May 1st 2010
Cannabis as a Treatment For Migraines
A glimpse into the therapeutic potential of MMJ (Part 1)
By: Jamie Lynn Thomas CCH, CN
In the debilitating world of migraine pain there are little options for medication without intoxicating side effects ie codeine and other pain killers. However, the green world of plants offers many such allies the foremost being Cannabis spp. Historical, clinical, scientific and case based applications are discussed with an emphasis on factors and mechanisms of action. As the field of Cannabis is still being developed other opportunities will arise so that a more focused area of discipline can emerge. However, for migraine sufferers there may be therapeutic options for the profound effects of the endocannabinoid system are still not fully understood.
Each year, an estimated 20% of Americans [5] at a whopping 23 million [11] are effected by migraines with a large proportion (¾) of them being women sufferers [5]; who have been estimated to have lost or missed from work at least ½-1 day per month. With these effects that extend far out into the work place thus, resulting in lost wages; it is estimated that this loss of productivity resulted in an economic impact of $1.2-17.2 billion US dollars, that is lost annually. With such drastic consequences on daily productivity and quality of life a simple and effective treatment is called for. The historical specific remedy, from antiquity till 1941, Cannabis spp. answers with a call for efficacy trials; so that it can come out of the historical shadows into the modern world of medically applied green herbal allies.
Historically, Cannabis was applied to treat various neurological conditions such as migraines and headaches. Numerous texts depict Cannabis as a specific remedy as well as its varied uses throughout many cultures in times past. In 9th century Persia, the first Arabic materia medica named Al-Aqrabadhin Al-Saghir, called for use of an “intranasal base preparation of juice from cannabis seeds was mixed with a variety of other herbs to treat migraines” [13].
Year’s later eclectic physicians were employing herbal remedies clinically, while documenting their successes and failures. Ellingwood, an eclectic physician, said to use Cannabis in, “anemic headaches, while the anemia is being overcome, the headache is controlled by this remedy” [3]. While Felter, Lloyd and King, also eclectic physicians, thought Cannabis was best employed in, “Migraine, or sick-headache,—in which it often prevents the recurrence of the attacks, seeming to act specifically on Ringer’s migraine centre” [9]. A few years later, in the US pharmacopoeia Cannabis was said to be useful in, “Migraine, nervous headache, facial, and other neuralgias, whether due to catamenial wrongs or attending the menopause, as well as those depending upon fatigue, are relieved when nervous depression is the most marked symptom… have been asserted to yield to Cannabis” [8].
Below is a table that illustrates the most common method of application for migraine and headache ie tincture or fluid extract. Note how low the dose is. This is intended to provide relief via the analgesic, anti emetic, antiinflammatory and calming actions without extending into the intoxicant dose range. Dose, form and application are factors that should be addressed with the individual situation in mind. This can best be accomplished through your healthcare provider as well as in conjunction with your local MMJ (medical marijuana) caregiver.
| Condition or Ethnobotanical usage | Form & spp. Used if noted | Method of application Ie in/external, IV etc. | Dose OR Amount administered | Time till effects are seen | Side effects OR Contraindications of usage OR Other effects seen | Resource OR citation |
| Migraine “associated with menstruation” | Fluid extract | Internal | “3 days before menstruation onset- 3 days after completion of menses…..Dose-3 days before onset start 5 drops tid, increase daily by 1 drop until 11 drops tid are taken. Then reduce 1 drop daily until 5 drops are taken tid and then 3 days before menses…etc” | Over a period of time- best taken in stacked doses | None noted | [13] |
| Menopause- Symptoms “Excitement, irritability, headache, pain in the neck of the bladder, flashes of heat & cold” | Tincture & other non-specified agent-Cannabis indica-resinous herb smoked or eaten, tinctures | Internal-Rectal suppository at night or bid | ¼ grain (15mg) | -No intoxication was necessary “ I do not think there is anything to be gained by pushing the drugs to their physiological action”-eases headaches, mood shifts | [13].[2]. |
Although some historical uses point to internal applications in the form of edibles or liquid preparations such as tinctures; other sources disagree. One such source is Conrad from Hemp for health, who believes that the best form of treatment for migraine is cannabis smoked as an inhalant not as a fluid extract or tincture [2]. Some claim that this method can be “titrated to the medical requirement of the patient for symptomatic relief” [11]; while others question the efficacy of smoking as a primary source of medication. This particular usage may be useful in some sufferers for it is theorized that gastrointestinal absorption is hindered and thus; would render internal applications less potent. The secondary pulmonary effects caused by smoking may pose long term consequences. If smoking was the only form of treatment this argument may be valid but, in “safe and moderate doses using it occasionally or intermittently would seem to cause minimal issues” [11].
Below is an excerpt from Hemp for health that illustrates some other methods of application for migraine and headache. With a nice base in historical applications, a discussion of the role of endocannabinoids in migraine is presented to illustrate the new advances in technology and some of the newly highlighted mechanisms behind migraine.
| Condition | Method of application | Therapeutic effect |
| Migraine | Resinous herb smoked or eaten | Eases pain, acts as a prophylactic to prevent migraine attacks. |
(2).
Conversion table
| Grains | To Grams |
| ½ | 0.032 |
| 1 | 0.065 |
| 1 ½ | 0.097 (0.1) |
| 2 | 0.12 |
| 5 | 0.30 |
| 10 | 0.65 |
| 15 | 1.00 |
| 20 | 1.30 |
| 30 | 2.00 |
May 11th 2010
Part 2 is below
In a 2010 review, the endocannabinoid system is implicated in the pain response as well as offering sufferers of migraine a potential for medication without intoxication. The newly established endocannabinoid system has initiated thought provoking research into its effects upon pain signals and its connection to adipose tissue (fat). Interestingly enough, some of the most aggressive “transmission and modulation” of pain signals are usually initiated by the release of neurotransmitters; which seem to be in the highest concentration in various adipose tissues throughout the body ie “sensory terminals, skin and dorsal root ganglia”. Endocannabinoids, when initiated, seem to block the commencement of pain signals through the “cannabinoid type one receptor (CB1R)-dependant retrograde mechanism”; which stops the pain cascade before it starts. The authors conclude that the results suggest that once the endocannabinoid system is activated it could act as a promising tool that could reduce both the inflammatory pain response as well as the migraine physiological process. Other theories about the connection between both exogenous cannabinoids and endocannabinoids are discussed but the mechanism is unknown; thus the authors call for more focused research in the future [6]. In a 2009 review study entitled, Dynamic regulation of the endocannabinoid system: implications for analgesia, the analgesic effects of the endocannabinoid system are explored opposed to the “psychoactive side effects” that are present in exogenous cannabinoids. This was one of the first papers that highlighted the effects that endocannabinoids have upon the entire pain mechanism. The above 2010 paper, sited this as a revolutionary stance in the field of Cannabis, for this was when endocannabinoids were first considered as a source for future treatment. The authors call for more directed research and exploration into the mechanisms behind “cannabinoid-based analgesics” [15].
In a 2008 review called, Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? The author, Ethan B. Russo, speculates that certain conditions with similar clinical presentations or treatments as well as similar biochemistry may be linked to an endocannabinoid deficiency. Migraines in particular are “among the most complex of any human malady.” With this in mind the author reviewed all the available research via the National library of medicine database and other internet sources not specified. Western treatment of migraine focuses on serotonergic pathways, as well as pain reduction and neural uptake. THC and other cannabinoids were seen to exert a deeply profound effect on “inhibiting serotonin release from human platelets” as well as affecting endocannabinoids within the body; thus increasing their effectiveness. Dopaminergic blocking activity was also explored as well as antiinflammatory properties. THC showed promise as a “neuroprotective antioxidant” for its actions were seen to work against glutamate neurotoxicity and cell death working better then other antioxidants (vitamin C & E). Other endocannabinoid actions were thought to impede the gray matter migraine generating tissue in the brain, but more research was called for. Overall, the paper highlights clinical endocannabinoid deficiency, a culprit in migraines, which may easily be treated with “cannabinoid medicines” [14]. In the field, applications of Cannabis in its varied forms have yielded relief for some migraine victims.
Applications of the legal prescription dronabinol were applied in a 2009 case study called, Cluster attacks responsive to recreational Cannabis and dronabinol. This was presented in Headache: the journal of head and face pain in 2009. In this article the author discusses the consistently seen relief of cluster attacks with any form of Cannabis ie smoking or pharmaceutical preparations. He argues that the later is best suited to the clinical/medical applications of Cannabis. The product dronabinol, which does not cause intoxicating side effects, has been seen to work wonders on sufferers. Implying the above theorized actions of the migraine/Cannabis mechanism ie pain signals are affected by the exogenous cannabinoids results in a heightening of the endocannabinoid system, were seen to profoundly affect the quality of life for sufferers. The unanswered questions are whether the effects were due to a heightening of the internal endocannabinoid system or a moderating effect of an incomplete system suffering from endocannabinoid deficiency [10]. Another earlier case study from the same journal illuminates the sufferings of a 38 year old migraine sufferer whose migraines are always relieved when she smokes cannabis [4]. Although, these case studies give a direction for researchers to follow other questions such as why do specific people suffering from migraines when others do not? Some genetic factors have been illuminated by a recent animal trial that may show a hereditary predisposition.
In a 2009 pioneer human trial named, Variations in the cannabinoid receptor 1 gene predispose to migraine, offers some direction for human studies. It has been noted, in animal trials, that endogenous cannabinoids ie endocannabinoids block the activation of the cannabinoid receptor 1(CB1). However, when investigated on humans with migraine symptoms (ie nausea, photophobia and disability- all three were required to be present) the genetic receptor gene (CNR1) was implicated in migraine suffers and not it the control group. The phenotype patterns were produced for each individual using haplotype analysis; thus studying genetics associated using the CNR1 receptor gene. Although the results showed a correlation more research is needed to “elucidate the role of CNR1 and the cannabinoid system in migraine” [7].
In the newly developing field of cannabis research a call for more directed and focused research will dominate the field. The differences in our endocannabinoid system as well as how it is affected by deficiencies or supplementations are not well understood and until a time when more detailed work can be concluded many questions will be left unanswered. However, the question of Cannabis efficacy for migraine and headache sufferers shows promise of relief without those pesky psychoactive effects. A lesson from the eclectics would be best heeded for they used this herb for many pain and neurological conditions as a low dose herb; persistently. Although, a recommendation can be given the reality of this plants legal status makes that useless unless one possesses a medical marijuana card. Who knows where the legal waters will tender the use of this plant from antiquity?
References
1-Abrams, Di., et al. (2007). Chronic Pain and Migraine. Headache: The Journal of Head and Face Pain. 47 (8), 1259-1261. 2- Conrad, C. (1997). Hemp for health: The medicinal and nutritional uses of Cannabis sativa. Rochester, Vt: Healing Arts Press.
3- Ellingwood, F. (1907).(Ellingwood’s therapeutist, A monthly journal of direct therapeutics. (Vol 1-3) Chicago. Retrieved from: http://www.henriettesherbal.com/eclectic/journals/elth1909/01-cannabis.html
4-Evans, R., & Ramadan, N. (2004). Are Cannabis-Based Chemicals Helpful in Headache?. Headache: The Journal of Head & Face Pain, 44(7), 726-727.
5- Gieringer, D. H., Carter, G. T., & Rosenthal, E. (2008). Marijuana medical handbook Practical guide to therapeutic uses of marijuana. Oakland, Calif: Quick American.
6-Greco, R., et al. (2010). The endocannabinoid system and migraine. Experimental neurology. Doi:10.1016/j.expneurol.2010.03.029
7-Juhasz, G., Lazary, J., Chase, D., Pegg, E., Downey, D., Toth, Z. G., et al. (2009). Variations in the cannabinoid receptor 1 gene predispose to migraine. Neuroscience Letters. 461 (2), 116.
8-King, J., Felter, H. W., & Lloyd, J. U. (1898). King’s American dispensatory. (pp. 77-82, 1328-1330). Cincinnati: Ohio Valley.
9- Potter, S. O. L. (1902). A compend of materia medica, therapeutics and prescription writing, with especial reference to the physiological action of drugs; Based on the eighth revision of the U. S. pharmacopœoœeia including also many unofficial remedies. Philadelphia: P. Blakiston’s son &. Retrieved from http://www.henriettesherbal.com/eclectic/potter-comp/cannabis.html.
10-Robbins, M., et al. (06/2009). “Cluster attacks responsive to recreational cannabis and dronabinol”. Headache (0017-8748), 49 (6), p. 914.
11- Russo, E. (1998). Cannabis for migraine treatment: the once and future prescription? An historical and scientific review. Pain. 76 (1), 3.
12-Russo, E (2001). Hemp for headache: an in depth historical and scientific review of cannabis in migraine treatment. In the Journal of Cannabis Therapeutics (pp 21-92).
13-Russo, E. (2002). Cannabis Treatments in Obstetrics and Gynecology: A Historical Review. In Russo, E., Dreher, M. C., & Mathre, M. L. (2002). Women and Cannabis: Medicine, Science and Sociology. (pp. 5-35). Binghamton, NY: Haworth Herbal Press.
14- Russo, E. (2008). Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions?. Neuroendocrinology Letters, 29 (2), 192-200
15- Sagar DR, Gaw AG, Okine BN, Woodhams SG, Wong A, Kendall DA, et al. (2009). Dynamic regulation of the endocannabinoid system: implications for analgesia. Molecular Pain. 5.
16- Williamson EM, & Evans FJ. (2000). Cannabinoids in clinical practice. Drugs. 60 (6), 1303- 14.
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