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It appears that migraines are linked to the poor performance of the endocannabinoid system. Could CBD be an effective remedy for migraine headaches? Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature This is an open access article distributed under the terms of the Creative Commons Attribution License, which

CBD Oil for Migraines: How to Apply CBD Oil for Headaches

If you suffer from migraines, there are two things that probably irritate you the most.

First — the debilitating migraine headache itself.

Second — your friends use the term “migraines” to talk about any headache they experience.

Seriously, if you’ve ever had a migraine attack, you’ll never compare it to a regular headache, even if you think it’s on the verge of being manageable. Migraines can prevent you from performing even the simplest tasks.

Migraines are a serious problem among women; 18% of women in the US suffer from regular migraines compared to 6% of men. And yet, despite the striking prevalence, we know very little about the cause of this condition and how to fight it.

After failing with conventional treatment methods, many people desperately turn to natural resources for help — such as CBD oil.

CBD oil may relieve pain and reduce inflammation, but recent research shows it’s also a potential anti-migraine agent.

In this article, I will highlight the top 5 CBD oil brands that may help you relieve migraine headaches and perhaps even prevent them from happening.

Of course, I’ll also take you on a journey through the science behind CBD and migraines, so let’s get started.

Top 10 Best CBD Oil for Migraines (Brand Recommendations 2022)

Buying CBD oil online is a hard nut to crack.

Most people don’t have the time to read about extraction methods, certificates of analysis, hemp source, and all the other factors that decide about the quality of CBD oil.

Some people just want straight answers — “that brand is awesome because…”

And that’s exactly where you’ll get your answers. Below I show you my top 5 brand recommendations for CBD oil and migraines.

1. Royal CBD (Best Migraine Reliever)

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Pros:

  • Their products are available as full-spectrum or “zero-THC”
  • Up to 83.3 mg of CBD per mL (2500mg bottle)
  • Every batch of product has been tested by independent labs
  • Their CBD is sourced from American-grown hemp
  • The natural flavor tastes great

Cons:

  • The price is slightly higher than average (although this is well justified)

What I Like About Royal CBD:

Royal CBD is a premium CBD brand that offers a range of high-quality CBD products. They like to keep it simple; their assortment consists only of CBD oil, capsules, and gummies.

I’ve been using their 1000mg CBD oil for quite a while now, and I must say I’m excited about how it works for my migraine headaches. Most of the time, when I have a migraine attack, I’m so debilitated that I can’t even move my finger, so taking CBD capsules or chewing on gummies is not an option.

With the oil, the experience is different because all I have to do is put a few drops under my tongue and wait for them to get absorbed while I’m lying on the couch and trying not to explode.

This full-spectrum CBD oil is pretty strong, so I’d recommend the 1000mg option to those with really severe migraine symptoms. At a lower cost, you can try their 250mg and 500mg bottles.

2. Gold Bee (Best Organic CBD Oil)

Pros:
  • Unique product selection
  • Gold Bee uses non-GMO, Colorado-grown hemp
  • The oil contains full-spectrum CBD
  • The company’s products are extracted with CO2
  • You’re getting up to 2400 mg of CBD per bottle
  • The oil is sweetened with organic honey
  • Third-party lab tested for potency and purity
Cons:
  • No high-strength oils
  • Not available in-store
What I Like About Gold Bee:

Gold Bee is a true maverick when it comes to CBD extracts. This California-based brand offers a unique selection of products, including full-spectrum CBD oil that is sweetened with organic honey and CBD-infused honey sticks for the flavor chasers. The entire product line up is sourced from organic hemp, extracted with CO2, and third-party lab tested for potency and purity.

I’ve been taking the 1200 mg kiwi flavor for prevention and to ease the migraine pain once it has kicked in. I’ve noticed similar results to what I’ve been getting with some more potent oils from competitor brands, which already tells much about the oil’s quality. The kiwi flavor also does a great job in masking the earthy aftertaste of full-spectrum CBD, and most importantly, both flavorings and the sweetener are all-natural.

Gold Bee offers a 30-day money-back guarantee for its products, allowing customers to return their products for a full refund if they decide they are not satisfied with the results; it’s a great sign of the brand’s confidence about their quality.

3. CBDPure (Runner Up)

Pros:

  • Sourced from American-grown hemp
  • Tested for potency and purity in 3rd-party laboratories
  • Contains the full spectrum of cannabinoids and terpenes
  • You can return the product within 90 days for a full refund if you’re not satisfied with the product.

Cons:

  • Narrow product range
  • Low potency

What I Like About CBDPure CBD Oil:

CBDPure is one of the most honest companies I’ve ever encountered. They give you a nice insight into each production stage of their CBD oils and prove their label claims with certificates of analysis from independent laboratories.

When it comes to migraines, I would use CBDPure oil as a preventative supplement to ease mild to moderate headaches, ones that aren’t caused by migraines.

These guys are keepers for those CBD users buying CBD on a budget, and if you end up not satisfied with the purchase, you can return the product within 90 days for a full refund.

4. Hemp Bombs

Pros:

  • They have a diverse product range made from CBD isolates
  • Each batch is subject to third-party lab testing
  • Their products offer the highest dose of CBD per serving

Cons:

  • The extracts used by Hemp Bombs are of lower quality than Royal CBD
  • CBD isolate doesn’t induce the entourage effect because it lacks other cannabinoids

What I Like About Hemp Bombs:

Hemp Bombs has one of the most diverse product ranges in the entire industry. They sell oils, topicals, edibles, vape oils, pet treats, CBD shots, and some really crazy products like CBD-infused beard lotions.

While the quality of their extracts is one class lower than the one offered by brands like Royal CBD, HempBombs makes great products for those who can’t use full-spectrum extracts for a variety of reasons (e.g., pregnancy or the risk of testing false positive on drug screening).

Because these products are made from 99.9% pure isolate, you need higher doses to achieve relief than with full-spectrum CBD oil. As such, I encourage you to opt for their higher potencies, as can have a better effect on you and turn out more cost-efficient in the long run.

5. CBDistillery

Pros:

  • Their products are available as full-spectrum CBD or pure CBD oil (Zero THC)
  • Each batch of product is tested for potency and purity in a 3rd-party laboratory
  • Five strengths to choose from
  • Great price for the value

Cons:

  • Their hemp isn’t organic
  • Their website doesn’t provide the best User Experience

What I Like About CBDistillery:

Here’s my top 3rd pick. There are two reasons why I decided not to give this brand a higher note — the way CBDistillery farms their hemp (the plants aren’t organic) and how their website gives me a heart attack every time I come back to see what’s new in their store.

On a positive note, I’d like to stress how much I love the fact they cater to every type of CBD user out there. CBDistillery sells their extracts as either “full-spectrum” or “pure oil.” On top of that, they ensure an outstanding potency range, starting at 250mg up to 5000mg of CBD per bottle.

6. NuLeaf Naturals

Pros:

  • Their CBD comes from domestic hemp
  • NuLeaf obtains its extracts using a mix of subcritical and supercritical CO2
  • Each batch is lab-tested for potency and contaminants
  • Sold as full-spectrum extracts
  • Up to 4850mg of CBD per bottle

Cons:

  • Narrow product range
  • More expensive than the other companies

What I Like About NuLeaf Naturals:

Another pioneer (next to CBDistillery), NuLeaf naturals sells full-spectrum CBD oil for humans and dogs.

The reason why I decided to keep them in this ranking is the fantastic choice of bottle sizes this brand offers — from 5mL to 100mL.

The potency in those sizes are the same, so your choice will depend on how frequently you use CBD oil and how long you need to supply yourself for.

These are full-spectrum extracts, so you gain the benefit of the entourage effect. However, for some reason, these oils are priced higher than all the brands in this ranking. That’s weird because there’s no extra value in their products — the hemp isn’t organic, and the formula is rather typical of most CBD oils.

7. Charlotte’s Web

Technical Details
Total CBD Content 200 – 1800 mg
Available Flavors Mint Chocolate, Lemon Twist, Orange Blossom, Olive Oil
Potency 7 – 60 mg/mL

About Charlotte’s Web:

Charlotte’s Web is one of the companies that blazed the trail for the CBD market as we know it today. Launched by the Stanley Brothers, the company has made big headlines in the mainstream media when they helped now late Charlotte Figi with her treatment-resistant epilepsy. Although the brand has recently received a warning letter from the FDA due to their health claims, they still have a reputation of a solid manufacturer.

The Charlotte’s Web CBD oil is available in 4 concentrations: 200 mg, 500 mg, 1500 mg, and 1800 mg of CBD per bottle. The strongest version comes with 60 mg of full-spectrum CBD in every milliliter. You can choose between two bottle sizes — 30 mL and 100 mL — and four flavor options, including Olive Oil, Mint Chocolate, Lemon Twist, and Orange Blossom.

What could Charlotte’s Web do better?

Well, for starters, they could switch from ethanol extraction to CO2 extraction because such products have a better chemical profile and are more efficient in terms of production. Secondly, and more importantly, I’d like to see these CBD oils suspended in MCT oil because suspension in olive oil makes them taste a bit too bitter for my palate — even in the flavored variants.

Pros:

  • One of the most reputable brands on the market
  • Full-spectrum CBD
  • Delicious flavored versions
  • Up to 1800 mg of CBD per bottle
  • Available in two sizes: 30 mL and 100 mL
  • Third-party tested for potency and purity

Cons:

  • Non-organic hemp
  • Ethanol extraction
  • Suspension in olive oil (bitter taste)
  • The company received a warning letter from the FDA in the past due to inappropriate health claims

8. cbdMD

Technical Details
Total CBD Content 300 – 7500 mg
Available Flavors Natural, Berry, Orange, Mint
Potency 10 – 250 mg/mL

About cbdMD:

cbdMD is another well-known brand that sells an array of CBD extracts, including tinctures, capsules, gummies, sleep aids, topicals, bath bombs, and pet products.

The company offers a broad range of CBD oils, with up to 7500 mg of CBD per bottle. The strongest version packs a healthy dose of 200 mg of broad-spectrum CBD suspended in MCT oil for better absorption and a smoother flavor. These oils are available in three flavored options: Berry, Orange, and Mint.

The lack of the trace amounts of THC makes cbdMD products suitable for younger users, athletes, and people who are regularly tested for THC at work. But on the other hand, broad-spectrum CBD doesn’t evoke the full entourage effect. The effects of CBD aren’t linear on the dose-response curve, so higher concentrations may not translate into better results in this case.

CbdMD also has high transparency standards. All of their products are tested by a third-party laboratory; the batch-specific certificates of analysis are available on the cbdMD’s website.

cbdMD is another popular manufacturer that offers a wide range of CBD extracts, from tinctures to cummies to capsules, bath bombs, topicals, sleep aids, and pet products.

Pros:

  • US-grown, non-GMO hemp
  • CO2 extraction
  • THC-free
  • Up to 7500 mg of CBD per bottle
  • Batch-specific certificates of analysis

Cons:

  • Limited entourage effect due to the lack of THC
  • Most people don’t need such high doses of CBD in their routine

9. Medterra

Technical Details
Total CBD Content 500 – 3000 mg
Available Flavors Natural, Citrus, Mint Chocolate
Potency 16 – 100 mg/mL

About Medterra:

Medterra is a small artisan brand rooted in California. The company specializes in premium CBD oils in various cannabinoid spectra, including full-spectrum CBD, broad-spectrum CBD, and CBD isolate. These products contain from 500 mg to 3000 mg of CBD per bottle, which is a regular range for CBD companies. Aside from the unflavored version, you can choose from two flavored options: Citrus and Chocolate.

The company prides itself on making real full-spectrum CBD, with 2 mg of THC in each bottle. However, the problem with these extracts is that they’re not legal in all 50 states. So, if you want to purchase their products legally, your options are limited to broad-spectrum CBD and CBD isolate. On the other hand, these products contain upwards of 1000 mg of CBD, which may appeal to those who benefit from higher doses in their routine.

Medterra’s products are tested in a n independent laboratory for their CBD content and safety.

Pros:

  • Premium-grade CBD oils
  • Up to 3000 mg of CBD per bottle
  • Available as full-spectrum CBD, broad-spectrum CBD, and isolates
  • Lab tested for potency and purity

Cons:

  • The “real” full-spectrum CBD oil isn’t available in all states
  • Some of the lab reports indicate higher CBD levels than stated on the bottle
  • No discounts for returning customers

10. Joy Organics

Technical Details
Total CBD Content 450 – 900 mg
Available Flavors Tranquil Mint, Fresh Lime, Summer Lemon
Potency 15 – 30 mg/mL
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About Joy Organics:

Joy Organics is one of the most well-known brands in the CBD space. The company was founded by a woman named Joy Smith, who has been using hemp extracts to manage her problems with pain and sleep. After reaping the benefits of CBD herself, she has decided to share her passion for CBD oils with other people seeking natural and safe alternatives to conventional treatments.

The company offers a range of broad-spectrum CBD oils from certified organic hemp. They have a lot of positive reviews all over the internet; they also haven’t received any warning letter from the FDA regarding health claims or other ‘unfair’ practices.

Joy Organics focuses on broad-spectrum CBD formulations in a low potency range — from 450 to 900 mg of CBD per bottle. The stronger version features 30 mg of CBD per milliliter, which is a standard dose among daily users who use this product as a means of supplementation. These are one of the tastiest CBD oils I’ve tried to date; you can choose from three refreshing flavors: Fresh Lime, Tranquil Mint, and Summer Lemon.

In 2018, one of the company’s flavored CBD oils was found to be contaminated with a fungicide that is commonly sprayed on citrus fruits. Fortunately, Joy Organics has quickly fixed the problem by removing the flawed product batch and implementing new third-party testing systems to make sure such mistakes won’t happen again.

Pros:

  • Non-GMO, US-grown hemp
  • Supercritical CO2 extraction
  • Broad-spectrum CBD
  • THC-free
  • Delicious flavors

Cons:

  • A bit expensive
  • No high-strength oils

What Are Migraines?

Migraines are severe headaches that can last for anywhere between 4–72 hours. They are perceived as a throbbing sensation usually affecting one side of the head.

Most often, it feels as if someone was trying to squeeze your skull while pounding it with a hammer at the same time.

Nothing enjoyable, to say the least.

Aside from the unbearable pain, migraines can also trigger other symptoms such as nausea or vomiting, and sensitivity to light and sound.

Migraine headaches affect more than 38 million people within the US alone. Women are three times as likely to suffer from migraines as men.

Migraines come in two distinct forms: with or without aura.

The vast majority of people (70–90%) experience migraines without aura. This type lasts between 4–72 hours and is accompanied by pulsating pain on one side of the head.

Migraine with aura is another common type that derives from neurological symptoms triggered by the headache. These symptoms include tunnel vision, flashing lights, and colored spots in the eyes, as well as blind spots in the field of vision.

Migraines can be both acute and chronic; chronic migraine lasts even 15 days in a month.

Scientists are still trying to figure out the exact cause of migraine headaches, but they believe them to result from alterations of chemicals, nerves, and blood vessels in the brain.

Common Migraine Treatment Options

If your migraines aren’t severe and result mostly from environmental triggers, you can learn to avoid them and thus reduce their frequency.

Consider using the following techniques:

  • Stress management (behavioral therapy)
  • Taking care of your sleep quality
  • Avoiding allergens and bright lights

When these methods fail to deliver expected results, your physician will recommend one of the conventional treatment options.

Acknowledged migraine treatments include:

  • Over-the-counter (OTC) painkillers like acetaminophen
  • Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen or aspirin)
  • A combination of medicines that mix pain relievers and caffeine
  • Anti-migraine prescription drugs, such as antidepressants, seizure medications, and beta-blockers
  • Botox treatment

No treatment works for everyone, but some of these methods can reduce the frequency of migraine headaches and dampen the intensity once they start.

However, when absolutely none of the above methods relieves you from migraines, CBD oil may be your last hope.

Does CBD Help with Migraines?

CBD stands for cannabidiol and is one of the 400+ compounds found in the cannabis plant. It’s the most abundant cannabinoid along with THC, but unlike THC, it has no psychoactive properties, meaning it won’t get you high.

CBD is a modulator to the endocannabinoid system (ECS). It acts on the two sets of cannabinoid receptors (CB1 and CB2) to help the ECS maintain the chemical balance in the body and brain.

In essence, CBD signals these receptors to produce more of the body’s own cannabinoids and makes them more available for the body by blocking the enzyme responsible for their breakdown.

Studies have shown that CBD can work as a painkiller, anti-inflammatory, antioxidant, and neuroprotectant, hence the impressive number of its health benefits.

But how could CBD help with migraines? To answer that question, we need to examine the relationship between CBD and the endocannabinoid system closely.

Why Would CBD Oil Work for Migraines?

Although the research in this area is still in its infancy — mainly due to the federal restrictions on cannabis and its molecules until recently — there are some indications that CBD may assist migraine attacks or intense headaches.

Migraines & the Endocannabinoid System

The endocannabinoid system has been proposed as a significant factor when it comes to migraines and its management through CBD administration.

According to a study published in the Journal Experimental Neurology, this system may be centrally and peripherally engaged in pain signaling. This may be caused by the endocannabinoids’ ability to inhibit the release of neurotransmitters responsible for perceiving pain via interaction with the CB1 receptor in the brain.

The authors of the paper suggest that the endocannabinoid system is where migraines may have their roots, and that CBD could serve as a promising tool for alleviating the physiological and inflammatory aspects of pain that are involved in migraine headaches.

CBD, Anandamide, and Migraines

If this theory proves accurate, then the lack of endocannabinoids within the ECS may just as well be a contributor to migraines. This condition, which is officially described as clinical endocannabinoid deficiency, could be the cause of migraine headaches in many people.

Anandamide (or AEA), one of several endocannabinoids produced by the human body, has the ability to both increase and decrease the activity of serotonin receptors. A paper from Neurology Letters suggests that this feature can have therapeutic applications within the domain of migraines. Anandamide has also been shown to be tonically active within the gray matter of the brain, which is responsible for migraine generation.

Another research published in the Journal of Headache and Pain has investigated the role of AEA administration with animal models. The study confirmed that a compromised endocannabinoid system might cause the development of migraine attacks. The authors of the paper suggest that modulation of CB1 and CB2 receptors can be useful in the treatment of migraines.

CBD can manipulate AEA levels within the body and maintain its adequate concentrations in the brain, hence its potential to relieve migraine pain.

How to Use CBD Oil for Migraines?

There are several ways to use CBD oil for migraines. Each of the methods I describe in this section provides a slightly different type and duration of effects.

Inhalation

You can inhale CBD oil or concentrates for migraine relief. The healthiest and easiest method of inhaling CBD is vaporization, which means heating the CBD vape oil in a device called a vaporizer.

Vaporization only heats the material to the point where it releases CBD-rich vapor. You then inhale through the vaporizer’s mouthpiece.

Since there’s no combustion, vaping CBD oil doesn’t deliver harmful substances to your system.

But most importantly, vaporization has the highest bioavailability of all consumption methods. In other words, vaped CBD delivers more active substances than sublingual or oral CBD.

Research has shown that the bioavailability of vaporized cannabidiol ranges between 35–56%, which is about 1.5 times as much as sublingual products and 10–14 times as much as edibles.

Sublingual Drops

In its most common form, CBD is applied sublingually. Once you measure out the necessary amount of CBD oil with a dropper, you squeeze the dose under your tongue and wait until it gets absorbed through a special membrane.

From there, CBD travels straight to the bloodstream. This helps the user to avoid the “first-pass effect” because cannabidiol doesn’t have to be processed by the liver. Usually, the ad hoc effects become noticeable after 20–30 minutes.

Sublingual CBD is a good option to consider for those migraine sufferers who want to steer clear of additives like propylene glycol or vegetable glycerin, which are present in CBD vape oils.

Topicals

Although CBD topicals offer the lowest bioavailability, they can be a viable option for fighting localized pain. Not only that, but topical products also soothe the nerves in your head that release Calcitonin Gene-related Peptide (CGRP) — a peptide that has been scientifically proven to trigger migraine headaches.

It turns out that chronic migraine sufferers have high levels of CGRP and low levels of endocannabinoids. According to a study published in the European Journal of Pain, topical CBD can reduce CGRP, inflammation, swelling, and pain in animal arthritis.

Potential Risks & Side Effects

Just as any health supplement, CBD oil can cause some side effects. However, these side effects are relatively minor and don’t put your health or life in danger — as long as you buy high-quality CBD oil from a trusted manufacturer.

That’s why people use it so eagerly.

The only side effects that may appear when you take too much CBD oil is dry mouth, lowered blood pressure, and dizziness. Rare cases include examples of diarrhea after consuming extremely high doses of CBD.

CBD blocks the enzyme in the liver that is responsible for processing drugs; given this, taking CBD oil along with many medicines may lead to increasing the concentration of these drugs in your system and cause “second-hand” side effects (not related to using CBD on its own).

That being said, it’s important that you talk to your doctor prior to buying CBD oil if you take any other medications it could potentially interact with.

Things to Do Before You Decide to Buy CBD Oil from Any Company

Buying CBD oil is an investment in your well-being, but as with any investment, you shouldn’t act on the spur of the moment.

When browsing through different brands and products, make sure you don’t miss out on any of the following points:

Ask for Lab Reports from 3rd-Party Testing

Lab analysis will tell you everything about CBD oil, from its CBD potency to the cannabinoid profile and terpenes to potential pollutants.

Every company has the option to submit a sample of their product to a third-party laboratory for examination. If there are any inconsistencies in the potency, or the product turns out contaminated, the lab test will detect it.

Therefore, if a company isn’t honest about how they test their CBD oil and they don’t show lab reports anywhere on their website — even on request — that’s an instant red light.

Choose the Right Potency

The potency of CBD oil is measured in milligrams of CBD per one milliliter of the liquid. Lower potencies are designed rather for preventive supplementation or to fight mild symptoms, so options like 100mg or 250mg of CBD will suit you if you’re new to CBD oil or if you suffer from headaches caused by weather or changes in pressure.

On the other hand, if your migraine symptoms are on the verge of manageable and you’ve used up other resources, then opt for potencies of 1000mg and up — preferably with the full spectrum of cannabinoids.

Which brings us to the next point.

Opt for Full-spectrum CBD Extracts

Full-spectrum CBD oil contains all cannabinoids, terpenes, and other phytonutrients from hemp.

Research shows there’s a unique synergy between cannabinoids and terpenes which greatly increases their effects — this concept is known as the entourage effect. Simply put, the aforementioned compounds are more effective together than each of them in isolation.

Studies suggest that full-spectrum extracts are superior to isolates in easing pain and inflammation, both of which affect migraine sufferers.

CBD Oil for Migraines: Can It Really Help?

While the research on CBD and migraines is in its early stages, what we already know is that this cannabinoid may be a potent anti-migraine agent with some potential to reduce or even eliminate migraine headaches for good.

If the theory that migraines are caused by endocannabinoid deficiencies finds confirmation in clinical human studies, we may finally find an effective tool for easing the symptoms of this painful condition and fixing the problem at its roots.

I hope this article has helped you understand the apparent relationship between CBD, the endocannabinoid system, and migraines — and that you’ll find the best CBD oil to relieve yourself from that crippling pain.

What’s your experience with using CBD oil for migraines?

  1. Greco, R., Gasperi, B., Maccarrone, M. & Tassorelli C. (2010) The Endocannabinoid System and Migraine. Experimental Neurology, 224(1), 85–91.
  2. Russo, E.B. (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.
  3. Greco, R., Mangione A.S., Sandrini, G., Maccarrone, M., Nappi, G., Tassorelli, C. (2011). Effects of Anandamide in Migraine: Data from an Animal Model. The Journal of Headache and Pain, 12(2), 177–183.
  4. De Petrocellis, L., Di Marzo, V. (2010). Non-CB1, non-CB2 Receptors for Endocannabinoids, Plant Cannabinoids, and Synthetic Cannabimimetics: Focus on G-protein-coupled Receptors and Transient Receptor Potential Channels. Journal of Neuroimmune Pharmacology: the Official Journal of the Society on NeuroImmune Pharmacology, 5(1), 103–121.
Nina Julia

Nina created CFAH.org following the birth of her second child. She was a science and math teacher for 6 years prior to becoming a parent — teaching in schools in White Plains, New York and later in Paterson, New Jersey.

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Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Cannabis has been long used since ancient times for both medical and recreational use. Past research has shown that cannabis can be indicated for symptom management disorders, including cancer, chronic pain, headaches, migraines, and psychological disorders (anxiety, depression, and post-traumatic stress disorder). Active ingredients in cannabis that modulate patients’ perceptions of their conditions include Δ 9 ‐tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes. These compounds work to produce effects within the endocannabinoid system to decrease nociception and decrease symptom frequency. Research within the United States of America is limited to date due to cannabis being classified as a schedule one drug per the Drug Enforcement Agency. Few anecdotal studies have found a limited relationship between cannabis use and migraine frequency. The purpose of the review article is to document the validity of how medical cannabis can be utilized as an alternative therapy for migraine management. Thirty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: “Cannabis,” “Medical Marijuana,” “Headache,” “Cannabis and Migraine,” “Cannabis and Headache.” This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.

Introduction and background

Cannabis has a rooted history for both medical and recreational use. Cannabis has been used since ancient times to manage various conditions, including acute pain, anxiety, cancer pain, chronic pain, depression, headaches, and migraines [1]. It exists in forms that include: Cannabis indica, Cannabis ruderalis, and Cannabis sativa of which contain 400 compounds [2]. Important compounds of interest include Δ 9 ‐tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes [2]. THC and CBD are the major components of different medical cannabis formulations [2]. Both CBD and THC stimulate cannabinoid (CB) receptors throughout the human body, constituting the endocannabinoid system [2]. The endocannabinoid system consists of CB1 (central/peripheral nervous system) and CB2 (peripheral/immune tissues) receptors [2]. CB1 receptor activation leads to decreased neurotransmission of dopamine, γ-aminobutyric acid (GABA), and glutamate. On the other hand, CB2 receptor activation leads to analgesia and decreased immune system function [2-4].

In migraines, current theory suggests that the CB system mitigates migraine through several pathways (glutamine, inflammatory, opiate, and serotonin) both centrally and peripherally [4]. Anandamide (AEA) potentiates 5-HT1A and inhibits 5-HT2A receptors supporting therapeutic efficacy in acute and preventive migraine treatment; it is active in the periaqueductal gray matter, a migraine generator. Cannabinoids also demonstrate dopamine-blocking and anti-inflammatory effects [5]. Furthermore, cannabinoids may have a specific prophylactic effect in migraines due to their ability to inhibit platelet serotonin release and peripheral vasoconstrictor effect [6]. In addition, CB1 receptors reduce nociperception via a serotonin-mediated pathway, whereas CB2 receptors act to produce analgesia without developing tolerance or side effects [4]. Current research suggests that the endocannabinoid system plays a role in migraine mitigation, but updated research is lacking within the United States of America (USA) [7,8].

Cannabis is classified as a Schedule I drug, per the Controlled Substances Act and the Drug Enforcement Agency, indicating that it has a high potential for abuse, and medical use is prohibited [9,10]. However, state governments have utilized their powers and legalized cannabis for medical and/or legal use within the last several years. California was the first state to legalize medical cannabis back in 1996 [9]. Still, to date, 36 states and four USA territories deem this compound for medical use, with 18 states, two territories, and the District of Colombia allowing it for recreational use [9]. Medical societies have even incorporated cannabis use in medical management. For example, the Canadian Pain Society recommended back in 2014 that cannabis be utilized as third-line therapy for chronic pain management [11]. Chronic pain is often a common reason for a patient to register with a medical cannabis state registry [12]. Other uses for medical cannabis include symptom management of Alzheimer’s disease, amyotrophic lateral sclerosis, migraines, multiple sclerosis, and seizures [4,13,14]. To utilize medical cannabis, an individual must establish care with a medical cannabis physician and have a qualifying or similar diagnosis [15]. Florida, for example, requires that a patient have a qualifying medical condition that includes, amyotrophic lateral sclerosis, cancer, chronic nonmalignant pain, Crohn’s disease, epilepsy, glaucoma, human immunodeficiency virus disease/acquired immunodeficiency disease syndrome, multiple sclerosis, Parkinson’s disease, post-traumatic stress disorder, and terminal condition [12,15]. In addition, as defined per Florida amendment 2, similar conditions include disorders (alcoholism, anxiety, depression, diabetes, and endometriosis) that have symptoms that are common to the above qualifying conditions [12]. Once a physician determines patient eligibility for medical cannabis use, a patient can access medical cannabis products for seven months [12].

Medical research for medical cannabis use is sparse, given the lack of randomized control studies. Current literature is limited to case reports, case series, cell phone survey applications, and retrospective analyses. In addition, few studies document the improvement of migraine symptoms with medical cannabis use. However, two prospective trials done by Robins et al. and Aviram et al. have noted migraine improvement within their studies [16,17]. Also, there are limited studies that qualify or quantify an ideal dosage and method of cannabis use. Hence, with minimal research studies on the effectiveness of medical cannabis on different medical conditions, review papers are essential to summarize how this compound can be effective in headache and migraine management.

This paper aims to determine if medical cannabis can be utilized as an alternative treatment for headache and migraine management. It emphasizes how medical cannabis can reduce headaches and migraine duration and frequency, highlights different forms and ideal doses used for clinical effectiveness. After an extensive literature search using PubMed and Google scholar databases, 34 relevant articles were found to review the efficacy of medical marijuana use on migraines and headaches. Keywords used were “Cannabis,” “Medical Marijuana,” “headache,” “Cannabis and Migraine,” “Cannabis and Headache.” The articles were thoroughly screened by reviewing each article with titles, abstracts, and content of the full articles. We included the studies published between 1987 and 2020, human studies in the English language, including adults 18 years and older, whereas articles involving children less than 17 years and pregnant females were excluded from this study.

Review

Cannabinoids, similar to other analgesics and recreational drugs, act on the brain’s reward system, especially on cannabinoid one receptor localized at the same place as opioid receptors on nucleus accumbens and functions by overlapping the antinociceptive pathways [18]. Articles included in our study focused on identifying the cannabis treatment in migraines and headaches. These articles also analyzed the preferred cannabis forms and their substitution for medications. During the extensive search of the literature, we came across three main questions for which the studies are conducted and directed: (i) Is medical cannabis effective on headaches and migraines? (ii) What forms of medical cannabis do people prefer? (iii) What is an ideal dose for the “preferred form?”

Medical cannabis and its potential role in headaches and migraines

Several studies have reported both the benefits and effectiveness of medical cannabis use. A prospective clinical trial done in 2020 by Aviram et al. focused on 68 patients who smoked or vaped MC inflorescences evaluated the differences in total MC monthly dose between responders and non‐responders [17]. This study focused on the associations between phytocannabinoid treatment and migraine frequency [17]. The study also reported better migraine symptom reduction, less negative headache impact, better sleep quality, and decreased medication consumption [17]. In 2019, Cuttler et al., in their survey study from a Canadian data application (Strainprint), focused on the inhaled cannabis usage and their effect of reduction in migraine severity and frequency along with the factors affecting the dosage used [19]. Survey results demonstrated that headaches were reduced by 47.3% and migraines by 49.6% [19]. A higher proportion of males (90.9%) compared to females (89.1%) reported a more favorable reduction with headaches, whereas females (88.6) compared to males (87.3%) reported a more favorable reduction with migraines [19]. It also investigated the tolerance development with prolonged cannabis use [19]. Lack of a control group and sampling bias were limitations of this study [19]. In 2018, Baron et al. did a literature review of cannabinoid usage to treat migraines, facial pain, and chronic pain and their medicinal benefits [20]. The study shows the significant advantage of medical marijuana in improving nausea and vomiting associated with migraines [20]. Later in 2018, he and his team conducted another survey and identified different patterns of medical marijuana treatment in migraine headaches [20]. Rhyne et al., in 2016, did a retrospective study from medical record reviews, analyzed the frequency of headaches with medical marijuana as a primary goal, and focused on the type, dosage use, previous migraine therapies used, and patient-reported data as secondary outcomes [21]. They showed a significant reduction in migraine frequency with medical marijuana [21]. Leroux et al. conducted a survey and demonstrated that the prevalence of cannabis use is higher in patients with cluster headaches than in the general population [22]. The study included 139 patients from two hospitals in France and attempted to investigate the frequency of cannabis use among cluster headache sufferers and its effects on attacks [22]. Medical cannabis was found to have unpredictable effects in 1/2 of all the patients with cluster headaches, a modest effect in 1/4 of all patients, and eliminate an attack in 1/8 of patients [22]. Due to cannabis’s variable responses, the survey concluded that cannabis should not be used as a therapeutic option for managing cluster headache attacks [22]. Bagshaw et al. in 2002 provided a literature review with a summary of recommendations of when medical cannabis can be used in the palliative care setting [23]. The literature review focused on symptoms in palliative care not limited to nausea, migraines, muscle spasticity, and seizures [23]. This review found that oral THC was superior to placebo for managing symptoms. THC use, however, was found to be limited due to dose-dependent psychosis and psychotropic effects [23]. Pini et al., in their randomized controlled trial (RCT) study, evaluated the efficacy and safety of nabilone in reducing pain and frequency of headache, the number of analgesic intake, and in increasing the quality of life of patients with long-standing intractable medication overuse headache [24].

Despite mixed findings regarding the effectiveness of medical cannabis on both headaches and migraines, there is a consensus for the indication of medical marijuana therapy when first and second-line treatment fails. Current ethnobotanical and anecdotal references mention efficacy. Biochemical studies of THC and anandamide have provided a scientific basis for both symptomatic and prophylactic treatment of migraine [25]. Dronabinol and nabilone, synthetic cannabinoids, have been shown to act in place of first-line therapy for cluster headaches (triptans, verapamil) and can effectively control pain [16,26]. Non-synthetic cannabis (oral, inhaled, sublingual, edible, topical) can be indicated for managing headache and migraine symptoms, but it is dose-dependent [22,23]. Adverse reactions to medical cannabis use can include dizziness, dry mouth or eyes, nausea, vomiting, and psychosis [26]. Despite such side effects, patients have an overall favorable view of using medical cannabis along with or in place of medications, as it was reported to decrease the frequency and duration of migraines.

Different forms of medical cannabis and patients preference

Several studies have reported preferred forms of medical cannabis for the treatment of migraines and headaches. Salazar et al. conducted a cross-sectional survey to assess self-reported reasons for recreational and medical cannabis users in the southeastern United States [27]. From the survey, 50 participants (11.6%) reported medical cannabis use, 180 participants (41.7%) reported recreational use, and 202 participants (46.8%) reported combined usage [27]. The reported primary method of use was smoking, followed by vaporization (5.6%) and “dabs” (2.8%) [27]. Participants were asked about their cannabis use, frequency, amount, and methods to use it [27]. The survey’s results showed that 35.5% of the patients used it for headaches and migraines [27]. The effect of medicinal cannabis on headaches and other conditions had a mean score of 3.6/5, which meant an 86% efficacy in pain relief [27]. The dried Cannabis flower may be an effective medication for the treatment of migraine- and headache-related pain, but the effectiveness differs according to characteristics of the Cannabis plant, the combustion methods, and the age and gender of the patient [28]. Many patients were able to replace their pain meds with medicinal cannabis in a survey reported by Nicolodi et al. [29]. Limitations of this study include relying upon self-reported data along with a lack of diagnosis verification [29]. Boehnke et al., in 2019, conducted an online survey consisting of 1321 patients on medicinal cannabis use [30]. This survey analyzes cannabis use patterns among chronic pain patients [30]. More females, 59.1%, participated in the survey in comparison to male patients [30]. Males use smoke and vaporize form more, whereas females rank edible, tincture (oil-based), and topical cannabis as preferred first-line methods and also products that consist of low THC to high CBD in a “ratio” [30]. Piper et al., in 2017, conducted an online survey to evaluate the effects of medical cannabis usage by substituting opioids or other psychoactive medications and evaluated the communication about the usage of the patients with their physician [31]. This survey included 52.9% female and 47.1% male patients [31]. The results show that 76.7% reported a gradual decrease in opiate use [31]. Approximately, two-thirds of patients reduced anti-anxiety, migraine medications, antidepressants, and alcohol following MC usage [31]. Preferred delivery methods include joints (48.5%), vaporization (22.3%), edibles (14.3%), tinctures (10.8%), concentrates (3.4%), and topical (0.7%) methods [31]. This survey is limited as it did not examine “combination” medication use (antidepressant + sleep aid), and the data were designed to be interpretable by the general population [31]. Rhyne et al., in 2016, conducted a retrospective, observational review of patients in Colorado [21]. Patients between the ages of 18 and 89 years old with a diagnosis of migraines were included in the study [21]. Factors such as sex, the duration of migraines, medical history, past migraine treatment, number of migraines experienced per month, how often and how much cannabis was used were self-reported by the patient [21]. It was reported that out of 82, 20 patients used at least two forms of cannabis [21]. The study has shown different forms of cannabis used to treat migraines [21].

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After reviewing the literature, it is found that the primary method for cannabis use was smoking, followed by vaporization (5.6%) and dabs (2.8%) [27]. Patients with headaches were 2.7 times more likely to prefer a hybrid (Cannabis sativa + Cannabis indica) strain than chronic pain patients [20]. Females preferred to rank edible, tincture (oil-based), and topical cannabis as preferred first-line methods for chronic pain like arthritis and migraine [30]. Also, analysis of Strainprint responses reveals that inhalation methods like smoking, vaping, concentrates, dabs (79.4% of headache data and 82.8% of migraine data) were primary methods used by the patients [19].

Cannabis ideal dose and preferred forms

While medical cannabis exists in different forms, there is variability in the ideal dosage for medical cannabis use. Several studies done to determine the “ideal” dosage are described here. Ogborne et al., in 2000, interviewed 50 medical cannabis users recruited via advertisements in newspapers and job boards [26]. The participants were using medical cannabis for various reasons such as HIV, cramps, depression, pain, and migraines [26]. Almost all of the participants smoked cannabis approximately two to three times a day [26]. Baron et al., in 2018, in their electronic survey for the use of medical cannabis in a patient with headache, showed a pattern of cannabis use, including frequency, quantity, and strains [20]. In the ID Migraine™ questionnaire, hybrid strains of cannabis, of which “OG Shark,” a high THC/THCA, low CBD/CBDA, and strains with predominant terpenes β-caryophyllene and β-myrcene, were most preferred in the headache and migraine groups [20]. In the study trial, patients were intervened with 19% THC or THC+ 9% CBD [20]. It was found that a dose of 200 mg effectively reduced the intensity of migraine pain by 55% [20]. In another phase, 25 mg of amitriptyline or THC+CBD 200 mg per day was given prophylactically for three months in chronic migraine patients [20]; also, THC + CBD 200 mg was required for the acute attack [20]. The study concluded that THC + CBD 200 mg had a 40.4% improvement over amitriptyline use (40.1%) [20]. A similar study was done for the cluster headache, but it did not benefit as abortive treatment [20]. Sexton et al., in 2016, did an online survey that sought to collect epidemiological data to start a discussion on medico-legal recommendations, report patient outcomes, and inform the medical practice of medical cannabis users [32]. Many medical professionals (59.8%) used cannabis as an alternative treatment for their patients, reducing the symptoms by 86% [32]. This study also included the route and dosage of medical marijuana usage, where 84.1% of the participants had inhalation as the most common route, and 60.8% of the participants reported one to five hits usage per session [32]. Concerning the dosage of cannabis, 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 [32]. The survey was limited due to self-reported results, placebo effects, recall bias, and how efficacy was reported [32]. In this situation, the amount utilized per week ranges from 1 to 28 g [26,32]. Frequency is also a concern, as patients vary from “1-10 hits per day” or 2-3 times per day depending on the convention used [26,32].

Finding an ideal dosage of a medical cannabis product can be difficult due to its variation among users. Every study mentioned the different doses and forms used by patients for different causes. Some studies have shown that THC +CBD had a good outcome when used as prophylactic or when given in acute attack [20]. Combination studies of Amitriptyline and THC or Amitriptyline and CBD should be done in order to find the improvement in efficacy and dose reduction of Amitriptyline for abortive as well as curative treatment. Also, more research should aim in doing controlled studies about the route and dose of THC/CBD for migraine and headache patients.

As with all research, limitations exist that prevent a quality analysis. This literature review is limited by the number of articles that were selected to begin. The use of cannabis with other recreational drugs was not excluded from the studies. Also, the selected studies had their own limitations as the articles were surveys collected, online surveys, a small sample size, and very few controlled trials. The lack of standardization may affect the quality of our results. Despite the limitations of the above studies, medical cannabis is an effective alternative treatment for managing headache and migraine symptoms. Our review article shows that cannabis use is picking up in patients with chronic pain and can be expected to continue to rise upwards in the face of increasing societal awareness and availability of legal cannabis [33]. Careful questioning and discussing with the patients about the use of marijuana, its risks, and benefits should be documented and researched. More information about the doses, frequency, methods, and forms of marijuana consumed, as well as alcohol use, illicit drug, and prescription drug use, should be explored to form the definitive treatment goal for migraine and headache patients [34].

Conclusions

The review article shows encouraging data on medicinal cannabis’s therapeutic effects on alleviating migraines in all of the studies reviewed. Beneficial long-term and short-term effects of medicinal cannabis were reported. It was effective in decreasing daily analgesic intake, dependence, and level of pain intensity. Some patients experienced a prolonged and persistent improvement in their health and well-being (both physically and mentally) after long-term use of medicinal cannabis. Overall, patients reported more positive effects rather than adverse effects with medical cannabis use. Chronic pain and mental health are the two reasons where medical cannabis is used often. It is found that some medical providers are hesitant to recommend medical cannabis due to a lack of current evidence, medical professional training, and a lack of uniform medical cannabis use guidelines. The therapeutic benefits of cannabis should be studied widely with intensive research trials supervised and controlled by authorities for safety and quality effectiveness. Further research should be performed once cannabis becomes legalized to determine a favorable delivery method, dose, and strain for migraine and chronic headache management and possible long-term effects of medical cannabis use. While medical cannabis is in a “disorganized realm” at the moment due to a lack of substantial research and medical provider education and patient education, this field is evolving and expanding to provide up-to-date research for both patient and doctor.

Acknowledgments

The authors would like to acknowledge Dr. Marcos A. Sanchez-Gonzalez for his constant support throughout the course of the manuscript. In addition, the authors appreciate the support of Dr. Marie-Pierre Belizaire, Dr. Madiha Zaidi, Prathima Guntipalli, and Rahima Taugir. Finally, the authors would like to thank the reviewers for their constructive feedback.

Notes

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

Footnotes

The authors have declared that no competing interests exist.

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