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Can Medical Marijuana Treat Migraines?
Approximately one in seven people throughout the world suffer from migraines. This neurological disease presents as a massive headache that attacks intermittently, causing immense stress for the people who suffer with them. They can be incapacitating, causing people to miss work or have difficulty raising their children. Some people only have a migraine attack a few times a year, but others can have them several times a day.
Studies have shown that medical cannabis can help treat migraines via the endocannabinoid system acting within the brain, where is alleviates pain and may reduce inflammation.
Because the components of medical marijuana - THC, CBD, other endocannabinoids, and terpenes - help alleviate pain, cannabis is a fantastic alternative to traditional pain killers such as opioids.
The Different Types of Migraines
In the medical field, we divide migraines into two basic classes that include:
Migraines without aura. This is the more common type of migraine. They tend to be unilateral (meaning the pain is felt on one side of the brain more than the other) and present with quick pain that escalates in 30 minutes to an hour. They can be triggered by things like physical activity, loud noises, lights, and lack of sleep. The headaches are often accompanied by nausea and tearing from the eyes. A single attack can last from 8 hours to three days.
The second class of migraines is called migraines with aura. These headaches come with a prodromal phase, where the patient experiences symptoms that let him or her know a headache is about to come. This phase is characterized by different types of neurological symptoms such as flashes of lights across the eyes, specifically smells (the taste of orange is a common example), prickly skin sensations, stuttering or other difficulties with speech, and a sense of vertigo or dizziness.
The aura phase can last from 30 minutes to an hour before the actual headache sets in. The underlying pathology of this migraine class is thought to be due to a lack of blood flow to the brain - perhaps causes by spasms of the blood vessels within a particular area of the brain that controls the sensations they experience. Once the headache begins, it is indistinguishable from the headache of a person who doesn’t experience the aura phase.
Migraines Are Also Classified into Subforms:
There are also rare forms of migraine involving the eyes. These include ophthalmoplegic and retinal migraines, where vision problems are the most common.
Migraines Are Also Linked to Hormones
About seven percent of all migraine patients suffer from menstrual migraines, which occurs about two days before or two days after menstruation. Shortly before that, estrogen levels drop sharply while progesterone levels rise. This can be the cause of the headaches with or without an aura.
Acute migraine attacks usually last for a few hours or days. In between, the patients are symptom-free. If patients have migraine attacks for more than 15 days in a month over a period of three months, doctors assume that it is a chronic migraine.
Another form of migraine is an abdominal migraine, which mostly affects children. This is not usually a headache, but a dull pain around the navel. Children often complain of other symptoms like loss of appetite, nausea and vomiting. Doctors assume stress or mental strain to be the triggers of this type of migraine.
Then there are vestibular migraines, which affect the balance system. The main symptoms are vestibular disorders and dizziness. Headaches, on the other hand, are usually only slightly noticeable.
Migraine: symptoms in four phases
A migraine attack is divided into four stages phase with different symptoms: the pre-phase (prodromal stage), aura phase, headache phase and regression; each phase being of varying severity. In addition, not every person affected goes through all phases. The following symptoms can occur in the stages:
What is the cause of a migraine attack?
A number of different factors are being discussed as the cause of a migraine attack. Apart from genetic factors, it could be caused by a circulatory disorder in combination with a malfunction of the neurotransmitters in the brain. The messenger substance serotonin (“happiness hormone”) seems to play a particularly important role in this. This is because it conveys certain information from one nerve cell to another nerve cell or to other organs. Finally, however, the effect of serotonin in a migraine attack has not yet been clarified. Nevertheless, it is assumed that the messenger substance plays a role in the brain (central serotonin) and outside the brain (peripheral serotonin). If this balance shifts in these two areas, it could trigger a migraine attack.
In some areas of the brain, circulatory problems, or rather the vessels in the affected area being narrowed, can be detected during an aura. The reason for this could be high serotonin levels.
What are migraine triggers?
Although the causes of the disease are not yet clear, trigger factors are known to trigger an attack. Which triggers these are in each individual case varies from person to person. Possible triggers could be:
To find out the individual trigger factors, patients should keep a migraine diary. The entries (date, time of day, duration and severity of headaches) often show a pattern.
Non-drug therapy for migraine
People can do a lot themselves to prevent migraines. These measures include avoiding trigger factors. It is also helpful to reduce stress, learn a relaxation technique (e.g. autogenic training) and take advantage of cognitive behavioral therapy. With the help of the therapist, patients learn to break through stressful and negative thought patterns.
Therapy with medication
The following drugs or active ingredients can be used in the medicinal treatment of migraine:
Measures in acute cases and prophylaxis
At the first sign of trouble, it can help to retreat into a darkened room and switch off all sources of noise such as the television or smartphone. Sometimes it is also possible to stop a seizure by taking painkillers early on. But it is important that you do not take painkillers too often. This is because there is a risk that the drugs themselves could become the trigger (drug-induced headache).
The following drugs are available for preventive treatment:
Migraine prophylactics of the first choice:
Migraine prophylactics of the second choice:
What role does the endocannabinoid system play in migraines?
Clinical and experimental studies suggest that a lack of regulation in the endocannabinoid system, or a lack of the body’s own cannabinoids (endocannabinoids), could trigger migraines.
For example, in a group of migraine patients, the amount of the body’s own cannabinoid anandamide, which is produced by the body as needed, was reduced. Anandamide is then broken down by the enzyme FAAH (fatty acid amide hydrolase).
However, it is still unclear whether the body simply does not produce enough anandamide in migraine patients or whether FAAH breaks down the endocannabinoid too quickly.
Studies on migraine and treatment with medical cannabis
Italian researchers investigated whether medical cannabinoids are suitable for the prophylaxis or acute treatment of migraine. A total of 48 people with migraines took part in the study, who were initially given two different cannabis preparations. While the first preparation contained 19 percent tetrahydrocannabinol (THC), the second preparation contained 9 percent of the non- intoxicating cannabinoid cannabidiol (CBD). However, doses of less than 100 milligrams each had no effect. Only from 200 milligrams onwards did the drugs have an analgesic effect.
In the second phase of the trial, the participants were given either the try-cyclic antidepressant amitriptyline (25 milligrams a day) or a combination of THC and CBD (200 milligrams a day) for three months as prophylaxis. For acute headaches, the volunteers took another 200 milligrams of THC-CBD.
The results showed that the frequency of migraine attacks decreased by 40.4 percent when they were treated with cannabis and by 40.1 percent when they were treated with amitriptyline. It is interesting to note that the cannabinoids THC and CBD reduced the intensity of pain by 43.5 percent.
In the summary, the researchers explained that medical cannabis might be an alternative therapy for the prevention of migraines.
In a recent study from 2019, researchers wanted to find out whether inhaling cannabis can reduce migraines and headaches, and whether gender, type of cannabis (concentrate vs. flower), delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) or dosage contribute to changes in these assessments.
The researchers obtained the data from the medical cannabis app Strainprint. This allows patients to track their symptoms before and after using different cannabis strains and doses. Data from 12,293 sessions using cannabis for headache treatment and 7,441 sessions for migraine treatment were analyzed.
The results show that headache and migraine values decreased significantly after cannabis use. Men reported a greater decrease in headaches than women. In addition, the use of concentrates was associated with a greater reduction in headache than the use of cannabis flowers.
It is also reported that inhaled cannabis reduced the severity of headaches and migraines by about 50 percent. However, the effect seemed to diminish over time, so patients had to increase the dosage. This suggests that tolerance to the effect might develop with continued use.
Unfortunately, there are hardly any clinical studies that provide clear evidence of treatment with cannabis-based drugs for migraine attacks. However, many patients with migraine report a positive effect or pain relief. The frequency of migraine attacks also seems to be reduced by the use of THC and CBD. From experience reports, it is also known that taking freely available CBD oil can have a positive effect on the disease
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