Migraines and headaches

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Cannabis medicines have been used primarily orally to treat migraines and other forms of headaches for over 1500 years. Dr. Ethen Russo hypothesizes that some forms of migraines are due to an imbalance in the endocannabinoid system. Because the symptoms of other serious ailments manifest as migraines, patients should always consult a physician for proper diagnosis and treatment of severe headaches.

Migraine is a class of severe headaches with two primary variants: common migraine occurring with nausea, vomiting, and sensitivity to sensory stimuli, and classical migraine, which is preceded by an aura of warning symptoms—for example, visual disturbances. Less common migraines include ocular, abdominal, and chronic migraines. Cluster and thunderclap headaches, while severe in intensity, are not considered migraines. Common tension headaches affect up to 80 percent of the population. The causes of tension headaches can include lack of sleep, poor posture, and emotional stress. 

Cannabis is effective as prophylaxis for reducing the frequency of migraines in many patients. It is also successful in treating the symptoms of many common tension headaches. 

Molecules to target migraines and headaches

Once again, any THC-rich strain is indicated. For vaping, stimulating sativa chemotypes are more appropriate at the migraine’s early-onset or aura phase. After migraine onset, heavier indica strains seem effective for their combination of sedative and analgesic effects. It is best to avoid CBD-dominant chemovars because CBD tends to produce or even exacerbate headaches.

Dosing for migraines and headaches

There are two approaches to cannabis dosage for migraines: prophylactic and symptomatic. Prophylaxis is intended to reduce the frequency and intensity of the headaches. The symptomatic approach relieves the pain and nausea associated with migraine after its onset. Prophylaxis is intended to supplement the body’s endogenous cannabinoids with their equivalent from the cannabis plant. Patients take a small daily dose of cannabis, usually below 2.5 milligrams of THC or its equivalent, which produces little or no psychoactive effect. This prophylactic dose is most effective when taken upon rising or in the mid-afternoon, depending on whether the patient has noticed a pattern for the occurrence of the headaches.

Symptomatic relief is most effective when taken early in the migraines progression. 

Sublingual administration or vaporization of up to 10 milligrams is helpful if the patient is already vomiting. With a migraine that has progressed in severity, doses of up to 25 milligrams of THC can be effective for helping to sedate a patient and reducing extreme nausea. The addition of CBD to the THC dose can reduce the intensity of the THC dose and reduce the intensity of the THC psycho-activity. Remember that cannabis dose has a “sweet spot” for pain relief, so caution must be used to avoid overmedication. Dosage for tension headache should also follow the “sweet spot” approach. For tension headaches, 2.5 to 5 milligrams is typical. Interestingly, CBD, when dosed alone, can result in a mild headache. 

Methods of ingestion

Patients report that small doses of oral cannabis are quite effective in reducing migraine occurrence. These oral doses can be administered sublingually for faster onset or swallowed for a slower release of THC.  Avoid overmedicating. If using an edible from a dispensary, choose one that provides less than 5 milligrams of THC and start by eating half.

Vaporized cannabis is effective for migraine treatment, especially early in the course of the headache.

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