerns.

In a new study, researchers at the University of Arizona say they have found evidence supporting the use of medical cannabis for the treatment of migraine.

The scientists say medical cannabis can help lower a person’s migraine frequency per month and reduces nausea and vomiting associated with migraine attacks.

How does medical cannabis help? 

Every person has a network of pain receptors called cannabinoid receptors, which are part of the overall endocannabinoid system. The majority of these receptors are located in the central nervous system, which includes the brain.

Cannabis, also referred to as marijuana, naturally contains substances called cannabinoids. When a person uses cannabis, the cannabinoids enter the body and attach to your cannabinoid receptors and alter their effect.

For a person with a migraine, researchers say this helps to alleviate pain from the migraine.

Previous research also shows cannabinoids can help alleviate nausea — a common secondary symptom of migraine — by affecting certain endocannabinoid system receptors.

Medical cannabis benefits

According to Dr. Cecilia Rosales, a research team member as well as associate dean and professor at the Mel and Enid Zuckerman College of Public Health at the University of Arizona, the objective of this review study was to evaluate how effective and safe medical cannabis is for treating migraine in adults.

For their study, Rosales and her team reviewed 12 publications involving almost 2,000 participants ages 18 and older in Italy and the United States.

Through their review, the researchers found that medical cannabis was around 50% more effective in reducing migraine compared with non-cannabis treatments. They reported that participants who used medical cannabis reduced their number of migraine days after 30 days and also reduced the frequency of migraine per month.

Additionally, the researchers found those who used medical cannabis significantly reduced migraine-associated nausea and vomiting after six months of use.

“There is promising evidence that medical cannabis can reduce the effects — nausea, vomiting — on the onset and duration of migraine in adults,” Dr. Rosales told Medical News Today.

MNT also spoke with Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

Mikhael said he was not surprised by the findings.

“(We) know that medical cannabis can be effective in the treatment of migraine,” he explained. “The study showed that patients that used it showed less monthly migraine days and (it also helped) with some of the acute episodes. That pinpoints that medical cannabis can be used for prevention of migraine and can be used also as an abortive measure for acute migraine.”

Dr. Sherry Yafai, an emergency medicine physician and cannabis specialist at Providence Saint John’s Health Center in Santa Monica, California, stated she was glad there is more research showing proof of cannabis’ effectiveness.

“Just like in this review study, we’re seeing a very similar response in patients that we’re treating as well, which is that patients have a shorter duration of their migraine headaches,” she explained to MNT. “Instead of their headaches ranging from days to weeks, lasting just hours, depending on when they intervene with the cannabis use.”

“Part two is that oftentimes associated with migraines we see nausea and vomiting,” Yafai continued. “Again, we see a decrease or a stop in nausea and vomiting that’s associated with it. And then the other nice part in treatment is that we’re seeing very minimal side effects with the treatment of migraines, and they can cut or reduce their other migraine treatments.”

Yafai also stated this study offers further support for the endocannabinoid deficiency theory.

“There’s an article that outlines this theory, which is that migraine, fibromyalgia, and irritable bowel syndrome, fall in line in this range of diagnoses that may be linked to our endocannabinoid system as being deficient,” she noted. “And that may be why a lot of the medications up until now have not been working well and why migraine can be very responsive to cannabis-based medications.”

Medical cannabis issues

While this research and previous studies support medical cannabis as a treatment option for migraines, Rosales does point out there are some potential downsides that require further study.

“Some of the possible side effects (are) an increase in heart rate, impaired concentration and memory, dizziness, (and) slow reaction time,” she explained. “There can be interactions with other medications, increased appetite, (and) potential for addiction, among others.”

Mikhael pointed out the current study reported an occurrence of medication overuse headaches in participants who used medical cannabis. Researchers reported the adverse events were mostly mild and took place in about 44% of participants using oral cannabinoid preparations.

“My goal as a headache specialist (is) that if I want to treat patients for migraines, I use medication that has the least amount of side effects and does not cause any other headache on top of the migraine,” Mikhael explained. “We do not want to use medications on a regular (basis) that can cause medication overuse or rebound headache because that’s a negative side effect that we don’t want to see. It becomes very confusing to the patient and to the providers in dealing with another problem on top of the problem.”

And Yafai stated another current downside to medical cannabis lies in its legalities. She explained even if people are seeing good results using medical cannabis as a treatment, their jobs, schools, and athletic programs may have rules in place barring its use.

“We’re seeing these things pop up more and more often where it becomes a question of is it worth it or is it not worth it?” she said. “For some people, it is most definitely worth it and they’re willing to run that risk. And for some not so much.”

Further research needed

Mikhael said he would like to see a longer study looking at the potential side effects of medical cannabis.

“Plus we don’t know what effect the long-term use of these medications has on the central nervous system and the brain, because there are definitely reported changes in cognition, memory, and some other effects that can have a long detrimental effect on the brain,” he said.

Yafai said that right now most studies regarding medical cannabis as a treatment option are observational studies, as opposed to the “gold standard” in medicine, which is a randomized double blind placebo controlled trial.

“That’s notoriously difficult to do in the world of THC specifically, but we are starting to see… [new] legal rules and options continue to change every six months to a year,” she said. “So really, the ideal would be to get a double-blinded, placebo-controlled study trial that’s a prospective study.”

And Rosales said she hoped her study’s findings will provide clinicians with additional tools to treat migraine in adults.

“Because the federal government continues to restrict the use of medical cannabis as a schedule I substance under the Controlled Substances Act, clinicians will hesitate to use it as an alternative medication,” she explained. “The U.S. FDA [Food and Drug Administration] has the federal authority to approve drugs for medicinal use in the U.S. As of this year, the FDA has not approved any medical cannabis product for clinical use [only cannabis-derived/related products], although many states have legislatively allowed the use of cannabis for medicinal purposes.”

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