The daily administration of cannabinoids over time is associated with a reduction in the frequency of migraine headache, according to findings. In another win for marijuana research, a study has found that the active compounds in cannabis are more effective at reducing the frequency of. In fact, studies show that headache can Patient with migraine, Case report, Women found superior relief of migraine with . a reduction in migraine frequency.
of Cannabinoids Study Migraine, Frequency Finds Reduce
In another California survey of patients, 8. Other studies have looked specifically at the change in the occurrence of headache disorders with use of cannabis. These results indicate that cannabis may be an effective treatment option for certain migraine sufferers. Reports from cluster headache patients 56 indicate that cannabis could have value in treating a portion However, cannabis was reported to provoke cluster headache attacks in some patients One possible explanation for this provoking effect is that cannabis is known to increase heart rate, increase blood pressure, and cause systemic vasodilation.
Interestingly, cluster headaches appear to show improvement with treatment using hallucinogens such as d-lysergic acid amide ergine or LSA , psilocybin, and lysergic acid diethylamide LSD.
Case reports also give insights into the mechanisms behind the anti-headache action of cannabis. Smoking cannabis has been reported to relieve pain associated with pseudotumor cerebri, 57 a condition that is characterized by an increase in the intracranial pressure of an uncertain etiology. This suggests that the therapeutic effect of cannabis in some headache conditions could be a result of reducing intracranial pressure.
In fact, dexanabinol, a synthetic cannabinoid, has been found to relieve intracranial pressure and improve outcomes after traumatic brain injury. The pathophysiological mechanisms of many headache disorders are not entirely understood. Nevertheless, preclinical data examining the effects of endocannabinoids on the neurological and vascular systems demonstrate the influence of endocannabinoids in modulating several major components of migraine pathogenesis Table 3 and Fig.
Proposed model of the influence of cannabinoids on headache pathogenesis. Each branch corresponds to a mechanistic category listed in Table 3. Various genetic factors can predispose individuals to migraines. For example, studies have shown that a decrease in expression of the cnr1 gene, which encodes the cannabinoid receptor type 1 CB1 receptor, is associated with migraine and trigeminovascular activation.
These findings support the proposed theory that alterations in endocannabinoid function with reductions in endocannabinoids such as AEA may be one of the mechanisms underlying migraine. A feature of headache disorders is that they are highly associated with other comorbidities, including anxiety and mood disorders, allergies, chronic pain disorders, and epilepsy.
One of the first subjective indicators of a migraine is the occurrence of an aura, a perceptual abnormality that often precedes a migraine attack. A wave of electrophysiological hyperactivity followed by inhibition, known as cortical spreading depression CSD , is considered the neurobiological event underlying the migraine aura.
CSD has been shown to be a result of excessive glutamate signaling, and one effect of endocannabinoids is the suppression of glutamate signaling via the inhibition of NMDA receptors.
Another component of most headache disorders is overactivation of the trigeminovascular system, the primary sensory nerve tree for the head. One of the most reliable triggers for migraine is NO. Studies have demonstrated the role of endocannabinoids in inhibiting NO.
Moreover, vasodilation is not necessarily pathogenic for headaches, and endocannabinoid-induced vasodilation could desensitize the vasculature to known headache progenitors, such as NO. The hematological properties within the dilated cranial blood vessels themselves may also play an important role in the pathophysiology of migraine.
Endocannabinoid levels are reduced in the platelets of migraine patients, 80 and women with migraine show increased FAAH and EMT activation in their platelets. Cannabinoid compounds have been shown to stabilize platelets and prevent release of serotonin from platelets during a migraine. Endocannabinoids have a well-established role in the modulation of pain signals at the spinal level 81 and contribute to the descending modulation of pain through brainstem nuclei. Headache disorders are common, painful, and disabling; moreover, treatment for these disorders is inadequate for many sufferers.
Before cannabis was made illegal, many prominent physicians praised its use in the treatment of headache disorders. Reports from this period emphasize the administration of consistent and uniform doses and the titration of doses to minimize intoxication. For prophylactic treatment, cannabis was typically given orally two to three times per day, for weeks or even months, 28 , 32 , 36—38 and for abortive treatment, cannabis was given at higher oral doses or smoked.
Although there have not been any clinical trials of cannabis as a treatment for headache to date, reports indicate that cannabis is commonly used by patients to self-medicate for headache disorders. A retrospective analysis has shown a significant impact of cannabis in treating migraine 47 and a clinical trial of a synthetic cannabinoid showed efficacy for MOH, 53 but properly designed placebo-controlled trials are needed to determine the true efficacy and complications of cannabis treatment for headache disorders.
Preclinical studies examining the role of the endocannabinoid system in migraine pathogenesis also suggest a potential therapeutic value for cannabis in the treatment of headache. It has been postulated that a general deficiency in endocannabinoid tone could underlie headache disorders. The studies presented in this review indicate the importance of further well-designed clinical trials of the efficacy of cannabis in the treatment of headache disorders.
Because there are still many obstacles present in constructing double-blind placebo-controlled clinical trials of cannabis, the following list outlines various other potential future investigations and recommendations based on the findings presented in this review. The present review examines the historical guidelines for cannabis treatment of headache, available clinical data on the use of cannabis for headache, and preclinical literature on the role of the endocannabinoid system in headache pathophysiology.
From this examination, various methodological recommendations are made for future studies and potentially novel treatment practices are considered. Although placebo-controlled clinical trials are still needed to appropriately determine efficacy, it appears likely that cannabis will emerge as a potential treatment for some headache sufferers.
Cite this article as: National Center for Biotechnology Information , U. Journal List Cannabis Cannabinoid Res v. Published online Apr 1. Lochte , Alexander Beletsky , Nebiyou K. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Headache disorders are common, debilitating, and, in many cases, inadequately managed by existing treatments.
Historical Use of Cannabis for Headache Historical reports, though not ideal forms of evidence, are important resources for understanding the potential use of cannabis in the treatment of headache disorders. All patients experienced improvement, some were cured. Donovan 41 Migraine A: Usually lasting relief, sometimes curative.
Greene 35 ; Russo 18 Clavus hystericus and migraine P: Waring 36 Migraine or sick headache P: Taken before each meal Women: Seguin cited in Russo 18 Migraine or sick headache A: Clinical experience Found to be the most effective drug for migraine. Can abort attacks in some cases. Clinical experience Helpful prophylactically and abortively, even in cases of migraine refractory to other treatments.
Mackenzie 38 Migraine P: Open in a separate window. A, abortive; P, prophylactic. Clinical Studies on Cannabis Use for Headache The schedule 1 classification of marijuana in has made rigorous clinical studies on the treatment efficacy of this substance difficult. Subject population Type of study Significant findings Source 3 Chronic smokers Case series Migraines after cannabis cessation.
Remission of headache with return to use in one patient. El-Mallakh 42 Patient with migraine Case report Women found superior relief of migraine with cannabis compared with beta-blockers, opiates, and ergots.
Petro cited in Russo 18 Patient with migraine Case report 18 years of treatment failure with standard pharmaceuticals, found success with smoked cannabis. Grinspoon and Bakalar 45 Patient with migraine Case report Successful treatment with cannabis that did not produce inebriation. Terwur cited in Russo 18 Patients prescribed cannabis for migraine Retrospective study Migraine occurrences decreased from In one case, cannabis improved response more than dronabinol.
In three cases, cannabis was used to abort headache in the prodromal phase. Mikuriya 48 Patients seeking physician recommendation for medical cannabis Survey Use as treatment unknown. Cannabinoids and Headache Pathophysiology The pathophysiological mechanisms of many headache disorders are not entirely understood. Studies on the Role of Cannabinoids in Headache Pathogenesis.
Mechanistic category Significant findings Source Systemic Variants in the cnr1 gene encodes for the CB1 receptor resulting in decreased expression of CB1 associated with migraine and trigeminovascular activation. Could desensitize receptor and inhibit pathophysiological mechanism of headache.
Underlying cause of headaches Various genetic factors can predispose individuals to migraines. Glutamate signaling One of the first subjective indicators of a migraine is the occurrence of an aura, a perceptual abnormality that often precedes a migraine attack.
Trigeminovascular activation Another component of most headache disorders is overactivation of the trigeminovascular system, the primary sensory nerve tree for the head. Platelet stabilization The hematological properties within the dilated cranial blood vessels themselves may also play an important role in the pathophysiology of migraine. Modulation of afferent nociceptive signals Endocannabinoids have a well-established role in the modulation of pain signals at the spinal level 81 and contribute to the descending modulation of pain through brainstem nuclei.
Discussion Headache disorders are common, painful, and disabling; moreover, treatment for these disorders is inadequate for many sufferers. The development of dosing and treatment guidelines for the use of cannabis in the treatment of headache disorders.
Physicians should consider discussing dosing strategies when recommending cannabis as headache treatment, with the aim of maximizing efficacy and minimizing harm. A focus on dose consistency through the use of oral cannabinoids or metered-dose inhalers could benefit future clinical trials by allowing for easier blinding and placebo control. Moreover, the use of oral cannabinoids could have unique benefits in the prophylactic treatment of headache, because it could avoid concentration peaks and individual differences in bioavailability.
Investigation of the anti-headache effect of cannabidiol CBD. This review found no available information on the use of CBD as a treatment for headache. Nevertheless, CBD has shown efficacy for headache-related conditions i.
Identification of variables that could predict treatment receptivity in headache patients. This could include stratification of headache disorders or patients based on sex, genetics, metabolic function, or neuronal biomarkers. Investigation of the long-term risks of cannabis treatment for headaches.
This should aim at quantifying any side effects, withdrawal symptoms, dependence, refractory headaches, or negative outcomes from cannabis treatment for headaches. Evaluation of other anti-headache drugs that target the endocannabinoid system. Evaluation of cannabis in combination treatment with analgesic or other anti-headache medications or as a second-line treatment in patients who are refractory to traditional medications.
Conclusion The present review examines the historical guidelines for cannabis treatment of headache, available clinical data on the use of cannabis for headache, and preclinical literature on the role of the endocannabinoid system in headache pathophysiology.
Author Disclosure Statement No competing financial interests exist. Burden of migraine in the United States: The global burden of headache: Migraine and tension-type headache in children and adolescents.
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Pathophysiology of medication overuse headache: Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Headache diagnoses in patients with treated idiopathic intracranial hypertension. Migraine pathophysiology and its clinical implications. Harrison's principles of internal medicine. S92—S [ PubMed ].
Prognosis of migraine and tension-type headache: Jensen R, Bendtsen L. Case-based diagnosis and management of headache disorders. Headache Siva A, editor; , Lampl C, editor. Springer International Publishing, , pp. Gunther R, Goodyer J. The Greek herbal of Dioscorides: Encyclopedia of Islam New Edition , vol.
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A Handbook of Therapeutics. Remarks on the value of Indian hemp in the treatment of a certain type of headache. The cannabinoids provided that same level of pain relief to patients diagnosed with cluster headache, a condition involving a series of short but extremely painful headaches, provided the patients had experienced migraine earlier in life.
The cannabinoids were found to have no effect, however, on cluster headaches in patients with no previous migraine history.
The cannabinoids were also well-tolerated, with reported side effects including just drowsiness and difficulty concentrating. In female subjects, the incidence of stomach ache, colitis and musculoskeletal pain decreased. Previous studies have also found cannabinoids effective for reducing the frequency of migraine in humans. Just recently, a published research review concluded that preclinical evidence suggests cannabis could effectively treat headache disorders. Migraine is thought to be associated with an abnormal fluctuation in brain neuronal activity, which activates the trigeminovascular system and leads to an inflammatory response that causes pain.
Studies have found evidence that cannabinoids act upon these cannabinoid receptors to elicit a response that inhibits the trigeminovascular system and restricts inflammation. Learn more about the research investigating the efficacy of cannabinoids for migraine and other pain conditions by visiting our education page. Keep up with the latest cannabis-related scientific research through our news feed.
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The Use of Cannabis for Headache Disorders
Medical marijuana might help migraine sufferers reduce the frequency of their headaches, a new study suggests. In the study of people. A study confirms that cannabis for Migraine prevention is as effective as leading drugs. Cannabis for Migraine: Prevents Migraines and Reduces Pain The incidence of stomach ache, colitis and musculoskeletal pain – in. A study has revealed that the active compounds in cannabis work better at reducing the frequency of acute migraine pain than traditional This research confirms earlier studies which show that medical cannabis is effective.