Using medical cannabis for headaches has become increasingly popular. It’s an alternative therapy that people turn to when pharmaceutical drugs don’t work.
Everyone experiences a headache in their life. This health issue can be more debilitating for some than for others. Acute head pain has been a health concern for many Australians.
Nearly 15% of this country’s residents take medication to relieve a headache. It affects people from any age, but mainly ages 25 to 44.¹
The origin of this chronic issue varies. An individual’s lifestyle could trigger this condition. Factors such as a poor diet, lack of exercise, and stress can cause headaches.
Medication and other underlying ailments can also result in head pain. A person with persistent headaches should report them to a medical practitioner.
There are various headache treatments in Australia. They depend on the type of head pain. Migraines differ in severity and could lead to depression and anxiety. Tension headaches feel like a pressure band wrapped around the head.
Then there are also cluster headaches. It’s a rare but extremely painful one. This pain could continue for an extended period without breaks.
Many resort to easing their pain with over-the-counter medication. These meds include ibuprofen, aspirin, paracetamol, and NSAID. In severe cases, doctors may prescribe codeine and morphine.
While these treatments all have their own benefits, they also have some side effects. Patients with adverse reactions to these meds resort to alternate remedies.
Some find comfort in drinking water. Studies show that it can ease headaches. While reducing alcohol, sufficient rest, and essential oils can also bring relief.²
Another form of treatment is cannabis therapy. It’s only legal in certain parts of Australia. Therapeutic Goods Administration (TGA) has made medical cannabis available with a valid prescription. Only registered practitioners can issue these scripts.
Many have found cannabis brings much needed relief to pain.³ Yet, research into the benefits of medical cannabis still continues.
An overview of headache disorders
In Australia, 5% of all doctor visits are headache related. Women visit their health practitioners more than men. Finding a suitable treatment for this disorder depends on the symptoms and origin.⁴
There are a few common types of headaches.
Cluster headaches
This pain is common in men 20–40 years of age. Alcohol or strong smells can trigger these headaches. Cluster headaches cause extreme pain.
It can occur multiple times per day and last between 15 minutes to an hour or more. These headaches can continue up to a year with periods of remission.
Some experience continuous pain without breaks, also called ‘chronic cluster headache’.
Those who experience this intense agony typically have a puffy and teary eye. They may even have a runny or stuffy nose.
Treatment for cluster headaches includes administering oxygen or medication called triptans. This medication can cause some dizziness, nausea, and fatigue.
Migraines
Certain food, lack of sleep, or hormonal changes can trigger migraines.⁵ The symptoms of this condition are sensitivity to light and sound. It typically affects a patient's vision and causes numbness to parts of their face.
Avoiding anything that might cause a migraine is one option. Other treatments include medication which can relieve the pain or prevent it.
Patients have also tried non-medication therapies, such as homeopathic remedies and acupuncture. They’ve experienced relief when doing yoga, hypnotherapy, and meditation.
While these may help ease pain, it takes a while for effects to set in.
Tension headaches
Stress triggers tension headaches. Also known as a ‘stress headache’. While this pain can occur occasionally, some people experience it often.
This condition can become chronic when it occurs more frequently. Anxiety, stress, eyestrain, noisy environments, and fatigue can cause this discomfort.
Besides traditional over-the-counter meds, relieving tension also eases the pain. Patients may find relief in resting, a neck massage, or applying a heat pack.
These forms of treatment are not quick fixes. Relief may only set in after a while. Patients avoid excessive use of medication as it can increase the pain.
Alternative treatments
Using over-the-counter medication can cause some headaches. Not following the directions of prescribed medication can also result in pain. Also known as a ‘rebound headache’.
This type of ache can lead to a patient consuming more pain relievers. The behaviour can become a cycle and lead to overuse and eventually dependence.
Similarly, various prescription drugs can each have their own side effects. Not adhering to the prescribed dosage can affect a patient’s wellbeing.
Common after-effects include nausea and constipation. Medications such as acetaminophen could affect a patient’s liver. While ibuprofen can negatively affect tummies.
Some patients may experience allergic reactions to certain drugs. These adverse effects, like with aspirin, could be hives, a runny nose, or the onset of asthma.⁶
To combat these effects many seek alternative treatments.⁷ These therapies cover relaxation techniques and lifestyle changes. They also include supplements and herbal remedies like ginger tea for migraines.
Another natural remedy is medical cannabis. A herb, proven to alleviate symptoms associated with migraine.⁸
Medical cannabis: composition and mechanism action
Medical cannabis is a herb used to relieve the symptoms of certain health conditions. Derived from the plant with the same name; it contains approximately 100 cannabinoids.
THC and CBD
The most popular cannabinoids are THC and CBD. Some products either contain one or both. Scientists and researchers continue to study the efficacy of these and other compounds.
Each has their own unique structure and affects the body differently. THC and CBD interact with the human body’s endocannabinoid system (ECS). What are THC and CBD?
- THC (delta-9-tetrahydrocannabinol): THC is the psychoactive ingredient in the cannabis plant. It’s the compound responsible for the ‘high’ that most recreational users appreciate.
Besides this effect, THC also has a range of therapeutic benefits. Health practitioners prescribe medical cannabis with THC to treat chronic pain and insomnia.
- CBD (cannabidiol): CBD has gained immense popularity over the decades. It’s commonly extracted for medicinal use. CBD alleviates pain, anxiety, and a few other symptoms.
TGA’s Special Access Scheme prescribes CBD in Australia. There’s a gradual increase in health professionals prescribing this compound.
It’s important to understand how these cannabinoids interact with the body.
Endocannabinoid system (ECS)
The discovery of the ECS took place in the early 90s. It helps to balance the body’s functions. They work with endocannabinoids, which are chemical messengers.
They attach to receptors on the surface of cells, found throughout the body. There are CB1 and CB2.
The peripheral nervous system and immune cells house CB2. The central nervous system is where the CB1’s reside.
The endocannabinoids bind to these receptors. They send signals to different parts of the body to activate certain changes.
The cannabis cannabinoids resemble the body’s endocannabinoids. This similarity means they too can bind to the receptors and prompt certain changes.
THC binds to the CB1, producing a range of effects, including the ‘high’. CBD binds to the CB2 and produces therapeutic benefits with no psychoactive effects.
The combination of the CBD and THC effects creates an entourage effect.⁹ One of the benefits of this blend is pain relief. The impact on the body depends on an individual's physiology, which includes metabolism.
Other lifestyle factors also play a role. However, consult a medical professional before commencing a cannabis treatment.
THC and CBD benefits
The similarity of the body’s endocannabinoids and cannabis cannabinoids indicates potential medicinal benefits.
- THC: a popular benefit of THC is how it reduces nausea and stimulates appetite. In the US, the FDA approved two synthetic formulations.
It treats both nausea and vomiting resulting from chemotherapy. It stimulates the appetite in patients with AIDS or anorexia.
Medical cannabis is commonly prescribed in Australia for chronic pain. It helps alleviate anxiety and encourages sleep.¹⁰
- CBD: CBD assists the body interpret certain signals, like pain. Health professionals prescribed it for seizures, inflammation, and migraine. In Australia, authorities have approved CBD for rare forms of childhood epilepsy.
Implementing cannabis into headache management
Patients should consult a medical professional before using medical cannabis for headaches.
There are a few steps to follow before they start any cannabis treatment planning.
Assessing the patient
Before commencing cannabis therapy, complete a detailed assessment. Record and address any risk factors beforehand.
The patient’s medical history plays an important role. It can impact the way the body reacts to medical cannabis.¹¹ These include conditions such as mental illness.
Consider any history of cardiovascular, liver, or renal disease. Review any failed treatments from a patient’s past. These include trial therapies and the reasons it ceased.
Highlight any risky behaviour from the past that’s linked to drug or substance abuse. Ensure the patient has support from their family or friends.
The assessment should include the symptoms of the condition requiring medical cannabis.
Treatment plan
As the health practitioner, make the patient part of the treatment planning. Together, determine a start and end date.
Document the risks associated with dispensing the prescribed product. The frequency and concerns regarding an increase of doses.
Closely monitor future consultations and blood tests. An exit strategy from the treatment plan is also important. If there’s no progress in the agreed upon time, the treatment should stop.
Obtain consent from the patient about the medical cannabis products. Ensure patient education of cannabis. Inform them of all the possible side effects, goals, and relevant information.
Methods of administration
In Australia, there are only certain methods of administration approved. Patients can consume it orally, sublingually, vaporise, and suppositories.
They should follow the doctor’s instructions related to dosing and administration. Which method is best?¹² The option will vary, depending on the person.
Other factors that can influence administration are the ECS and cannabis tolerance levels. Together with the patient, decide on a method.
- Smoking: While the effects set in quite rapidly, it doesn’t last very long. The effects set in within 30 minutes and lasts between 2–4 hours. It’s a popular method of consumption.
Combustion during smoking destroys about 40% of THC. The user may want to consume more to achieve the full benefits.
This method does pose a risk to the respiratory system. Combining cannabis with tobacco also creates an additional health threat. There’s the potential of developing a heart disease.
Smoking isn’t as discreet as vaping. Public smoking, however, isn’t supported by TGA.
- Vaporising: Vaping is a preferred method for rapid relief. It heats the extract and releases a vapour filled with the cannabinoids. It’s then inhaled.
The compounds are quickly absorbed into the bloodstream through the lungs. The quality of cannabinoids and terpenes remains intact. The user has more control of the temperature.
Vaping is legal in public smoking areas in Australia. This is the only inhalation method of medical cannabis approved by TGA. They’ve also approved dry-herb vaporizers. It’s more discreet than smoking.
Patients with existing respiratory conditions should avoid this method.
- Oral: Products for oral ingestion include edibles, oils, capsules, and tinctures. It takes longer to set in. It’s ideal when a patient needs control over a longer period.
In a 2022 study in Australia, oral consumption is the most common method.¹³ The liver metabolises the cannabis after ingestion. It is then released into the bloodstream.
This method allows for managing exact doses. Vaping allows for discreet consumption and the effects last much longer. It takes a while for it to take effect.
- Sublingual: With this method, place the treatment under the tongue. The blood vessels of the tongue absorb the active ingredients.
Sublingual products are tinctures, oil, lozenges, and sprays. They’ve a longer shelf life. Edibles have a much higher bioavailability.
The effects kick in faster and it has a higher concentration of cannabinoids. There’s no risk to the lungs and managing the dosage is easier. Some may not find this method convenient and the taste may not be appealing.
Dosing
The general principle of cannabis dosing is to start low and go slow. Anyone new to this herb should start with 0.1–0.5 of the recommended dose. Assess the effects before continuing.
As a health practitioner, consider all the safety information regarding medical cannabis. Cease the treatment plan when the desired effects aren’t met.
Patient education
Medical professionals should educate their patients on all aspects of cannabis. The relationship between these two is important. It ensures the safe use of medical cannabis.
The physician should address all possible side effects and concerns.¹⁴ Known reactions include:
- Nausea
- Vertigo
- Vomiting
- Fatigue
- Sedation
- Decrease/increase in appetite
- Dry mouth
- Diarrhoea
While medical cannabis for headaches may benefit one patient, it may not do the same for another. A similar product and dosage’s effects can differ from one patient to another.
Take the sting out of the pain
Many people want an alternative therapy for headaches. Some have found medical cannabis a successful option.
Medical cannabis for headaches is not a cure. It helps alleviate the symptoms related to the condition. While research still continues into the herb’s efficacy, there have been a few studies.
Patients in clinical studies experienced a reduction in migraines.¹⁵ While others with pain like cluster headaches have also found relief.
Treatment plans will vary between patients, depending on their physiology and medical history. Patients new to cannabis will also react differently. Doctors need to monitor doses and do regular follow ups.
Administration is also made easy with the various options available. Patients can access the medicine discreetly and avoid overdosing.
The health professionals feel hopeful about the success already obtained from medical cannabis. With ongoing cannabis research in Australia, the future of headache treatment looks positive. There’s no doubt that cannabis benefits personalised medicine.
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References
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- Khorsha F, Mirzababaei A, Togha M, Mirzaei K. Association of drinking water and migraine headache severity. Journal of Clinical Neuroscience. 2020 Jul;77:81–4.
- Schubert EA, Johnstone MT, Benson MJ, Alffenaar JC, Wheate NJ. Medicinal cannabis for Australian patients with chronic refractory pain including arthritis. British Journal of Pain. 2022 Dec 20;204946372211471.
- Frese T, Druckrey H, Sandholzer H. Headache in General Practice: Frequency, Management, and Results of Encounter. International Scholarly Research Notices. 2014 Oct 29;2014:1–6.
- Diamond M. The Impact of Migraine on the Health and Well-Being of Women. Journal of Women’s Health. 2007 Nov;16(9):1269–80.
- Administrator. Allergic reactions to Aspirin and other Pain Killers [Internet]. Australasian Society of Clinical Immunology and Allergy (ASCIA). Available from: https://www.allergy.org.au/patients/drug-allergy/allergic-reactions-to-aspirin-and-other-pain-killers
- Wells RE, Bertisch SM, Buettner C, Phillips RS, McCarthy EP. Complementary and Alternative Medicine Use Among Adults With Migraines/Severe Headaches. Headache: The Journal of Head and Face Pain. 2011 Jun 7;51(7):1087–97.
- De Felice M, editor. Medical Cannabis for the Treatment of Migraine in Adults: A Review of the Evidence. Fronteirs [Internet]. 2022 May 30 [cited 2024 May 14];13. Available from: https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.871187/full
- Anand U, Pacchetti B, Anand P, Sodergren MH. Cannabis-based medicines and pain: a review of potential synergistic and entourage effects. Pain Management. 2021 Apr;11(4):395–403.
- Kuhathasan N, Dufort A, MacKillop J, Gottschalk R, Minuzzi L, Frey BN. The use of cannabinoids for sleep: A critical review on clinical trials. Experimental and Clinical Psychopharmacology. 2019 Aug;27(4):383–401.
- Goods T. Guidance for the use of medicinal cannabis in Australia: Overview [Internet]. Therapeutic Goods Administration (TGA). 2023. Available from: https://www.tga.gov.au/resources/resource/guidance/guidance-use-medicinal-cannabis-australia-overview
- Australia V. Medicinal cannabis information for health professionals [Internet]. Vic.gov.au. 2017. Available from: https://www.health.vic.gov.au/drugs-and-poisons/medicinal-cannabis-information-for-health-professionals
- Lintzeris N, Mills L, Abelev SV, Suraev A, Arnold JC, McGregor IS. Medical cannabis use in Australia: consumer experiences from the online cannabis as medicine survey 2020 (CAMS-20). Harm Reduction Journal. 2022 Jul 30;19(1).
- Administration (TGA) TG. Guidance for the use of medicinal cannabis in Australia: Patient information | Therapeutic Goods Administration (TGA) [Internet]. www.tga.gov.au. 2023. Available from: https://www.tga.gov.au/resources/resource/guidance/guidance-use-medicinal-cannabis-australia-patient-information#:~:text=The%20side%20effects%20of%20medicinal%20cannabis%20treatment
- Rhyne DN, Anderson SL, Gedde M, Borgelt LM. Effects of Medical Marijuana on Migraine Headache Frequency in an Adult Population. Pharmacotherapy [Internet]. 2016 May 1;36(5):505–10. Available from: https://pubmed.ncbi.nlm.nih.gov/26749285/