Migraine treatment: how medical cannabis can help?

 The International Headache Society classifies 150 to 200 different types of headaches, including migraine, a chronic condition whose exact cause remains unknown.

 

It may be associated with a genetic predisposition, but some factors such as anxiety, stress, poor sleep quality, prolonged fasting, alcoholic beverages and some types of food – such as those rich in sugar and fat, dairy products and caffeine – are common triggers for those who suffer from this disease.

 

According to World Health Organization (WHO), this is the sixth most disabling disease in the world, characterized by a unilateral, pulsating headache of moderate to severe intensity, which tends to worsen during routine activities.

 

Also according to the WHO, migraine affects 30 million Brazilians, especially females. The decrease in hormone levels in the period before menstruation would be one of the reasons that explains why 85% of migraine sufferers are women.

 

 

 

The diagnosis of chronic migraine is based on the level of pain and the number of attacks, which in the most severe cases can reach 15 days a month or more. Pain cycles usually range from 4 to 72 hours.

 

Importantly, overuse of pain medications is one of the reasons why an episodic migraine becomes chronic. Additional symptoms are also common in these conditions, such as nausea, vomiting, sensitivity to light and sound, dizziness and tingling.

 

Due to the high refractoriness rate, migraine treatment is often challenging and inspires a range of prescriptive care. In this context, medicinal Cannabis has been highlighted as a promising therapeutic alternative, with a millennial history of use for this purpose.

 

The main highlight is cannabidiol (CBD), due to its analgesic and anti-inflammatory properties, whose results in chronic pain are already scientifically proven. Other cannabinoids, such as tetrahydrocannabinol (THC), have also been the subject of studies.

 

In this content, we will talk about this evidence and how to prepare to incorporate this important therapeutic arsenal in your prescriptive practice, aiming to bring more well-being and quality of life to patients who suffer from migraine.

 

 

History of cannabis use for migraines

 

 

Scientific research brings historical records of the use of Cannabis both for the symptomatic and prophylactic treatment of migraine between the years 1874 and 1942. Ethnobotanical and anecdotal references from the second half of the 20th century attested to the analgesic potential of cannabinoids for this purpose, as reported this literature review Performed by Dr. Ethan Russo, one of the world's leading researchers of cannabinoid derivatives.

 

The research examines the history of the plant's medicinal use by smoking and other methods in ancient cultures, including Chinese, Indian, Egyptian, Assyrian, Greek and Roman, as well as in the Islamic world, and its subsequent adoption by Renaissance and Early Europeans. It was Industrial.

 

The most modern references corroborate the efficacy of Cannabis in the treatment of migraine based on biochemical studies involving the phytocannabinoid THC and the endocannabinoid anandamide (AEA) – the endogenous neurotransmitter known as “the substance of happiness” – from anti-inflammatory, serotonergic mechanisms and dopaminergic.

 

>> Read the full review at: Cannabis for migraine treatment: the once and future prescription? An historical and scientific review.

 

 

Mechanisms of action of the Endocannabinoid System in migraine

 

 

Studies involving medicinal Cannabis gained strength in the second half of the twentieth century, due to scientific discoveries around the Endocannabinoid System (ECS). This system works as a set of receptors, ligands and enzymes that act as signals between cells, helping to maintain and restore the body's homeostasis.

 

 

 

Do you want to go deeper into the subject? Learn more about the Endocannabinoid System and see why you need to know him!

 

Nowadays, there are already several pre-clinical and clinical evidences attesting the mechanisms of ECS action in episodic or chronic migraine. An example is this literature review which associates dysfunctions of the endocannabinoid system with the development of migraine and its chronicity.

 

Although the exact nature of this relationship is still not fully understood by science, the review brings a series of studies which suggest that ECS is a potential target of cannabinoid substances in the treatment of migraine.

 

>> Read the full review at: Significance of the endocannabinoid system in migraine.

 

Another reference is this research that correlates SEC dysregulation to the occurrence of migraine. The activation of the Trigeminovascular System (TS) and the vasoactive release of the trigeminal endings, close to the meningeal vessels, are considered two of the main effector mechanisms of migraine attacks.

 

Research suggests that SEC is one of the mediators of ST, bringing clinical data showing that anandamide (AEA) levels are reduced in the cerebrospinal fluid and plasma of patients with chronic migraine. This reduction, in turn, would be associated with the facilitation of pain in the spinal cord.

 

>> Read the full review at: Endocannabinoid System and Migraine Pain: An Update.

 

Already this survey published in the European Journal of Clinical Pharmacology investigated serotonin levels in patients with chronic migraine or who suffer from headache due to excessive use of medication, demonstrating the ECS imbalance in these conditions.

 

To test this hypothesis, the levels of the two main endogenous cannabinoids – anandamide (AEA) and 2-arachidonylglycerol (2-AG) – were determined in platelets of 20 patients with migraine, 20 patients with headache and 20 patients without any of these conditions.

 

The study measured platelet serotonin levels in these patients. The results showed that AEA and 2-AG levels were significantly lower in headache and chronic migraine patients taking medication than in control groups.

 

These data show the potential involved in the relationship between the dysfunction of the serotoninergic system and the Endocannabinoid System in patients with migraine and other headaches, attesting to the potential of Endocannabinoid Medicine in the treatment of these pathologies.

 

>> Read the full survey at: Endocannabinoids in platelets of chronic migraine patients and medication-overuse headache patients: relation with serotonin levels.

 

We also highlight this observational study Performed on 20 women with migraines and 18 healthy women, based on their respective ages and body mass indexes. Image acquisition by the positron emission tomography (PET) method was performed 90 minutes after intravenous injection of the radiotracer [18F]MK-9470 to assess the binding of the substance to the CB1 receptor.

 

An increase in radiotracer binding to the endocannabinoid CB1 receptor was observed in patients with migraine compared to those without the disease. This increase was detected in the brain regions related to pain modulation - anterior cingulate cortex, mesial temporal lobe, prefrontal and superior frontal and other regions of the brain - which also indicates changes in the functioning tone of the Endocannabinoid System in patients of the same gender. female suffering from episodic migraine.

 

>> Read the full survey at: Interictal Type 1 Cannabinoid Receptor Binding is Increased in Female Migraine Patients.

 

 

Scientific evidence of medicinal cannabis in the treatment of migraine

 

 

There are also other studies indicating a decrease in the frequency of migraine attacks after prolonged treatment with medical cannabis. This survey led by Israeli scientists investigated the associations between phytocannabinoids and migraine frequency in 145 patients (97 women, 67%) based on self-reported questionnaires.

 

The average duration of cannabis treatment was three years. Patients were retrospectively classified as responders vs. non-responders (≥ 50% vs. <50% reduction in monthly frequency of migraine attacks after initiation of treatment with cannabinoid derivatives, respectively).

 

Compared with non-responders, responders (89, 61%) reported a decrease in migraine frequency, less negative impact of attacks (which were less disabling), and lower rates of opioid and triptan consumption.

 

>> Read the full survey at: Migraine Frequency Decrease Following Prolonged Medical Cannabis Treatment: A Cross-Sectional Study.

 

It is also worth remembering that the routine and concomitant use of four or more drugs characterizes polypharmacy – an important public health issue that brings high costs to the health system and contributes to drug dependence, higher occurrence of side effects and adverse drug interactions. . The reduction in the use of anti-migraine drugs (triptans) and various analgesics, including opioids, also helps to reduce polypharmacy and its aggravating factors.

 

Learn more about polypharmacy and understand how medical cannabis can help fight overuse of medications!

 

As for headache due to excessive use of medication, we highlight this survey which investigated the efficacy and safety of nabilone – a synthetic cannabinoid that resembles THC – on the intensity and frequency of this type of pain.

 

In this research, 30 patients were evaluated in a crossover, randomized, double-blind and controlled study, comparing the use of nabilone 0.5 mg/day and ibuprofen 400 mg.

 

Patients received each treatment orally for 8 weeks, with a 1 week wash-out in between. Of the 30 patients in the group, 26 completed the treatment. Improvements were noted during the use of both substances. However, nabilone was more effective than ibuprofen in reducing pain intensity.

 

 

 

In addition, nabilone contributed more significantly to reducing the daily use of analgesics, having been the only substance capable of reducing the level of drug dependence and improving the quality of life of patients. As for the safety profile of nabilone, mild side effects were observed, which disappeared after the drug was discontinued.

 

>> Read the full survey at: Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial.

 

 

Oral formulations of cannabinoids for the treatment of migraine

 

 

Many scientists have dedicated themselves to also evaluating the efficacy and safety of oral Cannabis formulations in the treatment of migraine. An example is this study conducted by Italian researchers that investigated the use of FM2®, Bedrocan® and Bediol® formulations in the relief of chronic migraine.

 

The patients evaluated in this study received one of the three medications for up to six months. Throughout the treatment – at the beginning, in the third month and in the sixth month – the following information was recorded:

 

• The number of migraine days per month;

• The intensity of pain;

• The number of immediate pain relief medications taken per month;

• The number of days per month that the patient took at least one drug for immediate pain relief;

• Adverse effects occurred.

 

The results showed that there was no significant change in the number of migraine days after the third or sixth month of treatment. The other variables – pain intensity and consumption of medication for immediate pain relief – decreased considerably.

 

No significant differences were found between patients who were on prophylactic treatment for chronic migraine and those who were not. Adverse events observed were mostly mild and occurred in 43.75% of patients.

 

 

 

>> Read the full survey at: Oral Cannabinoid Preparations for the Treatment of Chronic Migraine: A Retrospective Study.

 

Another example is this literature review which evaluated 34 articles relating the interactions between CBD, THC, flavonoids and terpenes in the relief of chronic migraine. These Cannabis active ingredients work in synergy to modulate the Endocannabinoid System, optimizing the therapeutic results of the plant and minimizing possible adverse effects.

 

The studies that make up this review demonstrate that the use of medicinal Cannabis is effective in reducing the duration and frequency of migraines and other headaches of unknown origin, thus attesting to the synergistic potential of plant substances in the fight against this type of chronic pain.

 

>> Read the full review at: Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature.

 

In addition to migraine and headache, other chronic facial pain syndromes were evaluated. in this literature review which also considered the interaction between the cannabinoids, terpenes and flavonoids of Cannabis in the synergistic therapeutic effects of the plant.

 

The studies evaluated in this review attest to the analgesic and anti-inflammatory properties of these substances, as well as the potential of Cannabis in detoxification and weaning from opiates – which is of great relevance considering the high rate of dependence and side effects associated with these substances. medicines..

 

Do you want to understand this relationship better? See how medical cannabis can contribute to reducing opioid use in patients with chronic pain!

 

>> Read the full review at: Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science.

 

 

Cannabis flower vaporization in the management of migraine

 

 

We also highlight this study American pioneer in evaluating the effectiveness of the use of Cannabis flower in the treatment of migraine. This is the most consumed type of Cannabis product in the United States. In the study, different characteristics of the product and changes in the intensity of migraine symptoms after use were considered.

 

The evaluation period was three years, covering 699 people who registered in the Releaf App the real-time details of the use of Cannabis in relation to the intensity of the pain symptoms – before and after self-administration of the product. Data included 1,328 sessions of use to treat headache and 582 sessions of use to treat migraine.

 

Changes in pain levels were measured on a scale of 0 to 10 before and immediately after cannabis flower consumption. The results showed that 94% of users experienced relief of symptoms within a two-hour observation window.

 

 

 

The mean reduction in symptom intensity was 3.3 points, with men experiencing greater relief than women. Younger users (< 35 years old) also experienced greater relief than older users.

 

In addition, products with levels of tetrahydrocannabinol greater than 10% were the strongest predictors of symptom relief. This effect, in turn, was more prevalent in headaches than in chronic migraines.

 

The results also showed that women and younger users obtained greater relief from symptoms when using flowers labeled as Cannabis indica instead of Cannabis sativa.

 

Learn more about as Main chemovariants of Cannabis, its benefits and applications!

 

>> Read the full survey at: Alleviative effects of Cannabis flower on migraine and headache.

 

On the short- and long-term effects of medical cannabis use on migraine relief, we highlight this survey American company that evaluated the mechanisms of action of the cannabinoids CBD and THC during crises.

 

The evidence was based on data collected by a medical cannabis app that allows patients to record symptoms before and after using different doses and chemovariants of the plant. Data from 12,293 sessions in which cannabis was used to relieve headache and 7,441 sessions in which cannabis was used to treat migraine were evaluated.

 

Results showed that there were significant reductions in ratings for both types of pain after using cannabinoids. Male patients had higher percentages of pain relief than female patients. In addition, the concentrated products were more effective compared to Cannabis flowers.

 

Records indicated that inhaled cannabis was able to reduce the intensity of headaches and migraines in about 50% of cases. However, the researchers point out that the effectiveness of the treatment tends to decrease over time, suggesting a possible tolerance to the effects of cannabinoids in the long term.