Not enough research on CBD as a treatment for migraines?
In an October 2018 interview, Dr. Silberstein stated that there is still no reliable scientific evidence or research on CBD as an effective treatment for migraines. However, according to Dr. Silberstein this does not mean that it cannot be effective. For patients interested in CBD oil for the acute treatment of migraines, according to Dr. Silberstein, should use a pure product and if possible a doctor should be consulted.
Stephen Silberstein, MD, FACP, FAHS
Director of the Headache Center at Jefferson University Hospital in Philadelphia
Migraines as a widespread disease
What is a migraine?
A migraine is known in every day life as a recurring throbbing headache. It typically affects one side of the head and is often accompanied by nausea and vision problems.
5 common symptons of migraines:
1. Sensitivity to light or noise
2. Sensitivity to smell or touch
3. Nausea and/or vomiting
4. Drowsiness
5. Blurred vision
Migraines are the third most common disease in the world (behind tooth decay and tension-type headaches) with an estimated global prevalence of 14.7% (that’s around 1 in 7 people).
Research suggests that 3,000 migraine attacks occur every day for evey one million people in the general population. This equates to over 190,000 migraine attacks every day in the UK.
What triggers migraines?
10 possible triggers of migraines:
1. Beverages.
This includes alcohol, especially wine, and too much caffeine.
2. Stress.
Any kind of stress can cause migraines, but stress at home and work are listed as the most common.
3. Sensory stimuli.
Bright light and sunlight can trigger migraines, as can loud noises. Strong smells - including perfume, paint thinner, secondhand smoke and others - trigger migraines in some people.
4. Sleep changes.
Lack of sleep, too much sleep or jet lag can trigger migraines in some people.
5. Physical factors.
Intense physical exertion, including sexual activity, can cause migraines.
6. Weather change.
A change in weather or air pressure can trigger a migraine.
7. Medication.
Oral contraceptives and vasodilators like nitroglycerin can make migraines worse.
8. Food.
Certain types of cheese as well as salty and processed foods can trigger migraines. Skipping meals or fasting can also induce migraines.
9. Food additives.
These include the sweetener aspartame and the preservative monosodium glutamate (MSG), which are found in many foods.
10. Hormonal changes in women.
Fluctuations in oestrogen, such as before or during menstruation, pregnancy and menopause, seem to trigger headaches in many women. Hormonal medications such as oral contraceptives and hormone replacement therapies can also make migraines worse. However, some women find that their migraines occur less frequently when they take these medications.
As you can see, the list of potential causes is extensive and often can seem quite innocuous, especially to people who have never suffered a migraine.
What do people affected by migraine attacks do?
Common treatments include medication (such as Ibuprofen), dietary restrictions, retreating to a dark room and relaxation techniques.
The usual medicines for migraines are pharmaceutical pain relievers, anti-emetics (for nausea) or triptans (which cause the brain to reverse migraines).
There are now also positive experiences from migraine sufferers who've tried CBD. However, this has not yet been scientifically proven, but it's worth noting that it has not been refuted either. We'd refer you back to Dr. Silberstein and the Headache Society in the US:
"There is very little evidence that any of the components of marijuana are effective for the treatment of migraine and headache disorders. That does not mean they do not work, however. What it means is that they have not been studied."
Why could CBD work on migraines?
There are a number of studies which lead us to believe CBD could be effective in the treatment of migraines.
In a 2016 study by the University of Colorado, 121 migraine patients were given medical marijuana daily.
It was investigated whether migraine attacks can be prevented in this way. The results were outstanding: around 40% of the test subjects stated that the number of migraine headaches had halved.
However, one of the most promising treatment methods, according to some studies, is CBD.
Another study involved 48 sufferers of chronic migraines. The participants were given 10mg of one of two combinations of THC and CBD. One with a higher dose of (THC), and one with CBD, but practically zero THC. They found that doses of less than 100mg had little effect. But when a dose of 200mg was reached, acute pain dropped by a massive 55%.
The study also included a second phase. Everyday 79 migraine sufferers were given a dose of either 25mg of amitriptyline or 200mg of the THC-CBD combination for a period of three months. In addition ot this 48 cluster headache patients also participated in the study.
The results showed, after 3 months, that the THC-CBD combination worked slightly better than the amitriptyline. There was just over a 40% reduction in attacks, but the strength and frequency of cluster headache attacks only slightly reduced.
The study states that the difference was only marginal. But what is very positive here, is that CBD offers fewer side effects than amitriptyline, which is a strong drug often used to treat depression.
CBD offers a natural alternative to prescription medication which not only results in fewer side effects, but is also non-addictive.
Quick recap - what is CBD again?!
CBD, as a quick reminder, is the shorthand term for cannabidiol, which is one of the active ingredients in cannabis. More specifically, the cannabis sativa plant.
Unfortunately, many still associate the use of CBD with the use of cannabis, the illegal recreational drug. But this most certainly is not the case. CBD is not psychoactive and does not get you 'high'. It is the high THC content that causes these effects. Often low amounts of THC can be found in CBD products. Whilst this can most certainly be beneficial, there are often legalities to consider.
CBD - like THC - comes from the cannabis plant, is known as a powerful natural pain reliever, as well as having numerous other benefits. For example, it's anti-inflammatory, and also it's antidepressant-like effects.
But CBD and THC are not the only cannabinoids found in the cannabis plant.
In fact, the hemp plant contains over 100 cannabinoids!
CBD products often contain some of these other cannabinoids, as well as flavonoids and terpenes.
This is because the cannabinoids work together and enhance the effect of the products.
This is known as the entourage effect.
CBD products which have this mix of cannabinoids are referred to as full-spectrum products. Be aware that these can contain THC. Products that contain only trace amounts of THC are called broadspectrum. CBD products that contain zero THC are known as CBD isolate. These are the three types of CBD products you can buy.
How does CBD work in the body for migraines?
Migraines typically begin in the hypothalamus, which is found in the brain.
A common trigger of migraines is stress.
Despite the cause, the majority of people suffering from migraines have the neurotransmitter serotonin in rather unbalanced amounts.
Low serotonin levels can cause blood vessels to widen, increasing the number of migraine attacks.
Cannabis has been proven to increase serotonin levels by preventing blood vessels from dilating. An increased serotonin level reduces the occurrence of migraine attacks.
In addition, another study claims that CBD generally acts as a pain reliever for chronic pain. A study conducted in 2016 concluded that fewer migraine attacks actually occur.
An explanation of how CBD actually works and combats the pain caused by migraines, is given by Dr. Ethan Russo in his theory of clinical endocannabinoid deficiency.
This theory suggests that certain diseases are the cause of certain deficiencies in the endocannabinoid system.
This is a biological system that works in response to the types of cannabinoids known as endocannabinoids that are naturally found in the body' but can also be affected by external cannabinoids such as those found in cannabis and hemp.
The lack of these biological endocannabinoids (i.e. the ones that should be in the body already) in the body can cause chronic pain, including migraines.
According to the Dr. Russo, specialist in neurology, CBD regulates and releases the cannabinoid receptors of the endocannabinoid system - which are found in the central nervous system - and relieves the pain.
Mitigation of the side effects
As we’ve already discussed, migraines have many unpleasant side effects.
Fortunately, CBD can be used quite broadly, which is why it could also be used for symptoms such as nausea or sleep disorders.
What's more, it's now being researched whether CBD can help alleviate any of the suffering of people with cancer. In various studies, for example, it has already been used in addition to chemotherapy.
The nausea typical of this form of therapy did not occur in some of the patients as a result of taking CBD or CBDA (a precursor to cannabidiol, which is explained on our page about key cannabinoids).
The side effects of CBD itself, as explored earlier in this piece, are actually quite rare and mild.
Clinical trials are desperately needed in the world of CBD, given the number of unknowns we still have.
For example, some research suggests that CBD causes a fluctuation in blood pressure, while other studies claim to lower it.
Similarly, some research suggests CBD causes nausea, while other studies confidently claim CBD can be used - as described above - to reduce nausea during chemotherapy treatment.
Are there benefits of treating migraines with CBD?
Cannabis has been used as a pain reliever for thousands of years, as claimed by the National Cannabis Institute.
One of the fastest ways to feel the effects of CBD is by vaping.
This could be an effective way to consume CBD, especially if you suffer from very severe migraines, as inhaling CBD reaches the bloodstream and therefore has a much faster effect than eating or drinking CBD.
If you are using CBD for the first time, one option is to try to take it orally by putting drops under your tongue using a CBD oil tincture. CBD oil is one of the most common CBD products.
Many people believe that CBD will make you "high", but this is not true. It's actually another element, known as THC (Tetrahydrocannabinol) also from the hemp plant, which is responsible for the state of intoxication.
This was also demonstrated in a study with 127 participants who suffered from chronic headaches such as migraines or cluster diseases.
Participants received a combination of THC-CBD daily for a month. CBD is known to counteract THC and also help relieve pain.
Other options for taking CBD.
Also available are topical creams, bath bombs and chocolate. If your migraine is stress-induced, these may be stress-relieving options for you. Other options include gummies, e-liquids, skincare products, paste, tea, hot chocolate, and many more.
A note of exercise caution, however, when venturing into the world of CBD products. Given the fact over the counter CBD products are not FDA approved, it is wise to check the label thoroughly.
It can be quite difficult to know which is the best CBD to buy. Some companies can be misleading, and some products may not contain CBD at all! We generally advise to choose products from a company that openly shares it's third party lab reports.
Dosage and intake of CBD for migraines
Everyone is unique and the response to CBD is different for everyone. The recommended dosing for each product can vary widely, leading to confusion.
There are many ways to take CBD and dosage can vary depending on the percentage concentration of CBD in the product used.
On average, 25 mg of CBD per day is effective for most people.
You can slowly increase the dose of CBD until the symptoms improve. Of course, this is different for each individual and should be monitored.
If you choose to take CBD oil orally, just put a few drops under your tongue and keep the oil there until it is completely absorbed.
Do not swallow the oil immediately, but wait until it has absorbed under the tongue. Alternatively, you can also take CBD by capsules or mix it with a drink or yogurt.
Another method of taking CBD oil is by vaping using vape pens or other inhalers. This method is one of the fastest and works immediately. This form of intake is is suggested if you suffer from severe migraines. This could alleviate the pain more quickly.
However, you should avoid vaping CBD if you have asthma or another lung disease. CBD newbies might want to try another CBD product first.
