CBD, Hemp and Marijuana for Migraine: What You Need To Know

Defining Cannabis, Hemp and Marijuana

We’ve all heard the words cannabis, hemp and marijuana being used more than ever in the past few years. People often use these terms synonymously but it is important to know how they differ. To start, let’s go over some of the components that make up cannabis…

The cannabis plant contains numerous compounds such as cannabinoids, terpenes and flavonoids. Cannabinoids, such as THC, CBD, CBN and CBDA interact and bind to receptors within the body’s internal endocannabinoid system while terpenes are responsible for the distinct aroma of cannabis and flavonoids contribute to the color of the cannabis plant.

THC is a cannabinoid that is responsible for a psychoactive response (a “high” feeling), while CBD does not. It can improve appetite, mood and reduce pain.

CBD is a cannabinoid extracted from either hemp or marijuana and has medicinal properties including pain relief.

Two types of cannabis plants are hemp and marijuana. 

Hemp contains less than 0.3% THC and has higher concentrations of CBD.

Marijuana contains greater than 0.3% THC and has smaller concentrations of CBD.

What is the Endocannabinoid System? 

Every person has an internal endocannabinoid system that helps regulate pain, appetite, inflammation, sleep, mood and more. The endocannabinoid system works to decrease pain and alleviate neurodegenerative and inflammatory damage. 

The three main components of this system are endocannabinoids, receptors, and enzymes. Endocannabinoids are molecules that are produced by the body whereas cannabinoids are found within the cannabis plant. “Endocannabinoids and their receptors are found throughout the body: in the brain, organs, connective tissues, glands, and immune cells.”¹ The enzymes assist in breaking down cannabinoids and endocannabinoids.

How is the Endocannabinoid System Related to Migraine?

One theory that exists is that migraine may occur due to deficient levels of endocannabinoids.² A study analyzing cerebral spinal fluid of chronic migraine patients found a deficiency of one of the major endocannabinoids.³ This theory is also pertinent to irritable bowel syndrome and fibromyalgia which are both strongly linked to migraine. The connection between this system and migraine is not fully understood and needs further studies.

What are the Benefits of CBD?

CBD has potential to be used for its analgesic, anti-epileptic, anti-nausea, anti-inflammatory, anxiolytic, anti-psychotic, and anti-ischemic properties.⁴ CBD is an appealing option to those looking for pain relief with minimal or no psychoactive properties.

What are the Different Forms of CBD? 

1. Full spectrum CBD contains all of the components of the hemp plant. Products that are labeled full spectrum CBD have less than 0.3% THC in them along with other cannabinoids, terpenes, flavonoids,vitamins and minerals. All of the components of the cannabis plant working together are thought to have increased medicinal properties, also known as the entourage effect. Full spectrum products contain small amounts of THC and may cause impairment and produce a psychoactive effect. 
2. Broad spectrum CBD contains all of the components of the cannabis plant except for THC.
3. CBD isolate is solely CBD and does not include THC, other cannabinoids, terpenes or flavonoids. 

All of these forms of CBD are derived from the Hemp plant.

How to Consume CBD? 

Prior to initiating CBD as part of a treatment regimen, it is important to discuss its use with a health care provider to ensure it does not interfere with other medications. CBD can be administered as an edible, a topical application, sublingually (under the tongue), or as a transdermal patch. It may be more effective for those with migraine to use CBD sublingually or via inhalation due to a common comorbid condition known as gastroparesis which delays stomach emptying. 

A provider will be helpful in determining a starting dose and a plan to increase the dose as needed. A starting dose may be 10mg to 25mg and could be higher or lower depending on the person. It is important to note the amount of CBD may change depending on the route of administration. Some may prefer to use CBD in multiple small doses throughout the day, while others may prefer to use one large dose. For those that are unsure where to begin, seek advice from a medical professional. CBD is largely trial and error and it can take time to find the right dose, product and route of administration that works best for the person.

What Should I Look for When Purchasing CBD?

Some common tips when looking for CBD: 

1. Be sure it has a Certificate of Analysis (COA). This provides information about the potency of the cannabinoids. It also ensures testing was completed to check for molds, metals, pesticides etc. This may be online or linked to a QR code on the bottle. The COA should come from a 3rd party testing site to avoid biased results. 
2. Check to see if the information panel includes: Nutrition information, allergens, ingredient list, expiration date, manufacturer information, manufacturing date, government warning, batch or lot number.⁵ This may vary state to state so check your state’s requirements. 
3. The product contains information on how to consume, dosage amount (usually in milligrams), the total amount of cannabinoids in the bottle and a list of added ingredients. 
4. States full spectrum, broad spectrum, or a cannabinoid isolate (CBD, CBN, etc.)
5. Check to see if it was grown in the USA, products overseas may not have to go through the same testing requirements.
6. Avoid vaping products with propylene glycol as this was linked to EVALI (E-cigarette vaping associated lung injury) per the CDC.⁶

Why are oils added to CBD? 

Adding fats/oils substantially increases the absorption of cannabinoids. MCT oil, coconut oils, hemp seed oil, avocado oil, and sunflower oil are commonly used for this reason.

Should I take CBD as a Preventive or Abortive Therapy? 

A preventive medication is taken to reduce the frequency of attacks before they occur while an abortive therapy is used to stop or decrease the severity of an attack when it occurs. Some people may prefer to take smaller doses of CBD daily and larger doses during the onset of an attack.

Another study reviewing 38 clinical trials of cannabis used for pain management found that 71% of subjects had pain relieving effects from cannabinoids while 29% did not.⁴

Can CBD help my nausea during a migraine attack? 

Studies in animals found cannabinoids such as CBD may produce an anti-nausea effect but it has not been studied for migraine related nausea.⁷ Opting for a full spectrum CBD product may be more beneficial than a CBD isolate because it also contains small amounts of THC and CBDA which are other promising cannabinoids for nausea relief.

Will CBD interfere with other medications? 

CBD must be used in caution with drugs that induce the liver enzymes CYP3A4 or 2C19 such as anticoagulants, antiepileptics, antiarrhythmics and thyroid medications.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997295/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928495/
3. https://www.nature.com/articles/1301246
4. https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.12570
5. https://www.gaiaca.com/california-cannabis-labeling-requirements/
6. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
7. https://pubmed.ncbi.nlm.nih.gov/21175589/

*The contents of this blog are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The writer does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.

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