What are Migraines/Headaches, and What are Their Types?
Headaches are referred to as pain that is felt in the head and, in certain types, is felt around the eyes. There are many kinds of headaches based on the location at which the pain is felt. They can be categorized into four types: sinus, cluster, tension, and migraine. Sinus headaches are felt behind the brow and cheekbones, while cluster headaches are felt around a single eye. On the other hand, tension headaches cause pain that is felt like a band squeezing the forehead.
Meanwhile, migraine headache is the most severe type of recurring headaches. It is often associated with at least one, or a combination, of other symptoms, including nausea, vomiting, or sensitivity to light or sound. Visual disturbances are typically seen in the classic forms of migraines. Typically, such headaches are localized to one side of the head, causing severe pain, which significantly affects the affected person’s activities of daily living. These migraine attacks usually resolve after 4 to 8 hours; however, they can, sometimes, be as long as three consecutive days.
In the United States and Europe, migraine is reported to affect around 18% of all women and 6% of all men. Worldwide, migraines are known to cause pain to almost a tenth of the global population, accounting for around 700 million people with migraines all over the globe. There are around 38 million people suffering from migraines in the United States, which is more than 12% of the total U.S. population, with approximately 1 in 4 households having migraines at some point in their lives. It is known as the second most leading cause of disability globally.
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What are the Causes of Migraine?
Unfortunately, the exact cause of migraine is still not clearly identified by researchers. It is even harder to predict when the next migraine attack will occur and how severe it will be. That being said, there are multiple theories as to what causes migraine. Recent research indicates that migraines can occur from stress, disturbances in hormone levels, allergies, or even exposure to chemical substances. Migraines can occur due to one of these causes or due to a combination of them.
Needless to say, if you have had at least one migraine attack, there are some common triggers that you can use to predict when the next attack will occur. These common triggers include:
- Stress or emotional disturbance.
- Hormonal changes
- Being on a severe diet.
- Having sleeping problems.
- Particular foods and habits, such as smoking, drinking alcohol, using oral contraceptive drugs, and certain foods like chocolate and aged cheese.
- Sudden changes in body temperature, odors, or colors.
How can we Treat Migraines?
The management of migraines involves two steps: treating the acute attack (treatment therapy) and preventing any further attacks (preventive therapy).
The prevention of migraines involves the use of anti-seizure medications, antidepressants, and anti-hypertensive drugs. Unfortunately, these medications have many side effects and are not well-tolerated. Therefore, they result in poor patient compliance and the reoccurrence of more migraine attacks.
Chronic migraines are treated by Onabotulinumtoxin A. On the other hand, the following options are used to treat acute migraine attacks or as preventive therapies:
- Calcitonin gene-related peptide inhibitors
- Neuromodulation devices.
Acute migraine attacks are often treated by the use of a wide variety of analgesics, including non-steroidal anti-inflammatory drugs and triptans. Even though triptans were designed primarily for the treatment of acute migraines, there are around 25% of people who fail to respond to them. Furthermore, the response to triptans in migraine patients is very variable. Some patients remain pain-free for 24 hours, and sometimes they remain pain-free for just 2 to 4 hours.
Because of all of these limitations in the current management of acute migraines, researchers have been devoted to investigating other options that would provide greater benefit with a safer profile. Cannabidiol (CBD) has shown great therapeutic potential in treating different kinds of pain in previous research, so it was investigated to see whether it is of benefit in migraines or not.
The Endocannabinoid System and Pain Modulation
The Endocannabinoid system consists of endocannabinoid compounds, which are normally present in our bodies, and cannabinoid receptors: cannabinoid receptors 1 (CB1) and cannabinoid receptors 2 (CB2). This system plays an important role in inflammation and pain modulation, as well as the regulation of many other physiological processes in many different organs and body systems.
It has been reported that cannabinoid compounds, such as CBD, are effective in treating chronic neuropathic pain since the endocannabinoid system modulates the pathway of pain in the central nervous system. Cannabidiol, or CBD, acts on CB1 and CB2 receptors to modulate pain perception.
CBD indirectly activates CB1 receptors leading to an increase in the level of endocannabinoids, which exert its action by reducing pain. CB1 receptors are typically located in the brain and the peripheral nerves. They are also found in anatomical pain pathways, such as substantia gelatinosa, spinal cord, peripheral nerves, and pain receptors. Both endogenous and exogenous cannabinoids, including CBD, are known to affect various pain pathways involving opioid receptors, serotonin receptors, and other nociceptive compounds.
Meanwhile, CB2 receptors are mainly found in the immune cells and peripheral tissues. It is stated that CBD tincture can modulate pain through the activation of these receptors in the periphery, which in turn causes pain relief through a complex pathway involving dopamine release.
The Role of Cannabinoids in Migraine and Headaches
Preclinical research has indicated that CBD can be quite effective in treating migraine attacks through the inhibition of various pain pathways.
There are many benefits to using CBD in migraines, including:
- Preventing serotonin release in patients where the cause is related to serotonin. Serotonin is known to cause pain.
- Inhibiting brain inflammation.
- Preventing the contraction of brain blood vessels, which causes headache.
- Alleviating the degree of pain.
What does Research Say?
There is moderate evidence recommending the use of cannabinoids (such as CBD) in treating different types of headaches, including medication overuse headache, cluster headache, and chronic migraines. Most of the current evidence is based on observational studies of human data and clinical trials. However, to date, there are no randomized, placebo-controlled clinical trials investigating the effectiveness of CBD in treating migraine.
There are two clinical trials recommending the use of CBD in migraines. The first prospective trial investigated 30 patients with medication overuse headache over 2 months. Patients were randomized to receive either ibuprofen 400 mg or nabilone 0.5 mg (synthetic tetrahydrocannabinol (THC)). Patients were given these medications for 2 months, followed by a week of no medication and then a second round of therapy (2 more months). The results indicate that nabilone, a synthetic cannabinoid, was superior to ibuprofen in reducing the degree of pain intensity. Patients who took nabilone also had a better quality of life, less degree of medication dependence, and a reduced amount of daily analgesic intake.
The second clinical trial investigated the effectiveness of oral CBD (9% CBD and 0.4% THC) as a prophylactic and acute treatment of chronic migraines and chronic cluster headaches in 48 patients. Patients were given either 19% THC or an increased dose of oral CBD (9% CBD and 0.4% THC). The oral dose started from 10 mg and was as high as 200 mg in acute attacks. It was observed that does of less than 100 mg had no effect at all. It was reported that the 200 mg CBD and THC reduced pain intensity by 43.5% in migraine patients.
A Take-Home Note
CBD is very effective in reducing pain in patients with chronic migraine. However, to further recommend it in general practice, randomized, placebo-controlled trials are still needed.
Make sure to consult your doctor before taking CBD for Migraines in order to adjust the dose for optimal response.
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