Medical cannabis: modern treatments for migraines

When is Migraine Awareness Week in 2024?

Migraine Awareness Week takes place from 23-29 September 2024. It is an initiative led by The Migraine Trust to raise awareness of the condition and highlight its impact on the millions of people affected around the world.

What is migraine?

According to the Migraine Trust, migraine is the third most common disease in the world, affecting over a billion people globally and over 10 million in the UK.

Despite often being dismissed as ‘just a headache’, migraine is a complex neurological disorder, which can have a significant impact on an individual’s quality of life, impacting their mental health, relationships, education and ability to work.

According to the NHS, migraines usually last between two hours and three days, with some symptoms (such as feeling very tired) starting up to 2 days before the head pain starts and finishing after the headache stops.

What are the different types of migraine?

There are several subtypes, each characterised by distinct symptoms and triggers. 

The three main types of migraine are:

• Migraine without aura (common migraine)

Symptoms include throbbing or pulsating headache, usually on one side of the head, lasting four to 72 hours. It may be accompanied by nausea, vomiting, and sensitivity to light, sound, or smells.

• Migraine with aura (classic migraine)

Symptoms include visual disturbances (such as flashing lights or zigzag patterns), sensory changes (like tingling or numbness), or speech/language difficulties that precede the headache phase.

• Chronic migraine

Symptoms include headaches occurring on 15 or more days per month for more than three months, with at least eight of these headaches being migraines.

Other, less-common types of migraine include: Migraine with Brainstem Aura (Basilar-Type Migraine), Hemiplegic Migraine, Retinal (Ocular) Migraine, Vestibular Migraine, Menstrual Migraine, Abdominal Migraine, Status Migrainosus.

What causes the pain of a migraine?

The cause of migraine pain isn’t known, but you are more likely to experience them if you have a family history.

Some people find they have certain triggers such as: 

• starting their period
• anxiety and depression
• stress and tiredness
• not eating regularly or skipping meals
• too much caffeine
• not getting enough exercise

What is the best treatment for migraine?

Migraine treatment varies, with each type requiring different management strategies.

Common treatments include:

• painkillers such as ibuprofen and paracetamol
• medicines called triptans
• medicines that stop you feeling sick or being sick

Your GP may also recommend making changes to your lifestyle to help manage your migraines, such as eating at regular times and drinking less caffeine.

New migraine treatment 

If these treatments don’t work, you may be offered a new type of medicine by the NHS called a gepant, which works in a different way to other migraine medicines. 

Gepants are injectable calcitonin gene-related peptide (CGRP) antagonists which bind to that CGRP receptor on the trigeminal nerve and block it from being released.

Early indications suggest that gepants may be the first acute treatment not associated with medication overuse headaches, and may also be used as a preventive measure.  There are currently two types of Gepant medications available on the NHS. 

Migraine and medical cannabis

Many patients report migraine relief with medical cannabis, and it is increasingly being explored as a potential new treatment option.

Experts believe that cannabinoids such as CBD and THC may have benefits due to how they interact with the endocannabinoid system, which plays a role in pain regulation. Alongside this it could have a preventative effect through suppressing the abnormal wave of voltage depression in the brain’s cortical neurons, which precedes all migraine attacks.

As well as pain relief and a reduction in frequency, cannabis has (anti-nausea) properties, which can be particularly helpful for migraines accompanied by severe nausea and vomiting.

It can also help promote relaxation and improve sleep, which can be beneficial since sleep disturbances and stress are common migraine triggers.

Research on medical cannabis and migraine

While more research is needed on the potential role of medical cannabis in managing headaches and migraines, a literature review concluded that the data is “encouraging”, with “beneficial long-term and short-term effects”.

One study published in the Journal of Pain in 2019 found that inhaled cannabis could reduce migraine severity by almost 50%. Cannabis reduced migraine severity regardless of the type, dose, THC, or CBD content, however, reductions in headache severity were significantly greater with concentrates than with flowers.

A separate cross-sectional trial investigated the association between medical cannabis treatment and migraine frequency. Those who used cannabis reported lower current migraine disability, less negative headache impact, lower rates of opioid and migraine medication (triptans) consumption, and improved sleep compared to those who didn’t. 

Cannabis and migraine: it’s complicated

However, it’s also important to consider the possible risks and side-effects of medical cannabis for migraines. Like a lot of other treatments, some migraine sufferers report significant relief with medical cannabis, but some others may find little benefit or experience adverse effects. Medical cannabis is not a one-size fits all solution. 

For some individuals, cannabis use may lead to increased anxiety or paranoia, which may worsen migraine symptoms. One study also suggested that cannabis could lead to ‘rebound’ headaches in patients living with chronic migraine. 

‘Rebound’ headache, also known as medication overuse headache, occurs when pain medication is overused by patients who have an underlying primary headache disorder such as migraine. The research found that those using cannabis were six times more likely to have medication overuse headaches than those who did not use cannabis. 

Can you get medical cannabis for migraines in the UK?

In a word: yes. Medical cannabis is prescribed in the UK by specialist doctors for chronic pain related to migraine. Due to variability in response and potential side effects, it should be considered carefully and under the guidance of a clinician.

If you think you may benefit from treatment with medical cannabis you can use Releaf’s free eligibility checker to determine if it’s right for you. If appropriate you will be invited to schedule an appointment with a specialist consultant.

You can find out more about medical cannabis via the FAQs page or by contacting a member of the team. As always, never make any changes to your treatment plan without consulting a doctor first.