Migraine and Medical Cannabis

Chronic Migraine

Chronic migraine is defined as migraine attacks experienced on at least 15 days of the month. Chronic migraine is highly debilitating and makes life extremely difficult for the sufferer.

Migraine Causes

The exact cause is unknown, but migraine is believed to develop as a result of abnormal brain activity which affects nerve signals, chemicals and blood vessels in the brain. The brain activity is temporary which is why migraine symptoms come and go. Some research suggests that genetics play a role in making a person susceptible to migraine.

People with migraine are commonly affected by triggers which bring on the headaches and associated symptoms of migraine. However, the evidence of whether these are true triggers is mixed, with some studies suggesting that craving of certain foods may be part of prodromal symptoms of migraine itself.

Possible triggers may include:

• Hormones – common for women around the time of their menstrual period due to hormone level changes. Some women experience migraine shortly before, during or after a period. This is sometimes referred to as ‘menstrual migraine’.
• Emotions – this may include stress, anxiety, tension, shock, depression or even excitement.
• Physical activity – this may include lack of sleep, unusual working hours such as shift patterns, poor posture, tension in the neck or shoulders, jet lag, low blood sugar levels, physical excursion (when not used to exercise) such as commencing a new gym regime.
• Diet – this may be missing meals or eating irregularly, dehydration, alcohol consumption, caffeine intake, or foods containing tyramine.
• Environmental factors – bright or strobe lighting, flickering from a PC or television screen, smoking, excessive noise levels, humidity changes or very cold weather, strong smells such as perfume or aftershave, poor air circulation resulting in a stuffy room or building.
• Medicinal factors – this may include certain sleeping tablets, the combined oral contraception pill (COCP), hormone replacement therapy (HRT).

Keeping a diary to identify a pattern of migraine attacks can help sufferers identify any possible triggers.

Migraine Symptoms

The main symptom is an intense headache described as a throbbing pain on one side of the head, however in children the pain is more commonly felt on both sides. The pain may be moderate or severe and worsen with movement. In more severe cases, the pain may be present on both sides of the head and may also affect the face or neck.

Other symptoms include:

• Feeling and/or being sick
• Increased sensitivity to light and sound
• A drop in concentration levels

Rarer symptoms include:

• Perspiring
• Temperature changes – feeling either too hot or too cold
• Stomach pain
• Diarrhoea

Types of Migraine

There are several different types of migraine.

1. Migraine with aura – these are migraines with warning signals such as:

• Visual disturbances including seeing flashing lights, dark spots or zigzag patterns
• Numbness or a tingling sensation similar to pins & needles which usually starts in one of the hands and
• moves up the arm before affecting the face, lips and tongue
• Dizziness or a loss of balance
• Speech impairment
• In very rare cases, a loss of consciousness

2. Migraine without aura – migraines without warning signals

3. Migraine aura without headache (silent migraine) – warning signs of a migraine will be present, but the headache does not materialise

4. Abdominal migraine – often diagnosed in childhood, rather than headaches, individuals experience episodes of stomach pain, nausea, and vomiting. Those with abdominal migraine often have a family or personal history of migraine headaches.

Migraine Diagnosis

There is no specific test to diagnose migraine. A GP will complete an assessment of an individual to identify a pattern of the recurring headaches.

It is helpful if an individual keeps a record of migraine attacks to identify a pattern and their possible triggers. A migraine diary may include information such as:

• Date
• Time of day
• Location
• Activity prior to the attack
• Any other notable details such as being in a particularly bright room, close to a strong scent, or subject to excessive noise

It may be necessary to conduct blood tests or imaging scans to help rule out other potential causes of headaches.

Medical Cannabis for Migraine

There is no cure for migraine, but over-the counter painkillers or retreating to a dark, quiet room may help reduce the pain and discomfort. When symptoms are persistent and debilitating, medical cannabis may be an option to explore for limiting the length and frequency of migraine.