By: Elements of Green
With CBD increasing in popularity for pain, migraine sufferers are right to wonder whether CBD might be an effective treatment for them. Here we identify what a migraine is and how it is different from other headaches, introduce CBD and how it works to relieve pain generally, and examine whether CBD might be an appropriate migraine treatment.
What is a migraine?
A migraine is a headache unlike any other. Migraine sufferers get headaches which are so severe that they disturb your senses – patients often have vision problems and increased sensitivity to light, sound, and smells. Nausea is often a symptom of a migraine. A typical migraine headache lasts at least four hours and up to three days or even more.
The International Classification of Headache Disorders identifies several types of migraines. A few of the most common types are:
- Migraine without aura: A migraine without aura is a headache lasting from 4 to 72 hours which occurs at least five times and which often involves a “pulsating” sensation and moderate to severe pain. In order to be classified as a migraine, the headache must be accompanies by nausea or vomiting or by sensitivity to sound or light.
- Migraine with aura. A migraine with aura is a migraine which also involves an “aura,” which is a visual or other sensory difficulty.
- Hemiplegic migraine: A migraine with aura which also includes motor weakness.
- Retinal migraine: A migraine which visual disturbance is severe, up to and including temporary blindness.
No one knows what causes migraines, but most people who have them seem to be genetically predisposed to have them. There are often triggers which start a migraine among those who are susceptible to them and those triggers vary from one person to another. Lack of sleep, alcohol, certain foods, hormone cycles in women, and stress are among common triggers.
Migraine Treatment Options
Treatments for migraines have advanced considerably over the past several years, but there is no single treatment which works for everyone. Once a migraine begins, patients can take any of a number of over the counter analgesics and NSAID pain relievers such as aspirin, ibuprofen, naproxen, and others. Some migraine sufferers also benefit from an anti-nausea medication. There is also a class of pharmaceutical known as triptans which are specifically targeted at migraine headaches.
Some migraine patients also benefit from drugs designed to prevent a migraine in the first place. These prophylactic medications have fallen out of favor recently because of side effects and because the acute treatments have improved. Other treatments which some people have associated with fewer migraines include supplements like magnesium and even acupuncture.
Whether taking drugs to fight the pain once a migraine has started or taking drugs to reduce the frequency of migraines, patients and their doctors must work together to establish a proper dosage. A single aspirin tablet rarely is sufficient to relive a migraine headache, but taking large amounts of drugs can bring its own problems.
Migraines are a chronic condition for most patients, so the long-term use of pain relieving medications creates an additional risk for them. There is a syndrome called Medication Overuse Headache, where the very drugs people are taking to relieve migraines can cause other headaches. The drugs which can induce Medication Overuse Headaches include not just specialized migraine drugs like triptans but also common over the counter pain drugs like Tylenol and Excedrin.
CBD is the popular term for cannabidiol, one of dozens of cannabinoids in the hemp plant. CBD works by reacting with with the human endocannabinoid system. Unlike the more well-known cannabinoid THC, CBD does not make the user high.
CBD works by binding to the CB1 or CB2 receptors in our cells. These are the receptors which make up the endocannbinoid system as it is now understood. CB2 receptors are mostly in the human immune system and CBD can help reduce harmful inflammation. More directly for purposes of migraine treatment, the CB1 receptors are mostly in the nervous system, especially in the brain. CBD can work by changing how the brain perceives pain.
There is another effect which CBD may have. In addition to interacting with the endocannabinoid system, CBD interacts with two other receptors. One, called the TRPV1 receptor, is associated with pain perception. It is most commonly activated by capsaicin, the part of the chili plant which can make them hot. CBD can reduce pain by binding to the TRPV1 receptor instead of creating pain the way a jalapeno pepper will. The other receptor is called 5-HT1a and it is usually associated with serotonin. Little is known now about how CBD affects this receptor.
Because CBD binds to different receptors in the body and in different ways, CBD can have several positive effects on the people who use it. Most commonly, people take CBD to reduce stress and anxiety. They also use CBD to reduce arthritis pain, regulate their sleep cycles and gain energy, for athletic recovery, and for skin conditions involving excess inflammation.
CBD and Migraines
Medical Cannabis Seems to Help Many Migraine Sufferers
Before getting into CBD specifically for migraines, it is useful to talk about one option more and more people are using. Medical cannabis, which contains the psychoactive ingredient THC, is increasingly popular for migraine treatment. By law, Elements of Green does not make medical cannabis available our site, but we want migraine sufferers to know about treatment options they might not have thought about.
There is clinical evidence for the use of medical cannabis as a migraine treatment and massive historical and anectodal evidence to confirm the science.
For example, a 2016 retrospective study of cannabis use among migraine sufferers in Colorado found that the frequency of migraine decreased from an average of 10.4 to 4.6 incidents per month among cannabis users. A 2019 study of over 7,000 incidences of migraine sufferers using medical cannabis found that more than 85 percent of the medical cannabis users achieved a positive effect, with pain ratings dropping by nearly half. And a 2020 study concluded that 94 percent of migraine sufferers benefitted from cannabis use<//a>.
Most recently, a popular migraine app called Migraine Buddy polled its users about cannabis use. Of nearly 10,000 people who responded to the survey, 30 percent had used medical cannabis to treat their migraines and 82 percent of those people found cannabis useful to reduce pain levels.
In addition to these studies and surveys, we know that medical cannabis was a popular treatment for headaches in the late 19th and early 20th centuries, before a wave of prohibition put cannabis out of reach for most patients. A recent survey article about cannabis use for headaches lays it all out.
What about CBD Alone?
As mentioned, medical cannabis contains the psychoactive cannabinoid THC. THC is well known as a powerful pain fighter. What about CBD which has no THC or only trace amounts of it?
There are no studies specifically about migraines and cannabidiol. Indeed, there appear to be no studies about CBD and headaches generally. However, some leading experts believe there may be a role for CBD in migraine treatment among some patients.
Specifically, a review of scientific literature in 2017 noted that “CBD has shown efficacy for headache-related conditions (i.e., anxiety)” and has demonstrated an analgesic (pain relieving) role. Many CBD users have also reported relief from pain when they begin using CBD.
CBD could alleviate pain because of how it works with the body. As mentioned above, CBD interacts with three key receptors in the body. The CB1 receptor regulates inflammation, while the CB2 receptor and the TRPV-1 receptors change how the body perceives pain.
The pain of a migraine is so severe that it is unlikely that CBD can relieve the pain on its own and entirely displace other pain fighters like analgesics. However, it may be able to play a complementary role along with other treatments. Dr. Stephen Silberstein, MD, the Director of the Headache Center at Jefferson University in Philadelphia, spoke about migraines and CBD with the American Migraine Foundation. Dr. Silberstein suggested that CBD can have a role in migraine treatment. The benefit, in his opinion, is less likely to be on the headache itself, but on some of the other symptoms of migraines. He singled out joint pain, neck pain or soreness, and nausea relief as areas where CBD might be beneficial.
An area which Dr. Silberstein did not mention in the interview but which may be helpful to some migraine sufferers is sleep regulation and energy. Migraines can interfere with sleep and they can be exhausting physically. Since many CBD users report that it helps them with both sleep and energy, this may be an additional benefit to using CBD.
Dr. Silberstein also emphasized two things which are important to us at Elements of Green. First, he recommended that migraine sufferers see a doctor before beginning to use CBD. Your doctor should know about everything you are taking for any condition. CBD’s interactions with drugs are not well understood.
Next, Dr. Silberstein emphasized the need to purchase high-quality CBD. His comments were meant for an American audience before CBD was legal in all states, but his general advice applies to CBD consumers in the UK and EU, too. If you decide to start using CBD for migraines or for any other reason, it is important to know what you are buying. At Elements of Green, we require all of the products we make available to you to be lab tested to ensure that you are getting the amount of CBD that is on the label and that there are no contaminants in the products you use.
If you and your doctor agree that CBD is worth trying as part of the fight against migraines, the next steps are to follow the rest of Dr. Silberstein’s advice (and ours at Elements of Green) and ensure that your CBD has the potency and purity you desire.
Unfortunately, there are many companies selling CBD products which have less CBD than they claim or even have no CBD at all. Other companies do not do sufficient testing to ensure that you do not get impurities with the CBD you use.
Elements of Green carefully selects each of the companies which sell through us and we insist that every product undergo lab testing. This testing not only allows you to be confident that you are getting the amount of CBD you are seeking, it also ensures that you do not get heavy metals, insecticides, or other impurities with your product. If you come across a product which is not lab tested or which does not make the results available to you, skip that product. Simple as that.
Next you have to decide how to consume the CBD. If you are taking CBD to alleviate joint pain associated with migraines, a lotion or other topical application might be right for you. For just about all other uses of CBD in the fight against migraines, an oil, edible, or vape product may be most desirable. CBD oil is the most common way for people to use CBD. When taking an oil, the liquid is taken orally, but instead of swallowing it the user holds the liquid under the tongue and allows it to be absorbed directly by the membranes in the mouth. Other people choose an edible product such as a pill, capsule, or gummy. In that case the CBD is swallowed and is digested. Some CBD users choose a vaping product. Vaping has the most immediate effect, which may be a consideration for many migraine sufferers.
Finally, you must decide how much CBD to take. Migraines are severe, so it may seem like taking as much CBD as possible is the right way to go. Oftentimes that instinct is not correct. Particularly if you are taking any medications, you should discuss the amount of CBD to take with your doctor at the same time you are deciding whether to try CBD at all.