10 Best CBD Oils for Migraines 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 Dr. Stephen Silberstein outlines what patients should know about CBD oil as a treatment for migraine, including effects and regulations.
10 Best CBD Oils for Migraines
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CBD oil is becoming an increasingly popular treatment for migraines, and there are several reasons why it might work well for this condition. Today we’re sharing the 10 best CBD oils for migraines and tips to help keep your migraines at bay.
Migraines are one of the most common neurological disorders in the world. An estimated 38 million Americans suffer from migraines, according to the Migraine Research Foundation. And while there are many different treatments available for migraines, finding the right one can be a challenge.
Some people find relief with over-the-counter medications, while others need prescription medication to get relief. But for some people, prescription medications don’t work at all and they’re looking for an alternative treatment.
How do I know if I have a migraine or headache?
Migraine headaches are characterized by throbbing or pulsing pain that often can worsen with activity. They typically affect only one side of the head and may be accompanied by nausea, vomiting, light sensitivity, and noise sensitivity.
What is CBD?
CBD, short for cannabidiol, is one of the active cannabinoids found in cannabis sativa. This compound can influence how we feel, think, and react. It does not produce a “high” feeling or psychoactive effects because it binds to other receptors in our bodies rather than those in the brain. People have been using CBD for a variety of conditions, including migraines and other types of pain.
CBD Oil for Migraines
When it comes to CBD oil, there are so many different brands to choose from that choosing the right one can be confusing. Some people have concerns over whether or not CBD oil is legal in their state. Others might be wondering how much they should take or which brand may be most effective.
If you’re considering trying CBD oil for your migraines, we want to make it easy for you by sharing a few tips and reviews of some of the best brands on the market.
How did we choose the best CBD oils for migraines?
When it comes to choosing the best CBD oil for migraines, we based our list on customer reviews and third-party lab tests. We also considered the price per milligram of CBD oil plus any discounts or coupons available.
Price and Discounts Available
One of the first things we considered when compiling our list is how much a company charges per milligram of CBD oil. A higher price point doesn’t necessarily mean a better product, but knowing available pricing and discounts can help if you’re on a budget.
Luckily, several of the companies on this list have discounts or coupons available on their websites that you can use for a better deal. It’s important to note that some of these discounts may have an expiration date, so be sure to check the company website for more information.
CBD Oil Reviews and Best Brands
We also considered customer reviews when compiling this list. CBD oil is a relatively new product and there aren’t many third-party lab tests available, so customer reviews are an important part of finding the best CBD oils on the market.
Finally, we also took into consideration any available third-party lab tests for any potential contaminants in the product. While some companies perform their own tests to ensure their products are clean, others rely on third parties to test their products. If you’re looking for a pure product, you’ll want to buy from a company that independently tests their products.
3 Tips for Finding the Best CBD Oils for Migraines
If you’re looking for the best CBD oils to ease your migraines, here are three tips to get started.
Tip 1: Choose Low or Full Spectrum CBD Oil
If you’re new to CBD oil, you might not know about full spectrum or broad spectrum CBD oils. There are several benefits of full spectrum CBD over regular hemp oil, but it’s especially helpful when treating migraines.
The main difference between the two is that full spectrum CBD oil contains other compounds found in hemp plants, not just CBD. These additional compounds are known as cannabinoids and terpenes. They contain antioxidants and help ease inflammation in addition to easing pain from migraines or headaches.
In order to get the most benefit from a full spectrum CBD oil, look for a product that’s high in both CBD and THCa or CBDa. Most full spectrum oils will also be broad spectrum, so consider this when deciding on a company.
Tip 2: Consider Third Party Lab Tests
If you’re new to CBD oil products, you might not know about third-party lab tests. Third-party lab tests are a good way to ensure that you’re getting a product that’s free from pesticides or any other harmful substances.
There are a few different places where you can find these test results, but many of the best CBD oil companies will have their results listed on their websites. This is also a good place to look if you’re concerned about whether or not the product is legal in your state.
Tip 3: Look for Coupons and Discounts
Did you know that many CBD oil companies offer coupons and discounts? If you’re on a budget, consider looking for a coupon before making a purchase.
What are the benefits of CBD oils for migraines?
There are many benefits of CBD oil and it might be one of the best ways for you to ease your migraine symptoms.
To start, CBD oil is a great alternative to western medicine. Migraine sufferers have been shown to benefit from the use of CBD oil and other cannabinoids. As with any natural product, it might take a little trial and error before you find a product that works best for you.
If you’re new to CBD oils, there are several benefits you might want to consider.
Improves Mood and Eases Depression
CBD oil is also a natural mood booster that helps ease depression in addition to the pain from migraines. It’s important to note that this may not work for everyone, but it can be an excellent option for some people.
One of the best ways that CBD oil helps ease migraines is by reducing anxiety. CBD oil contains terpenes that are known to help fight stress and decrease anxiety, which can help reduce your migraine symptoms.
CBD oils for migraines may also stimulate the appetite and help prevent nausea and vomiting related to migraines. This can be a great benefit if you’re going through treatment and struggling with food aversions or nausea.
Addresses Neuropathic Pain
CBD oil is also helpful for people who suffer from neuropathic pain related to migraine symptoms. This can be an excellent option if you’re dealing with head pain, neck pain, face numbness, dizziness, or any other type of symptom.
What are the side effects of CBD oils for migraines?
It’s important to know about all of the side effects before trying anything new.
Many people report feeling drowsy or groggy when taking CBD oil that contains higher levels of THC. If you’re new to CBD products, you should always start with a low dose and see how it affects you.
If the side effects are too much for you, it might be time to switch to an all CBD oil or full spectrum CBD oil product instead. This way, you won’t have any THC in the product and can still get all of the benefits of CBD.
How much CBD oils for migraines should I take?
The best CBD oils for migraines don’t come with dosing instructions, so you’ll need to do a little research before trying anything new.
It’s always best to start small and see how it impacts your overall migraine symptoms, including pain levels. If you find that you have a good experience with the product, there’s no need to increase your dosage.
You can always take more CBD oil as well if you’re struggling with pain and really want to get relief right away. Be sure not to take too much though as this can cause drowsiness or other side effects that go along with high doses of CBD oil.
What are the best CBD oils for migraines?
There are many benefits to using CBD oil and it might be the perfect natural alternative for you when dealing with migraine symptoms.
One thing that makes CBD oils great is that they’re natural, making them an excellent choice when looking at your overall health and wellness.
Another thing to consider when selecting CBD oils is the THC content if you’re looking for a more psychoactive product. If the CBD oil you choose has too much THC in it, make sure to purchase a CBD oil with less than 0.3 percent THC in order to avoid any unwanted side effects.
As you look through our top 10 list, keep in mind that your experience with CBD oil may be different than someone else’s. Everyone responds to CBD oil differently, so you might need to try a few brands before finding the best one for you.
With that in mind, let’s dive deeper into our top 10 list!
1. Penguin CBD Oil
Image courtesy Penguin CBD
Penguin CBD oil is the perfect addition to anyone seeking migraine relief from CBD oils! Made with Oregon-grown hemp, this supplement is a great way to rejuvenate your body and mind. Their fan-favorite mint, citrus, natural, strawberry, and cookies & cream flavors are sure to please.
Image courtesy Everest
Looking for an ultra-potent CBD oil that’s also vegan and non-GMO? Look no further than Everest CBD’s Delta-8 THC oils. High-grade, naturally grown hemp provides a potent dose of CBD (1,000 mg), while the mint flavor is refreshing and delicious.
3. R+R Medicinals
R+R boasts impressive levels of CBD, CBG, CBC, CBN, CBL, and more in their products so you can truly feel the entourage effect. Their 1000mg Fresh Mint Tincture is their best seller and of incredible value for a Full-Spectrum product at $46.99.
4. BATCH CBD
BATCH CBD is committed to creating natural and effective CBD products that you can rely on. All of BATCH’s products are rigorously tested to ensure the quality and potency of their organic ingredients. BATCH’s Original CBD Oil Tincture is infused with their premium full-spectrum hemp extract and a unique terpene blend of limonene, caryophyllene, and linalool so that you can effectively treat migraine pain, reduce tension, and ultimately find relief.
5. Verma Farms
Image courtesy Verma Farms
For a gentle CBD option that still delivers powerful results, look no further than Verma Farms. Their CBD products are made with your comfort and needs in mind, so you can find the right solution for you. Whether you want to use edibles, tinctures, topicals, or a combination, they have the best CBD oils for migraines.
6. Colorado Botanicals
If you’re considering trying CBD oil for migraine symptom relief, Colorado Botanicals CBD oils are the perfect starting point. Created through a proprietary process, the vendor’s extracts are designed to retain natural compounds for a truly authentic (and therapeutic) experience.
Available in full-spectrum and zero-THC broad-spectrum options sourced from meticulously tested industrial hemp, Colorado Botanicals carries the perfect supplement for any lifestyle.
Image courtesy CBDistillery
With options for every type of user, CBDistillery offers a range of extracts with different potencies to suit your needs. Plus, their products are always made with the highest quality ingredients and backed by a commitment to customer satisfaction.
8. Nuleaf Naturals
Image courtesy Nuleaf Naturals
Nuleaf Naturals’ potent full-spectrum extracts provide the benefits of the entourage effect, while high quality hemp ensures that your oil is pesticide and herbicide free. Plus, their affordable prices make Nuleaf Naturals a great choice for anyone on a budget.
9. Charlotte’s Web
Image courtesy Charlotte’s Web
Charlotte’s Web hemp extract is a natural dietary supplement that helps support your health and wellness. Made from the finest organic hemp, Charlotte’s Web extract is CO2 extracted to ensure the highest quality. It’s non-GMO, gluten-free, and vegan friendly.
Image courtesy cbdMD
Looking to boost your CBD intake with a high-quality oil? cbdMD has you covered, with up to 7,500 mg of CBD in each bottle. Choose from three delicious flavor options, or go for the unflavored version for a pure CBD hit. Thanks to the MCT oil base, this CBD oil is easy to absorb and has a smooth flavor.
How does CBD help with migraines?
One of the main components of marijuana that delivers many of its effects is CBD. This non-psychoactive cannabinoid not only alleviates pain but can also reduce anxiety.
CBD interacts with certain serotonin receptors in the human brain and immune system, acting as a natural anti-inflammatory substance that reduces pain and inflammation.
CBD can help relieve migraines by affecting serotonin signals in the brain. One study found this effect to be effective on chronic migraine patients. CBD also works to reduce inflammation in the brain, which is known to exacerbate migraines.
CBD oil for pain relief is becoming one of the most popular health topics on search engines. With more people turning to alternative medicine as a solution for their ailments, it only makes sense that CBD has become so popular among those who are in pain.
Here are some potential side effects to be aware of if you’re thinking about trying CBD for your migraines:
CBD can make users feel tired or groggy, especially after taking a large dose. If you have to go to work or school soon after taking CBD, it might be best to take the product in smaller amounts throughout the day so you don’t fall asleep at your desk.
If you don’t already have migraines, CBD can actually cause them to develop over time. If you start feeling pressure around your temples or the back of your head after taking CBD, it might be due to a headache.
CBD acts on cannabinoid receptors that are found throughout the body, including saliva glands. When activated, these receptors can lead to dry mouth, which can cause difficulties eating or drinking.
Nausea and Vomiting
Again, CBD acts on cannabinoid receptors throughout the body, including those in the digestive tracts. If you feel sick after taking CBD oil for migraines, it could be because of your digestive system.
What are some other common migraine treatment options?
There are other prescription drugs that can help treat the symptoms of migraines. For example, some people opt to take sumatriptan (Imitrex), which narrows blood vessels and limits the pain signal sent to the brain.
A medication called propranolol (Inderal) is also prescribed for migraine relief and comes in several forms, including capsules, tablets that dissolve under the tongue, and injections.
Side effects of some prescription migraine treatments can include insomnia, restlessness, dizziness, lightheadedness, dry mouth, nausea, and vomiting.
There are also natural remedies people can try out for migraines before seeing a doctor or trying pharmaceutical drugs. Here are some options that might help:
· Hot or cold packs on the head
What foods can trigger a migraine?
Foods can trigger migraines in different ways, depending on the individual. Some foods are said to cause certain chemicals in the human body to change, which can lead to a migraine.
Some common migraine-triggering foods include:
· Monosodium glutamate (MSG)
· Bananas, citrus fruits, and other foods containing tyramine
· Fermented or pickled foods (such as vinegar-based salad dressings)
What are some of the best CBD oils for migraines?
There are many retailers online that sell high-quality CBD products. Again, here are the best we chose:
8. Nuleaf Naturals
9. Charlotte’s Web
Why would CBD oils for migraines work?
All of the products featured above are made with high-quality CBD that can help treat symptoms associated with migraines.
CBD oil can also help prevent future migraines and lessen the number of attacks a person experiences. If you’re still on the fence about using CBD oils for migraines, just select the best CBD oils for migraines out of our list above, give a low dosage a try, and see how your body responds.
CBD is an effective way to treat migraines and other conditions without the harsh side effects of prescription medications. Whether you’re looking for CBD oil drops with a specific CBD:THC ratio or trying out full-spectrum products with a variety of cannabinoids, our list above has plenty of options that you can order online and start using right away.
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.
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 . It exists in forms that include: Cannabis indica, Cannabis ruderalis, and Cannabis sativa of which contain 400 compounds . Important compounds of interest include Δ 9 ‐tetrahydrocannabinol (THC), cannabidiol (CBD), flavonoids, and terpenes . THC and CBD are the major components of different medical cannabis formulations . Both CBD and THC stimulate cannabinoid (CB) receptors throughout the human body, constituting the endocannabinoid system . The endocannabinoid system consists of CB1 (central/peripheral nervous system) and CB2 (peripheral/immune tissues) receptors . 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 . 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 . Furthermore, cannabinoids may have a specific prophylactic effect in migraines due to their ability to inhibit platelet serotonin release and peripheral vasoconstrictor effect . In addition, CB1 receptors reduce nociperception via a serotonin-mediated pathway, whereas CB2 receptors act to produce analgesia without developing tolerance or side effects . 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 . 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 . 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 . Chronic pain is often a common reason for a patient to register with a medical cannabis state registry . 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 . 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 . Once a physician determines patient eligibility for medical cannabis use, a patient can access medical cannabis products for seven months .
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.
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 . 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 . This study focused on the associations between phytocannabinoid treatment and migraine frequency . The study also reported better migraine symptom reduction, less negative headache impact, better sleep quality, and decreased medication consumption . 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 . Survey results demonstrated that headaches were reduced by 47.3% and migraines by 49.6% . 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 . It also investigated the tolerance development with prolonged cannabis use . Lack of a control group and sampling bias were limitations of this study . In 2018, Baron et al. did a literature review of cannabinoid usage to treat migraines, facial pain, and chronic pain and their medicinal benefits . The study shows the significant advantage of medical marijuana in improving nausea and vomiting associated with migraines . Later in 2018, he and his team conducted another survey and identified different patterns of medical marijuana treatment in migraine headaches . 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 . They showed a significant reduction in migraine frequency with medical marijuana . 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 . 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 . 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 . Due to cannabis’s variable responses, the survey concluded that cannabis should not be used as a therapeutic option for managing cluster headache attacks . 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 . The literature review focused on symptoms in palliative care not limited to nausea, migraines, muscle spasticity, and seizures . 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 . 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 .
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 . 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 . 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 . 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 . The reported primary method of use was smoking, followed by vaporization (5.6%) and “dabs” (2.8%) . Participants were asked about their cannabis use, frequency, amount, and methods to use it . The survey’s results showed that 35.5% of the patients used it for headaches and migraines . 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 . 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 . Many patients were able to replace their pain meds with medicinal cannabis in a survey reported by Nicolodi et al. . Limitations of this study include relying upon self-reported data along with a lack of diagnosis verification . Boehnke et al., in 2019, conducted an online survey consisting of 1321 patients on medicinal cannabis use . This survey analyzes cannabis use patterns among chronic pain patients . More females, 59.1%, participated in the survey in comparison to male patients . 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” . 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 . This survey included 52.9% female and 47.1% male patients . The results show that 76.7% reported a gradual decrease in opiate use . Approximately, two-thirds of patients reduced anti-anxiety, migraine medications, antidepressants, and alcohol following MC usage . Preferred delivery methods include joints (48.5%), vaporization (22.3%), edibles (14.3%), tinctures (10.8%), concentrates (3.4%), and topical (0.7%) methods . 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 . Rhyne et al., in 2016, conducted a retrospective, observational review of patients in Colorado . Patients between the ages of 18 and 89 years old with a diagnosis of migraines were included in the study . 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 . It was reported that out of 82, 20 patients used at least two forms of cannabis . The study has shown different forms of cannabis used to treat migraines .
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%) . Patients with headaches were 2.7 times more likely to prefer a hybrid (Cannabis sativa + Cannabis indica) strain than chronic pain patients . Females preferred to rank edible, tincture (oil-based), and topical cannabis as preferred first-line methods for chronic pain like arthritis and migraine . 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 .
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 . The participants were using medical cannabis for various reasons such as HIV, cramps, depression, pain, and migraines . Almost all of the participants smoked cannabis approximately two to three times a day . 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 . 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 . In the study trial, patients were intervened with 19% THC or THC+ 9% CBD . It was found that a dose of 200 mg effectively reduced the intensity of migraine pain by 55% . In another phase, 25 mg of amitriptyline or THC+CBD 200 mg per day was given prophylactically for three months in chronic migraine patients ; also, THC + CBD 200 mg was required for the acute attack . The study concluded that THC + CBD 200 mg had a 40.4% improvement over amitriptyline use (40.1%) . A similar study was done for the cluster headache, but it did not benefit as abortive treatment . 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 . Many medical professionals (59.8%) used cannabis as an alternative treatment for their patients, reducing the symptoms by 86% . 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 . 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 . The survey was limited due to self-reported results, placebo effects, recall bias, and how efficacy was reported . 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 . 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 . 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 .
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.
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.
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.
The authors have declared that no competing interests exist.
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Migraine and CBD Oil
Dr. Stephen Silberstein outlines what patients should know about CBD oil as treatment for migraine
Cannabidiol has taken the U.S. by storm recently. Commonly known as CBD, the active ingredient found in the cannabis, or marijuana, plant, is becoming increasingly available through online retailers, with claims of pain and inflammation reduction. And those living with migraine have taken notice.
In an effort to understand the benefits and risks of using CBD oil for migraine, we recently spoke with Dr. Stephen Silberstein, director of the Headache Center at Jefferson University Hospital in Philadelphia.
The Effects of CBD
Unlike THC, another widely known derivative of the cannabis plant, CBD oil does not have psychoactive properties or effects. “It works locally, and even if taken orally, it won’t produce intoxication,” says Dr. Silberstein.
There is no scientific evidence or research on CBD as an effective treatment for migraine—in large part because it has not been formally studied. However, it may still be a viable topical option for some patients with joint and muscle pain associated with migraine. “If you have a lot of neck pain or soreness, it is perfectly reasonable to use CBD oil. It may even prevent nausea and vomiting,” Dr. Silberstein says.
Despite the fact that CBD oil does not elicit the same response as marijuana, it is not legal in all 50 states. So one side-effect could be the legal ramifications of partaking in using CBD oil in a state where it is not permitted by law. To determine if it is legal in the state where you reside, visit Americans for Safe Access.
Lack of Regulation
For patients interested in CBD oil for the acute treatment of migraine, Dr. Silberstein says it is important to ensure that you are using a pure product. You are likely to receive a pure and safe product in states where CBD oil is legal and grown. Local dispensaries will also be of use in determining origin and quality.
Dr. Silberstein advises against obtaining a product in states in which CBD oil is not currently legal or regulated. Illegal forms of CBD oil could be spiked with artificial THC which could be very harmful to patients. Additionally, there are legal implications if you attempt to purchase it where it is currently illegal, so it is important to speak with your healthcare provider and check your local and state laws.
Consult a Physician
Before beginning any treatment, it is important that you consult your healthcare provider and be open and honest about your plans. Having a strong doctor-patient relationship is key to establishing trust and determining an effective treatment plan that takes into account your lifestyle. “These drugs do interact with the body,” Dr. Silberstein says. “If you’re getting funny symptoms and you’re taking something that the doctor doesn’t know about, how’s he going to help you?”
Dr. Silberstein also cautions against CBD oil or marijuana in use in adolescents, as it may affect the developing brain. “In general, it should be avoided by adolescents until more research has been conducted,” he adds.
For more information on treatments for migraine, visit our doctor-verified resource library. You can also use our find a doctor tool to find a headache specialist in your area.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.