Are Migraines Due to a Dysfunction of Cannabinoid Neurons?

Article by Gary L. Wenk, Psychology Today

Are migraines due to a dysfunction of cannabinoid neurons? Recent research has found a link between migraine pain and the endocannabinoids Gary L. Wenk Ph.D.

Migraines are the second leading cause of disability in individuals under the age of 50 in the world. If you suffer with these headaches, you are not alone. The consequences are considerable: chronic and episodic migraines negatively impacting physical health, quality of life, inter-personal relationships, productivity, and financial security. The currently available medications for acute migraine pain are rarely effective for most migraineurs.  Even the triptans, which were developed specifically for the treatment of acute migraine headache, have limited effectiveness. In addition, triptans must be taken as soon as possible after the first appearance of a symptom. If you miss the window of effectiveness, then you suffer with the consequences. Furthermore, many available medications, especially aspirin or ibuprofen, produce unfavorable side-effects or induce rebound migraines.

The epidemiological evidence for cannabis’ effectiveness is highly variable. One small survey study reported that 36 % of recreational cannabis users treat their migraines with cannabis. Another study found that 85 % of individuals using medically prescribed cannabis, as opposed to recreational use only, reported a decrease in migraine frequency. The higher percentage may be due to the fact that these subjects sought out a medical recommendation. These older studies were small and limited by the participants limited access to cannabis products.

A recent study (Gibson et al., 2021) sampled 589 adult cannabis users living in states with full legal access.  The migraineurs in these states reported significantly more migraine relief from cannabis compared to non-cannabis products, even after controlling for migraine severity.

What might explain the effectiveness of cannabis?

Studies suggests that the brain’s endogenous cannabis system modulates migraine-associated pain pathways. The newest class of anti-migraine drugs, those that act as CGRP synaptic inhibitors, involve manipulation of endocannabinoid pathways in the brainstem. An endocannabinoid deficiency is may contribute to the pathophysiology of migraine according to one recent publication. Experimental and clinical studies have discovered links between dysregulation of endocannabinoid signaling and migraine headache. Apparently, the level of anandamide, one of the primary endocannabinoid neurotransmitters in the brain, is significantly reduced in the brain and body of patients with chronic migraine. The reduced levels of this endocannabinoid may facilitate the experience of the body aches and pains that are often associated with migraines.

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