Headaches are a major health concern, with 150 different types, many painful and debilitating, According to a study published by the American Journal of Managed Care, in 2016 migraines alone the direct and indirect costs of migraines in the United States was upward of $36 billion annually. While many can find relief through simple painkillers, repeated attacks are often inadequately treated by existing methods.
“Despite many treatment options, less than half of headache sufferers experience remission, and many continue to develop more severe or chronic headaches throughout their lifetime,” according to Igor Grant, MD and colleagues. Therefore, many believe that there is a need to explore additional treatment options—such as cannabis.
The use of cannabis as a treatment for headaches can be found as far back as the second millennium BCE in Assyrian manuscripts, in Ayurvedic documents for migraines, and ancient Greece. Ancient medicines used the whole cannabis plant as a tincture, utilizing benefits from its hundreds of cannabinoids like THC and CBD.
Unfortunately, the banning of cannabis has resulted in a huge lack of clinical data for cannabis as a treatment for headaches, aside from case studies and questionnaires. With the strains available today, the effectiveness of cannabis on headaches is unclear. One study analyzed questionnaires from 139 patients suffering from cluster headaches. The preliminary findings discovered that 22 percent of patients with cluster headaches said that cannabis made their headaches “worse or [was] unuseful,” with 27 percent believing it could even provoke an attack. So which is it? Does cannabis help or exacerbate headaches?
Migraine is a headache that is usually unilateral, pulsating and associated with photophobia and phonophobia. There’s encouraging evidence that cannabis could be an effective treatment for certain migraine sufferers, especially from early historical reports from the 19th and 20th centuries. More recently, a retrospective study found that 85.1 percent of patients reported reduction in migraine frequency after being treated with cannabis for four years. Additionally, 11.6 percent of patients found that smoking could arrest the generation of a migraine. Many case reports are also in favor of cannabis. For example, one patient experienced 18 years of failed treatment with standard pharmaceuticals but found relief with smoking cannabis.
The effectiveness of cannabis on cluster headaches is much less clear. Cluster headache is defined as severe unilateral pain in orbital, temporal and/or supraorbital locations, and typically occurring frequently and at regular intervals. “The effect of cannabis on cluster headache attacks is not clear, as 75 percent of patients find it poorly efficient, but 25 percent still claim efficacy,” stated Elizabeth Leroux, MD, of the Emergency Headache Center in Paris. Furthermore, 27 percent believed that cannabis could cause an attack, and four patients claimed cannabis could do both; either provoke or abort a cluster headache. Its inefficiency is likely due to cannabis’ ability to increase heart rate and vasodilation, which are both triggers for cluster headaches.
Tension headache is defined as frequent, infrequent, or chronic, typically bilateral pressure lasting minutes or days. Tension headaches can originate in the central nervous system, very often related to stress, but can also be triggered by myofascial tissue. The analgesic properties of cannabis may decrease muscle tightness known to induce tension headaches. Additionally, there’s evidence that when THC reacts with anandamide in the body, it produces a whole-body calming effect which may reduce the triggers for tension headaches.
It’s postulated that the endocannabinoid system may have a role in headache pathogenesis. One theory is that a deficiency in the endocannabinoid tone could be a cause in headache disorders. Cannabis has the potential to disrupt certain stages in the generation of headaches, mitigate pain, produce relaxing effects, however, much still remains unknown.