In Australia, around 4.9 million people suffer from migraine. While multiple prescription medicines exist for migraines, they aren’t always effective for many of the migraine sufferers who try them. Medicinal cannabis may have a place in therapy due to the limited tolerability and efficacy of existing migraine medicines.
- Many migraine medicines have an unfavourable side effect profile, resulting in poor compliance and limited efficacy.
- There is an overall consensus for the indication of medicinal cannabis therapy in migraines when first and second-line treatment have failed.
- Use of medicinal cannabis does not appear to lead to medication overuse headache that is associated with other conventional treatments.
- In Australia, medical marijuana (including CBD) is a scheduled medication and patients should discuss treatment with their doctor. If your doctor is not open to the conversation you may wish to speak with one of our medical marijuana doctors by booking in an initial consultation.
The Potential of Cannabis and CBD to Help Treat Migraines
Migraine is one of the most disabling conditions in the world. It is ranked as the seventh leading cause of disability. More than 90% of people living with migraine can’t function during an attack. The World Health Organisation (WHO) has stated that severe asthma attacks are as disabling as quadriplegia (paralysis from the neck down).1
Migraines are also difficult to treat. While multiple prescription medications exist for migraines, they aren’t always effective for many of the migraine sufferers who try them. This has left many looking for alternative treatments for migraines.
A recent study found that migraine sufferers who used both cannabis and prescription treatments for their migraines reported that cannabis provided a significantly higher level of migraine relief compared to prescription treatments.2
A 2021 literature review concluded that there is an overall consensus for the indication of medicinal cannabis therapy in migraines when first and second-line treatment have failed.3
Benefits of Medical Cannabis
Research has linked medicinal cannabis with the following effects, all of which are relevant to migraine treatment:4
- pain relief
- easing nausea (urge to throw up)
- reducing inflammation (redness and swelling)
- anticonvulsive effects (prevents seizures).
A 2017 survey found that 76.7% of participants reported a gradual decrease in opiate use for pain after using medicinal cannabis. Approximately two-thirds of these participants reduced their migraine medicines, anxiolytics, antidepressants, and alcohol after starting medicinal cannabis.5
Difference Between a Migraine and a Headache
Migraine is more than just a headache, or a sum of all migraine symptoms. It is a genetic disorder that causes our brains to over-react to sensory inputs like bright lights, loud noises, strong smells or even internal feedback from the body to the brain. That over-reaction causes a ‘storm’ of naturally occurring chemicals, which in turn causes the physical symptoms we experience when triggered.1
Current Treatments for Migraines
While there are a number of acute and prophylactic prescription medicines for migraines, they are not all effective. Even triptans, one of two medicine classes developed specifically for the treatment of acute migraine, display limited efficacy.6 Research suggests that 25% of triptan users do not respond to the medicine, and those who do, only one-third remain pain free two hours after triptan use.2
Many migraine medicines have an unfavourable side effect profile, resulting in poor compliance and limited efficacy.7,8 The therapeutic benefits of alternative migraine treatment options such as medicinal cannabis may have a place in therapy due to the limited tolerability and efficacy of existing migraine medicines.
Cannabis For Migraines: Mechanisms of Action
The cannabis (marijuana) plant exists in multiple forms, including cannabis sativa and contains more than 540 chemical substances. These include over 100 active chemicals known as cannabinoids that are only found in the cannabis plant. The important cannabinoids of interest are CBD (cannabidiol) and THC (delta-9-tetrahydrocannabinol), the major components of many different medicinal cannabis formulations.7
Both CBD and THC stimulate cannabinoid receptors throughout the human body that make up the endocannabinoid system (ECS).
Migraines and the Endocannabinoid System
The ECS consists of CB1 and CB2 receptors. Activation of CB1 receptors lead to decreased dopamine, GABA, and glutamine. Activation of CB2 receptors lead to pain relief and decreased immune system function.3
In migraines, the ECS mitigates migraine through several pathways (glutamine, inflammatory, opiate, and serotonin).9 Cannabinoids demonstrate dopamine-blocking and anti-inflammatory effects.10 It may also have a prophylactic effect in migraines due to their ability to block platelet serotonin release and peripheral vasoconstrictor effect.11
In addition, CB1 receptors reduce nociperception via a serotonin mediated pathway, whereas CB2 receptors act to produce analgesia without developing tolerance or side effects.9
Current research suggests that the ECS play a role in migraine mitigation, but more research is needed.12
What Does the Research Say?
Inhaled cannabis reduces self-reported headache and migraine severity by about 50%. Men reported larger reductions than women. Use of cannabis concentrates were more effective than the flower form of cannabis.13
One study found that 85% of individuals using medically prescribed marijuana to treat migraines reported a decrease in migraine frequency. Migraine headache frequency decreased from 10.4 to 4.6 headaches per month (p<0.0001) with the use of medical marijuana. Most patients used more than one form of marijuana and used it daily for prevention of migraine headache.14
A 2020 cross-sectional study investigated the association between medicinal cannabis and migraine frequency in 68 patients who smoked or vaped medicinal cannabis inflorescences. Users reported better migraine symptom reduction, less negative headache impact, better sleep quality, and decreased need for conventional migraine medicine.15
A 2019 survey study focusing on inhaled cannabis and their effect of reduction of migraine severity and frequency found headaches were reduced by 47.3% and migraines by 49.6%.13
A 2018 literature review of cannabinoid usage to treat migraines, facial pain, and chronic pain showed significant improvement of nausea and vomiting associated with migraines.7
A 2002 literature review investigated the use of medicinal cannabis in palliative care for symptoms such as nausea, migraines, muscle spasticity, and seizures. It found that oral THC was superior to placebo for managing these symptoms, which included migraines. However, THC use was limited due to it dose-dependent psychotropic effects.16
Table 1: Clinical reports of cannabis use as treatment for headache or migraine
|Study||Study type||Subject population||Findings|
|Petro (1997)17||Case report||Patient with migraine||Women found superior relief of migraine with cannabis compared with beta-blockers, opiates and ergots|
|Grinspoon et al. (1997)18||Case report||Patient with migraine||Patient found success with smoked cannabis after 18 years of treatment failure with conventional medicines|
|Terwur (1997)17||Case report||Patient with migraine||Successful treatment with cannabis without effects of intoxication|
|Rhyne et al. (2016)14||Retrospective study||121 patients prescribed cannabis for migraine||Migraine occurrences decreased from 10.4 to 4.6 per month; 39.7% had a positive effect, 19.8% had decreased frequency.|
|Mikuriya (1991)19||Case series||5 cases of chronic migraine headaches||All cases successfully treated migraine with dronabinol or cannabis|
|Noyes Jr. et al. (1999)20||Case series||3 patients with chronic headaches||Smoked cannabis provided relief similar or greater than ergotamine and aspirin|
|Pini et al. (2012)21||Clinical trial||30 outpatients with medication-overuse headache||Nabilone was superior to ibuprofen in reducing pain intensity, analgesic intake, and medicine dependence|
|Robbins et al. (2009)22||Case report||Patient with refractory cluster headache||Smoked cannabis or dronabinol at the start of a cluster headache provided complete and immediate headache relief|
|Leroux et al. (2012)23||Survey||139 patients with chronic cluster headache||45.3% used cannabis; 25.9% found it effective for chronic cluster headache|
How Do I Take Cannabis or CBD for Migraines?
There is limited evidence regarding which dosage form or dose of medicinal cannabis is most effective for treating migraines.
The correct dose is the lowest dose that gives you the most pain relief from your migraine without associated side effects. Start with the lowest dose possible and gradually work your way up to the full recommended dose. This will allow your body to get used to medicinal cannabis and reduce your risk of side effects.24
Research on Cannabis Dosing for Migraines
A qualitative study of online migraine forums discussed the potential for higher doses of cannabis to trigger or exacerbate, rather than alleviate, migraine symptoms.25 Hence, it is important to use the lowest effective dose.
One study indicated that particular strains may be more effective in reducing migraine symptom severity, noting that strains high in THC and low in CBD may be beneficial due to the analgesic, anti-inflammatory, and anti-emetic properties of THC.7
A small 8-week randomized controlled trial (RCT) found that migraine patients taking 0.5 mg of nabilone (a synthetic cannabinoid) daily reported greater reductions in migraine pain intensity and daily analgesic intake compared to migraine patients taking 400 mg of ibuprofen daily. Importantly, side effects of nabilone were uncommon and mild, and self-reported quality of life improved after treatment with nabilone but not ibuprofen.21
Another 3-month prospective study found that migraine patients taking 200 mg of THC + CBD per day experienced a greater improvement in migraine symptoms compared to migraine patients taking 25 mg of the tricyclic antidepressant amitriptyline.26
Different Forms of Cannabis for Migraines
Several studies have reported preferred forms of medicinal cannabis for the treatment of migraines.
Dried cannabis flower is the most widely used type of cannabis product in the United States. The results from a real-time cannabis usage study suggests that dried cannabis flower is an effective treatment for migraine and headache-related pain. However, efficacy depends on the characteristics of the specific cannabis plant and the combustion method for drying.27
Finding Your Ideal Dose
There have been several studies done to determine the ideal dose of medicinal cannabis for migraines.
An exploratory study interviewed 50 participants who used medicinal cannabis for various conditions, including migraines. Almost all participants smoked cannabis two to three times a day.28
A 2018 survey found that cannabis users in the headache and migraine group preferred hybrid strains of cannabis with high THC and low CBD.29
A 2016 cross-sectional survey investigated the conditions participants used medicinal cannabis to treat. Around 61% used cannabis for pain, 36% for headache or migraine and 27% for nausea, all symptoms related to migraines. The most common route of administration was via inhalation. Regarding the dose, 12.3% of respondents used less than 1 g/week, 20.3% reported using 1-2 g/week, 31.8% reported using 3-5 g/week, 26.1% reported using 7 g/week, 6% using 28 g/week, and 3.4% using more than 28 g/week.30 See Figure 1.
Figure 1: Medicinal cannabis doses used by participants for treatment of migraine-related symptoms (pain, headache, or nausea)30
Finding the ideal dose of medicinal cannabis for migraine can be difficult due to variation among users. There are many studies that mention different doses and forms used by patients for different conditions. Some studies have shown that THC and CBD combined provided a good outcome when used as prophylaxis or for an acute attack.29
Is Using Medical Cannabis for Migraines Safe?
A study investigating the effects of medical marijuana on the monthly frequency of migraine headache reported that negative effects, notably somnolence (drowsiness) and difficulty controlling drug effects, were reported in 11.6% of participants. These effects were reported after using edible, rather than inhaled, marijuana.14
Side effects of medicinal cannabis can include:3
- dry mouth or eyes
- nausea (feeling like you need to throw up) and vomiting
- psychosis (having trouble knowing what is real and what is not).
THC on its own may have psychoactive properties, which could negatively affect cognitive function in the long-term. However, research has shown that using low doses of THC in combination with CBD and gradually increasing the dose (known as titrating) can reduce these side effects without losing its analgesic action.31
Like all medicines, medicinal cannabis can interact with other medicines when taken at the same time. Though further research is needed, there are several potential serious or ‘red flag’ interactions that you need to be aware of. These include:32
- warfarin (increases the risk of bleeding)
- clobazam (increases risk of benzodiazepine toxicity)
- theophylline, clozapine, and olanzapine (reduces efficacy).
Risk of Rebound/Medication Overuse Headache With Cannabis Use
Medication overuse headache is fairly common, occurring in about 15% of migraine patients. It is thought to be related to the development of tolerance to conventional migraine medicines.33 This is when your body gets used to the medicine over time so either more medicine is needed or a different medicine is needed.
A study suggests that use of cannabis does not appear to lead to medication overuse headache that is associated with other conventional treatments.13 This means that cannabis does not make headaches or migraines worse over time.
What Should Patients and Caregivers Know?
- Use a headache diary to keep track of your migraine attacks, noting when the migraine starts, when it stops, where the pain is, what you’ve eaten and what you were doing when the attack started.34
- Record the dose and type of medicinal cannabis you took to ease the pain and how well it worked.34
- Start low and go slow, until the desired effect is achieved.
- Tracking your migraine frequency can help identify potential migraine triggers and the best course of action to treat and prevent future migraine attacks.34
- Some effective strategies to reduce the frequency of migraine episodes include practicing stress management techniques, avoiding bright lights, avoiding dietary migraine triggers (such as caffeine and alcohol), and finding ways to get regular high-quality sleep.35
What Are the Next Steps?
In most states in Australia, most GPs and specialists can prescribe medical cannabis including CBD oil. However, they will need to apply under the special access scheme.
If your doctor is unwilling to apply on your behalf or uncomfortable prescribing medical cannabis, you can book in with one of our doctors. Our doctors conduct virtual consultations nationwide. Click here for a quick online eligibility test to see if you qualify.
- Australian Centre for Cannabinoid Clinical and Research Excellence
- Centre for Medicinal Cannabis Research and Innovation
- Therapeutic Goods Administration (TGA) guidance for the use of medicinal cannabis in Australia patient information
- Migraine Australia
- Migraine & Headache Australia
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- Poudel S, Quinonez J, Choudhari J, et al. Medical cannabis, headaches, and migraines: A review of the current literature. Cureus 2021;13:e17407. https://www.ncbi.nlm.nih.gov/pubmed/34589318
- Leimuranta P, Khiroug L, Giniatullin R. Emerging role of (endo)cannabinoids in migraine. Front Pharmacol 2018;9:420. https://www.ncbi.nlm.nih.gov/pubmed/29740328
- Piper BJ, DeKeuster RM, Beals ML, et al. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J Psychopharmacol 2017;31:569-75. https://www.ncbi.nlm.nih.gov/pubmed/28372506
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- Baron EP. Medicinal properties of cannabinoids, terpenes, and flavonoids in cannabis, and benefits in migraine, headache, and pain: An update on current evidence and cannabis science. Headache 2018;58:1139-86. https://www.ncbi.nlm.nih.gov/pubmed/30152161
- Tassorelli C, Greco R, Silberstein SD. The endocannabinoid system in migraine: from bench to pharmacy and back. Curr Opin Neurol 2019;32:405-12. https://www.ncbi.nlm.nih.gov/pubmed/30883435
- Chayasirisobhon S. Cannabis and neuropsychiatric disorders: An updated review. Acta Neurol Taiwan 2019;28(2):27-39. https://www.ncbi.nlm.nih.gov/pubmed/31867704
- Russo EB. Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinol Lett 2004;25:31-9. https://www.ncbi.nlm.nih.gov/pubmed/15159679
- el-Mallakh RS. Marijuana and migraine. Headache 1987;27:442-3. https://www.ncbi.nlm.nih.gov/pubmed/3667262
- Greco R, Demartini C, Zanaboni AM, et al. Endocannabinoid system and migraine pain: An update. Front Neurosci 2018;12:172. https://www.ncbi.nlm.nih.gov/pubmed/29615860
- Cuttler C, Spradlin A, Cleveland MJ, et al. Short- and long-term effects of cannabis on headache and migraine. J Pain 2020;21:722-30. https://www.ncbi.nlm.nih.gov/pubmed/31715263
- Rhyne DN, Anderson SL, Gedde M, et al. Effects of medical marijuana on migraine headache frequency in an adult population. Pharmacotherapy 2016;36:505-10. https://www.ncbi.nlm.nih.gov/pubmed/26749285
- Aviram J, Vysotski Y, Berman P, et al. Migraine frequency decrease following prolonged medical cannabis treatment: A cross-sectional study. Brain Sci 2020;10. https://www.ncbi.nlm.nih.gov/pubmed/32526965
- Bagshaw SM, Hagen NA. Medical efficacy of cannabinoids and marijuana: a comprehensive review of the literature. J Palliat Care 2002;18:111-22. https://www.ncbi.nlm.nih.gov/pubmed/12164099
- Russo E. Hemp for headache: an in-depth historical and scientific review of cannabis in migraine treatment. J Cannabis Ther 2001;1:21-92. https://www.researchgate.net/publication/228469706_Hemp_for_Headache_An_In-Depth_Historical_and_Scientific_Review_of_Cannabis_in_Migraine_Treatment
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- Mikuriya TH. Chronic migraine headache: five cases successfully treated with marinol and/or illiciit cannabis. Berkeley, CA: Schaffer Library, 1991.
- Schnelle M, Grotenhermen F, Reif M, et al. Results of a standardized survey on the medical use of cannabis products in the German-speaking area. Forsch Komplementarmed 1999;6 Suppl 3:28-36. https://www.ncbi.nlm.nih.gov/pubmed/10575286
- Pini LA, Guerzoni S, Cainazzo MM, et al. Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial. J Headache Pain 2012;13:677-84. https://www.ncbi.nlm.nih.gov/pubmed/23070400
- Robbins MS, Tarshish S, Solomon S, et al. Cluster attacks responsive to recreational cannabis and dronabinol. Headache 2009;49:914-6. https://www.ncbi.nlm.nih.gov/pubmed/19220500
- Leroux E, Taifas I, Valade D, et al. Use of cannabis among 139 cluster headache sufferers. Cephalalgia 2013;33:208-13. https://www.ncbi.nlm.nih.gov/pubmed/23197349
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