Can Cannabis Help with Migraines?

Migraines are a real pain – literally. The pounding headaches, sensitivity to light and sound, and nausea can throw anyone off balance. For those seeking relief, traditional treatments don’t always cut it, leading many to explore alternative options like medical cannabis, but what is the research and evidence for cannabinoids?

What does the evidence say?

1. In 2019, Cutler et al. reported 49.6% reduction in migraine severity following a retrospective analysis of 653 patients reporting their migraine symptoms and cannabis use. The authors noted that 88.1% patients reported some symptom improvement following a cannabis session, with males having slightly higher response than woman. They also noted effectiveness appeared to decline over time, and the dosing needed to increase, suggesting a tolerance development. They reported the products were Health Canada regulated products, but no details provided, other than mean THC% was 14.88% and CBD 2.4%. They reported concentrates had a slightly better self reported response versus dried flower. PMID: 31715263

2. In 2024, Shuster et al. completed a randomized, double-blind, placebo-controlled, crossover trial, adults with migraine treated up to 4 separate migraine attacks, 1 each with vaporized 1) 6% Δ9-tetrahydrocannabinol (THC-dominant); 2) 11% cannabidiol (CBD-dominant); 3) 6% THC+11% CBD; and 4) placebo cannabis flower in a randomized order. Washout period between treated attack was ≥1 week. 92 patients, and 247 migraine attacks were analysed. THC+CBD was superior to placebo 67.2% v 46.6% of achieving pain relief, pain freedom 34.5% versus 15.5%, and 60.3% vs. 34.5% at 2 hours for reduction of bothersome symptoms. THC dominant was superior to placebo for pain relief (68.9% vs. 46.6%) but not pain freedom or post 2 hours. CBD was shown to be not superior to placebo. Note the highest THC percent was 6% THC, and CBD was up to 11%. PMC: 10889030

3. In 2016, Rhyne et al. completed a retrospective chart review on 121 patients with primary diagnosis of migraine headache treated or on prophylaxis with medical cannabis. Migraine frequency decreased from 10.4 to 4.6 attacks per month, with 85.1% patients reporting a decrease. 12% had no improvement. 42.9% patients reported using a migraine drug therapy in addition to medical cannabis. All forms of cannabis administration were used, and 51.2% report using 2 or more forms of cannabis. PMID: 26749285

4. In 2018, Baron et al. did a study via electronic surveys on numerous medical cannabis patients with pain. They identified 445 patients with migraines that reported medical cannabis allowed them to substitute cannabis for other pharmaceutical agents (41.2 to 59.5%). Prescription substitutions in headache patients included opiates/opioids (43.4%), anti-depressant/anti-anxiety (39%), NSAIDs (21%), triptans (8.1%), anticonvulsants (7.7%), muscle relaxers (7%), ergots (0.4%). PMID: 29797104

5. In 2022, Okusanya et al. did a review of 12 studies, including 1980 patients. They reported medical cannabis significantly reduced nausea and vomiting associated with migraine attacks after 6 months of use, and the reported reductions in the number of days of migraine after 30 days, and the frequency of migraine headaches per month. Medical Cannabis was 51% more effective in reducing migraines than non-cannabis products. Compared to amitriptyline, medical cannabis aborted migraine headaches in some (11.6%) users and reduced migraine frequency. There was an association with the occurrence of medication overuse headaches (MOH), and the adverse events were mostly mild and occurred in 43.75% of patients who used oral cannabinoid preparations. PMID: 35711271

SUMMARY: Discussion and Considerations

There is some evidence, mostly retrospective and self reporting evidence, that cannabis may reduce migraine frequency, and potentially help with migraine related symptoms such as pain, nausea and vomiting.
There is no conclusion on which form of administration, cultivars or should be considered. There was limited data on oral administration.
One small randomized controlled trial did support that a vaporized combination of THC+CBD is superior. THC dominant was more effective for acute pain only, and CBD was no better than placebo for pain, but CBD may prolong the the therapeutic relief.
Medical cannabis appears to be a potential therapeutic consideration to add to current pharmacological therapies or reduce the frequency of their use.
There appears to be some potential risk of developing tolerance, or migraines with a decreased response or the need for higher dosing over time.
Dosing of cannabis used in the studies were lower THC percentages that is trending in current adult recreational products. It is unknown how the higher THC products may impact the results – negatively or positively.
Although dosing cannot be established, it appear that a combination of THC/CBD may be a good starting point. Patients with limited experience with cannabis, specifically THC, should be counselled on a “go low and slow” approach to minimized any unpleasant effects of THC.