Migraines

#011: The Role of Cannabinoids in the Management of Migraines

Many people assume that a headache is a migraine. But they are experienced in different parts of the body and often have different triggers. I talk about the conventional treatments for migraine headaches, some common triggers for migraines, and explore a few ways that cannabinoids could help migraine sufferers. It’s unclear what causes migraines. It could be a number of factors, like genetics, environmental factors, or a genetic imbalance. Even not getting enough sleep could cause migraines. Identifying and removing the triggers for headaches and migraines are the best way to begin addressing this problem. Like I always say, you should start slow and go slow when looking for a solution to a medical problem. Besides triggers like oral contraceptives or stress, there are some food triggers for migraines like:

  • Aged cheeses
  • Monosodium glutamate
  • Preservatives
  • Chemical dyes

Of course, if you have constant or chronic headaches, and removing environmental triggers don’t help you, it’s time to turn to pharmacological means. I suggest the over-the-counter medicines you should start with, then I cover the stronger prescriptions, and finish by talking about botox and opiates. There are also preventative medicines, so I talk about some of the most common ones and their side effects. As always, every drug has side effects, so it’s important to weigh them against their potential benefit. Studies have shown that cannabinoids can reduce migraine pain by up to 43 percent, and the side effects are less than conventional medicines. However, some of our information about this comes from word of mouth. We definitely need more studies to show the efficacy of cannabinoids for migraine sufferers, but there are promising signs that it could really help those with chronic migraine headaches. Stay safe out there. We’re all in this COVID-19 thing together, so wash your hands, and call your neighbors up to check on them. Spread love, not hate.

What’s Inside:​

  • Women are three times more likely than men to experience migraines.
  • I talk about the two different kinds of headaches and describe how they’re experienced.
  • Triggers for migraines vary from food, diet, stress, and even medication.
  • When choosing preventative treatment for migraines, we need to consider the side effects, which can vary based on the patient’s medical history.
  • Why migraine sufferers sometimes prefer the inhalation route of administration.

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Transcription:

TRANSCRIPT

This show is for educational purposes and should not be taken for a doctor’s advice. Welcome to Let’s Talk About Medical Cannabis with Doctor O. A clinical pharmacist certified in medical cannabis. Every week, you’ll learn about alternative ways to improve your health and well-being, using the powers of healing botanicals.

Hi, welcome to another episode of Let’s Talk About Medical Cannabis with Dr. O. I’m sure all of you know me by now. For those that do not. that are just joining us for the first time, I’m Lola Ohonba, a clinical pharmacist certified in medical cannabis. People also call me Dr. O. So, if you want to call me Dr. O., that’s also fine. On today’s show, we’ll be looking into cannabis and migraine. The role of cannabis and the management of migraine. Before I go on to this topic, let me say my heart goes out to the people that have lost loved ones in death COVID-19 pandemic that we are going through all over the world right now. People that have family members in the hospital. My heart goes out to you. We are praying for you. So hang in there. We will overcome this monstrous disease. We just have to keep together as well. Family. So hang in there. And I also like to tell those spreading hates out there, people pick in on that tribe, other group blaming them, making them responsible for this pandemic. Nobody’s responsible for the pandemic. So stop the hate. Stop picking on other people. This is not a political show. But, I just mean, we have to show love to one another. We are all in this together. So stop spreading the hate. And finally, I would love to say thank you to all health care professionals, all the health care profession. High or low? I would like to say thank you for your service all over the world. I want to say thank you to everybody, out there. Truck drivers, grocery store, all you people out there walking hard. Trying to put your life in danger to be able to satisfy clients, patients, at the expense of yourself. Thank you all so much for what you do. We appreciate you. I want to say that you are out there walking hard, doing whatever it takes for us to overcome this pandemic. You are the real MVP. You are the real MVP. Thank you guys so much.

This episode is the eleventh of Let’s Talk About Medical Cannabis with Dr. O. On today’s episode, we’ll be looking in to difference between headaches and migraines. Well, we’re looking to triggers that causes migraine headaches. We look into other things that we might be doing that might be aggravating the symptoms. Then we’ll look into the non-pharmacological way, other chance we can do to prevent migraines or to reduce the effects of it. And we will also look into the pharmacological route. What are being used as a medication tool for the management of this disease? And also, we were looking to the role of cannabis, cannabinoids in the management of migraines. Thank you once again for joining me. Let’s start today’s show. Headaches are among the most common health condition. I’m sure everybody in this room have experienced, one form of headaches or another. Often people experience headaches. They claim, Oh I have a migraines, even though they are having a headache. They say, oh, I’m having a migraines. They many people don’t know the difference between a migraine and a headache. Not all severe headaches are migraines. Over 38 million Americans are said to be affected by migraines. Over 38 million people are affected. That is a lot of people. So what is the difference between migraines and a headache? Most headaches are due to tension. They are as a result of tension. So what is the tension type headache. Tension type headaches affect the whole head and can feel like a band wrapped around the skull. In tension type headache, the pain can affect the lower back of the head, neck and shoulder causing aching and stiffness. This headache pain is usually a chronic steady pain that can last for a couple of hours.

So what are the types of headaches that we have? We have what we call a sinus type headache. In sinus headache, this could be due to sinus infection like you have an infection that results in infection. It manifests in a form of pressure around your forehead, your eyes, your nasal, and cheek area. And that will make sense. That’s where our sinuses are always affected. So a sinus type of headache manifests in a form of pressure around your face area. The second type of headaches that we have is the cluster type headache. The cluster type of headache is caused in a cyclic pattern like in a circle. This is the most painful of all the headache type. It generally occurs around the eye. Even though cluster headache affects around the eye, its effect is generally felt all over the body, not other parts of the body. So it’s not just like, oh, I have this headache that is affecting my eye, but you can also feel the effect on other parts of your body. So we also have a muscular type headache. Those are due to muscle. It affects muscle movements. Unlike headaches that affects the whole body, migraines generally affect one side of the head. So when you have a migraine, it will be like a one side of your head. It could be the right side or it could be the left side, but it’s kind of characteristically seen as a one-sided pain. It’s manifest as a throbbing pain, and can worsen with exertion. And basically, what that means is that when you are having a migraine headache and you have to do other things, other chose, this can worsen the effects of the migraine.

Migraines can also occur with aura or without aura. When we see it with aura, we simply mean there will be a kind of people call signs that you notice before the actual pain started occurring. It could come in a form of nausea, of meeting, you could start feeling light sensitivity, sounds, or smells, vision changes. These are some form of aura that some people experience. When they are getting into that time of day or the month that the migraine occurs. These symptoms are not all inclusive. People have different symptoms or they experience, and not all migraines have aura that comes with it. All right. Just a sign to show you. So not everybody experiences aura, but a lot of people do. For people that experiences migraines with aura. It’s generally, they start generally feeling the effect between 20 to 60 minutes before the headache is going to happen. So for some people, this will be a way to quickly manage the migraine by using probably medication or other forms of therapy that they are used to. This is like a sign that something is happening, or is going to happen.

So what is the cause of migraines? What causes migraines? It’s unclear what causes migraines. It could be due to generics. It could be due to environmental factors. It could be chemical imbalance in the brain like a serotonin responsible for pain regulation in our body. Could be due to that. It could be due to sex, as in male or female. In female, in women, they are three times more likely to experience migraines headache compared to a male counterpart. And there are things that cause migraines that we call a trigger. Triggers could be in form of hormonal changes in female. Changes in hormones such as during the menstrual cycle, during pregnancy and during the menopausal stage of life. There is a change estrogen level. This could be a trigger for migraines. Also in female, you could have oral contraceptives, hormone replacement therapy. They are said to worsen migraine headache or the other trigger could be alcohol or caffeine. Caffeine tends to highly help migraines in low dose in lower quantity. It tends to have help, but when you take so much caffeine it can worsen the effects of migraines. Stress is a major, major factor. I mean, especially right now with the whole world is going through this tremendous stress with COVID-19 going on. So this is a kind of trigger for many people. In fact, that why I decided to do this particular topic because I know a lot of people are under immense stress right now. So stress is a trigger for migraines.

Apart from stress or oral contraceptives or two that we’ve already mentioned, food, some food can be a trigger also. An example of food that can cause trigger when it comes to migraines is the processed food like aged cheese, additives like sweeteners, preservatives such as monosodium glutamate. Monosodium glutamate are generally found in food is used for food sweetener. This is to help with. Is a chemical dyes used in seasoning food.So this could be a trigger for migraines, headache. And also some medications like nitrate for chest pain. People that have angina, they normally take nitrates for pain for the chest pain. This can be a trigger like we already said. Also, oral contraceptives. Other trigger could be a sleep disorder, a lack of sleep. I mean, that will make sense if you are not sleeping where you cannot rest. And this could be a trigger. All that encompasses stress, and everything that goes along, anxiety and stuff. So those are the triggers for migraines. Complication can occur when medication use in the management of migraines is overused. So most, a lot of the medication that we use in treatment of migraines, they are combination medication, which we’ll be talking about in the in the later part of this show. So when we overuse this medication, instead of helping to relieve the pain, it can worsen the effect of the pain. Sometimes it doesn’t even work at all. You’re just using the medication. So medication overuse could be problem there too. This will be status migraines.

So what are the ways that we can manage migraines, headache. Some of the ways we can manage migraine is sleep. There’s nothing that compares to having a restful sleep stress. Like I said, it’s a big one when it comes to manifestation of migraines. So when we sleep, we can relax. And how do we sleep? We can sleep. We can put application of ice to the head in combination with rest or sleep. Rest and sleep, they surely work better in the dark. When you are having a headache, migraine headache. If you turn out the lights and you put a cold or warm compress on whatever part of your body that is hurting and you turn off the light. This can help to alleviate the pain. Also, you can also use caffeinated drink. Yeah, I know. People will be like caffeine. Yes, caffeinated drink in low dose, in low quantity can help to reduce the effects of migraines. Also, we can use what we call Botox. When we start getting into the level of Botox then is like a crossroad between pharmacological therapy for people that use traditional medication and it doesn’t work, they can use Botox. This is an injection is used for a lot of things so it’s also in migraine, to manage migraines. Apart from Botox, other non-pharmacological therapy that is used and this will be maybe when the pharmacological therapy is not working. You start getting into the invasive part of the therapy. When I say invasive, it just they have to do a kind of procedure. Doctors will have to do a procedure. So other kind of forms that is used in the management. What we’ve called nerve block. The nerve block method that targets the nerve that is transmitting the pain. So basically, they try to block the nerve that is sending the pain to your head. That’s what do they do that in the hospital.

Next we’ll look into the pharmacological management for migraines headache. When we talk about pharmacological therapy, basically we are talking about medication, drugs. What are the drugs that we use. For their pharmacological management, we can divide them into two. We have the ones we can go over the counter, OTC, to buy. Example of those is acetaminophen, that is like Tylenol. Outside the country you may know it as paracetamol. So you can get this over the counter. You can get aspirin, ibuprofen, Aleve all this over the counter medication that we can use. Normally when we are trying to use medication we want to start, we want to go slow. You want to make sure you try all the medication that has been proven for a long time and it’s not known to be harmful to the body. When it comes to the acetaminophen, Tylenol or paracetamol, we have to make sure that we do not exceed four grams daily because the side effect too much of it can cause liver damage or it can worsen liver disease. So we want to make sure we… the best way to go is just to go to your pharmacist, to consult with your pharmacist, even if it’s over the counter And you are allowed to pick it up. The rule of thumb just talked to your pharmacist. That’s the idea. We are there to help you to navigate things like that.

So when we took about the pharmacological therapy, the first line that people always use is the what are called the fuel reset and the fuel ray now type of medication. These are combination product for their fuel resets. We have the acetaminophen, caffeine, butalbital. And sometimes they can also add codeine if there’s extra pain effect to that. For the furenol, this is the one that have the aspirin, acetaminophen. It also havebutalbital caffeine. And sometimes like I say, they can also have a form of codeine. So these are prescription medication. We have the fuel reset and the fiorina, those combo products. Like I said in the case of acetaminophen, when you are dealing with the butalbital based combination product. You want to make sure that the acetaminophen part of it is not too much. It’s not over 4 grams of acetaminophen. That is very, very important because while I’m emphasizing that is the other than this product, there are a lot of over-the-counter medications that contain some part of acetaminophen or aspirin and we might be using some other medication not related to headache that already has acetaminophen, Tylenol, already a name. So if you have a product that you are using maybe you use it for something totally different, maybe for some different kind of pain that already have Tylenol need. Then that’s why you need to talk to your pharmacist. So that they will know you’re already taking this medication and it can calculate to make sure the acetaminophen level, the Tylenol level is not exceeding four grams.

The same also goes for aspirin, the ibuprofen. Some of our other products already have what we thought non-steroidal anti-inflammatory product inside. The ibuprofen and the naproxen are already in there. So you want to make sure you consult with your pharmacist. You don’t have to necessarily have to go straight to the doctor. You could call your doctor, but pharmacist are accessible resources for the local community to go to and talk to about medication. They are medical, they know drugs. They are the expert in drugs. So you need to use the resources that are available to you and they are free. Many people you can go in and talk to them, they are very helpful. So for the non-steroidal anti-inflammatory like ibuprofen, we want to be careful too with that because of people that have a G.I. problem like they have bled, too much of which could lead to bleeding. So you want to be careful. Don’t don’t go over the counter and grab something. You still can consult with a professional. So other than those combination product. We have the other types of product that we call the Triptans. The triptans are the most common type that are used specifically for migraines. They are what we call the serotonin-based drugs. Example of the triptans are on sumatriptin, Imitrex the naratriptin, the rizzotripton. All those ones that have tripton at the end of it, these are serotonin-based drugs and they are the most common ones that are generally used. So what are the side effects of the triptans. The triptan, the side effect could be in form of fatigue. It could be dizziness; it could be flushing. And they are contra indicated that means people have to be super cautious in using. They are not supposed to be used in people with heart disease control or hypertension or the hemiplegic community. So those are the people that are not supposed to use this medication.

Apart from the triptan, some of the most recent agent that has been released in the market. This is what we call calcitonin gene related peptide CGRP based drug. Example of this one are the Aimovig. You might have been seeing it on TV. When they are advertising it on TV. We have the Aimovig, we have Emgality, we also have the Ajoby. These new products that are coming out, these are mostly subcutaneous. These are injection. you have to inject that under the skin subcu. And this one’s medication that I use for people sometimes probably have a headache day over, maybe from eight to 15 headache days a month. And they are used in those population. So for these people use these CGRP base medication like Aimovig and andEmgality. The reason they are using this is that these are monthly medication is just to reduce for people that don’t want to continuously use pills. They can just use this medication maybe once a month and it will continue to work. Other agents that we use when it comes to migraines headache is the opioid. Opioids are for pain. Migraines is a form of pain. So we do use opiate like oxycodone, hydrocodone, but a side effect we all know the side effect is very addictive. People can get addicted to it. So that’s part of why we are looking for alternatives to that. But the do use the opioids. So for the types of  migraines? They are called status migrainus. The status migrainus, these are the migraines that goes on for weeks. It could be up to a week. It could be up to two weeks. For those kind of migraines, the steroid, corticosteroid, maybe used as a rescutherapy. So for those kind of continuous migraines. Your doctor might decide to go with the rescue therapy in form of steroid. Next we’re looking to what I call prophylaxis therapy, which is a preventive form of managing migraines.

So basically, like I said in the beginning, a lot of people go through what we call aura. They have a sign and symptoms that their migraines is about to happen. For those type of people, they can use what we call prophylaxis treatment. That is a preventive treatment. In this form of treatment, the patient will take a medication before the headache, before the migraines even started. This is called a preventive or prophylaxis therapy. So we do do that for migraines, headache too. So for people that have maybe one migraines or maybe two, it’s not a regular thing with them. They might not need prophylaxis treatment, but for people with recurring and debilitating migraines is continuously and for some people have up to fifteen headaches a month. Some even have 30 headaches a month. So for people like that prophylaxis treatment will be the best fit. So most of the prophylactic medication, the preventive medication that we use. They have similar characteristics. They have similar form. So when choosing prophylaxis treatment, when choosing preventive treatment, we just need to consider the side effect with respect to the patient. That is all we need to see.

If you have maybe high blood pressure, we can decide to use like some agent. If you have depression, we can decide to use other agent. The first preventive medication that I will talk about is what we call beta blockers. Beta blockers, what they do is help to reduce the blood pressure up, to bring the blood pressure down. And they are the most widely used preventive therapy when it comes to migraine. Examples of beta blockers, the proponolol, timolol, any of those medication that have LOL, LOL. Those are the beta blocker. The side effect that comes with the beta blockers, are the drowsiness. You can experience fatigue. Like I said, for traditionally it’s used in the management of high blood pressure to bring the blood pressure down. So some of this side effect is low blood pressure, what we call hypertension. Also, it also reduces the heart rate. So what we call bradycardia, low reduction in the heart rate. We want to be very cautious when we’re using this medication in patients with heart failure, in depression, people going through diabetes. For, like I say, it will make sense because if it’s dropping the blood pressure for people, we have failure. We have to be careful with the blood pressure. The second class of medication that is used in the preventive or preventative form of managing migraines is the antidepressant and the most common agent that is use the tri cyclic antidepressant. This example of that is ellevel, which is in generic form is imatryptalin. Some of the side effects that we experience from this one are what we call the anticholinergic effect. I know that’s a that’s a little mouthful, but basically what that is it gives you a dry mouth. It could cause sedation. It could cause a fall.

There’s a risk of fall when you use anticholinergic medication. One asked to also be careful in people with the history of benign prostatic hyperplasia which is BPH. So mostly in the adult population, we try to stay away from tricyclic antidepressant because of the, especially the risk of falling. This could be dangerous. So we have to. That’s why we say we have to consider the underlying condition before we choose a prophylactic treatment. Another class of medication I use is the anticonvulsant. This is the one that we use generally use for the management of seizure. If you want to know more about all this medication. I mean we just finished discussing about seizure disorder and in that we go into detail about the anticonvulsant. In our episode on mental health and cannabis, we talk extensively on anti-depressant and all that. So if you want to go back and listen to those episodes on mental health and cannabis or the role of cannabinoid is seizure disorder, for cannabinoid and seizure disorder. Those are the episodes that we talked about extensively about this medication. So as I was saying, the anticonvulsant is an example of the one of the most common that is used is topiramate, Topamax, and we have the viproicasir and the viproiscasir. So those are some of the medication that we use.

Next, we’ll go into the role of cannabis in the management for migraines, headache. For people that have tried all of these conventional therapies. They have tried prophylactic treatment, but it’s still not working. Cannabis may be a safer alternative. So how can cannabis work. What is unique to cannabinoids that makes us say it might help people with migraines. Studies shows that cannabinoid combination of THC CBD works better than prescription drug in the management of migraines. Cannabinoids are also said to reduce migraine pain by up to 43 percent. Cannabinoids are said to have less side effect compared to a conventional therapy in the management of migraine headaches. Basically when people that use cannabis, they still have a lot of studies we need to do, but people from word of mouth. They have less side effects compared to traditional medicine. Cannabis and cannabinoids like CBD, THC is able to relieve migraine headache from several different angles. We already know from previous episode, Cannabinoid Cannabis, they have different mechanism of action. The way they work they have different targets where they can attack pain or whatever is going on with disease state. So cannabinoid is not just helping with the pain when it comes to migraine headache. They also help with reducing nausea associated with migraines. Inflammation from throbbing pain when you are having a headache. It’s like inflammation comes with that.

So CBD has been shown to have more anti-inflammatory properties than even non-steroidal anti-inflammatory or steroid or traditional corticosteroids. So the cannabinoid, the CBD, THC, they are not just helping to relieve the pain. They help with nausea; they help with inflammation.  Cannabinoids also have a muscle relaxant property which help migraine sufferer with vascular spasm from muscle contraction. So most migraine sufferer, they go through a muscular contraction, which it’s not just pain. They also have muscles spasm, contraction. So they cannabinoids helps to relax the muscle. The endocannabinoid system, the E.C.S is set to help in maintaining balance during migration episodes in normal body system. Like we said in the previous episode, if you ever listened to our episode on endocannabinoid system, that is the supercomputer of our body. You need to go back and listen to that. So the ECS is that part of the body. It exists in our natural body that helps in homeostasis, which is maintaining balance. So it also help in the management of migraine. Migraine sufferer are said to not always relive the endocannabinoid. The endocannabinoid, the natural one that we have in our bodies is the 2AG and the anandimine. The 2AG is similar to the CBD and the anandimine is similar to THC. Those are the ones that our bodies are already producing. But in people with migraine headache, it is observed that they might have a lower endocannabinoid. That they don’t have enough that is produced by their body. Researchers are looking to target a migraine through the CB2  receptor. The CB2 receptor is where the CBD binds to. So it would make sense. If the body is not producing enough of anandimine or enough 2AG, then we can supplement with the essogenius cannabinoids. When I say essogenius, I mean the one that we produce outside the body like THC or CBD. That will really make, it’s just like us are supplementing our diet with lots of vitamins. It absolutely makes sense to me.

So how do we dose when we are trying to use cannabinoids. What is the best route of administration? What is the best products to use? The best, when it comes to migraines and pain, generally when we are looking into cannabinoids-based therapy, you want to consider what you are trying to money and decide what routes of administration will give you the best effect when it comes to migraines. This is pain. You need to relieve right now. The inhalation routes like maybe smoking or vaping? Those have been proven to be the best and the fastest route to to relieve pain. Because when you talk about inhalation, the inhalation, what you are inhaling which is the cannabinoids, the CBD to THC, those go straight into the blood stream. It does not pass through the liver. It doesn’t get passed through the stomach. It goes straight into the bloodstream. Now what I mean by that is that it doesn’t go through a forced pass metabolism, and by going straight into your bloodstream you immediately feel the effects. When it comes to, so for people with migraines. That is what they want. They want the relief. They want it now. When it comes to the edible form of administration. This is less popular for people with migraine pain because it takes a while for you to start working. Although it last longer.

When you talk about the edible, edible last longer. Because when it gets into your system, the product is converted into a different form that lasts longer. But it takes a while for it to be broken down, to be digested into your body. It goes through the fast plus metabolism through the liver. And this might not be a good route for people already have maybe some form of liver disease or liver issue going on. For a migraine sufferer that is saying you have a migraine and you are looking for relief now. But when it comes to edible, it can take up to two hours for you to see the effects of it. So for a migraine sufferer that is, two hours of waiting for your medication to work, it can be unbearable. This is a chronic pain one is going through. So two hours of waiting is just two hours too long. So for migraine sufferer, that is two hours too long. So that is our show for today. I am so glad that you guys are here and able to join me for today. Check out lines of hemp derived products. We have various products that can help with sleep. Hemp derived CBD product on our web site. We have one for sleep. We have for energy. We have various products. We also have on the web site, if you are the type you do not want to use edible or you don’t want to use routes of self-administration. You can check out the topical we have for ointment. We have balms that will help you apply. Those go straight into the body.

So if you want to check that out. Also, please, we would like you to leave a review on your listening platform. Reviews is what we are measured by in the podcast community. So if you are using Apple podcast encouraging you, I’m asking I’m actually asking that. Please go on your listening platform, Apple podcasts and leave me a review, I would appreciate that. Also, if you would like to join our Patreon group. Our Patreon group are the ones that are helping us to put this show together. So if you want or join the Patreon, we will really appreciate your donation. So all information is on our website. You can have this information on the website WCI-health.com. All information about subscription, Patreon, they are all in there. And I just want you to be safe. We are going through a lot all over the world right now. Be safe. Wash your hands. Social distancing. Yeah, we are going through it right now. But it is the key. We have to destroy this monster that calls itself COVID-19. So social distancing doesn’t mean emotional distance. We can be socially distant, physically distance from each other, but we have to connect with our community. So call your neighbor. Call your family member. Check on people. Be kind to people out there. And like I said in the beginning. Please stop spreading hate. People should show love to one another. We are all in this together. We are one nation under God, indivisible. We are not red, black and blue. It’s red, white and blue. And all over the world. We are going through this together. So let’s show love to one another. And until next time. Always remember health equals wealth. Thank you so much. See you next time.

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