Do you suffer from migraines? These headaches are extremely debilitating, and you have likely tried many remedies; anything to alleviate the pain. Migraines are neurologically based headaches accompanied by light and sound sensitivity as well as nausea and vomiting. Additionally, migraine sufferers must often confine themselves to a dark room free of all noise, sometimes for several days, in order for the headache to alleviate. As an alternative, sleeping for an extended period of time often relieves a migraine headache.
If you have suffered for some time from migraines, the medications prescribed to you might work, but the negative side effects may be almost as bad as the migraine. Sadly, for many patients, prescribed medications don’t work.
CBD is short for cannabidiol, a non-psychoactive compound found in the cannabis and hemp plants. Both plants are known to contain over 80 such cannabinoid compounds. Perhaps the most well known cannabinoid is THC, or tetrahydrocannabinol, which is primarily responsible for the psychotropic effects of cannabis. Unlike THC, CBD is non-hallucinogenic. It has no known abuse potential.
CBD works with the body’s natural endocannabinoid system, a network of neurotransmitters and receptors. A neurotransmitter is a chemical molecule produced at the synapse (connection) of a neuron (brain cell). These chemicals bind with receptors and trigger a signal in a connecting neuron. This system of signaling molecules and receptors found on the surface of cells is the brain’s way of transmitting signals and relaying instructions to other cells in the body, telling them how to behave.
The brain produces a vast variety of these signaling molecules. Hormones are a type of signaling molecule. So is histamine, the molecule that mediates many allergic reactions. Neurotransmitters like dopamine, oxytocin, serotonin and melatonin are all signaling molecules as well. The body needs these signaling molecules to function properly. Serotonin, for example, elevates mood, and melatonin helps with sleep.
As it turns out, plant cannabinoids like CBD, are also signaling molecules. CBD actually fits the human endocannabinoid receptors, so it acts just like a human neurotransmitter would. Think about it this way: the cannabinoid receptor sits on the cell surface and “monitors” conditions outside that cell. When the outside conditions change, the receptor signals the inside of the cell about the change, and a chemical response occurs to always keep the cell in balance despite the changing conditions outside the cell.
Humans have two major types of receptors, called CB1 and CB2, as well as other minor types of receptors. CB1 and 2 receptors were the earliest discovered and therefore the most extensively studied. CB1 receptors are abundant in the brain; these are the receptors that THC interacts with in the process of getting a person high from cannabis. CB2 receptors exist outside the central nervous system, mainly in the peripheral nerves and in the immune system. It alerts cells about changing conditions outside of the peripheral nerve and immune cells. CBD has been shown to have high potency at both the CB1 and CB2 receptor sites.
CBD has been shown to decrease neuron overstimulation, sometimes called excess neuronal activity and, because of this, there has been increased clinical and scientific interest in CBD as a therapeutic alternative agent.
Scientists refer to CBD as a pleiotropic drug, meaning it has many effects on the body. So far, scientists have identified more than 65 ways CBD can act on various molecular targets in the body. It can target certain receptors to act a certain way. CBD can enhance or inhibit the binding action of other chemicals. CBD can also delay the reuptake of certain neurotransmitters to provide a specific physiological effect.
CBD is widely used to help a variety of health issues. CBD is used for everything from anxiety to insomnia. In addition, CBD may be beneficial for chronic pain and inflammation. Several studies, including one published in the European Journal of Pain shows that CBD inhibits the inflammatory response and also inhibits neuropathic pain. More human studies are needed. Research is somewhat hampered due to the illegal status of cannabis which contains THC according to federal law.
It is very important for consumers to know that CBD is not FDA regulated. There is only one CBD formulation that is FDA approved to date, and that is Epidiolex, an epilepsy drug made by British based GW Pharmaceuticals. Epidiolex is the first FDA approved natural cannabis based drug created to treat two rare forms of epilepsy, Dravet Syndrome and Lennox-Gastaut Syndrome. The strongest scientific evidence in favor of the use of CBD was acquired by GW Pharmaceuticals during the Epidiolex clinical trials.
This effect of CBD is another example of the cannabinoid’s ability to modify neuronal excitability, in this case, calming seizures. Like many migraine sufferers who don’t find relief using conventional medications, up to 35% of patients with refractory epilepsy cannot control their seizures with currently available conventional treatments. In both cases, there has been growing interest in the potential of cannabis derived products for treatment.
GW Pharmaceuticals had accumulated a tremendous body of research. They conducted a clinical trial that enrolled over 500 epilepsy patients, both children and adults. That scientific rigor helped the FDA to make its decision. Results of the clinical trial were published in the New England Journal of Medicine. Results showed that Epidiolex, when used alongside conventional anti-seizure medications, reduced seizures by more than 40 percent.
While Epidiolex does bring relief to so many epilepsy patients, the drug is not without its adverse side effects. Some studies have demonstrated several important adverse effects associated with Epidiolex, which must also be considered as it becomes more widely used. Adverse events were determined to be dose dependent in some studies; the higher the dose, the more likelihood there was of an adverse event. This effect was most often seen within the first two weeks after the dose was increased. The negative side effects also included diarrhea, vomiting, fatigue, lethargy, decreased appetite and others.
Regarding the legal status of CBD in the United States, even though the majority of states have approved some form of medical cannabis or CBD use and, despite the fact that a handful of states like California and Colorado have even approved recreational (adult-use) of marijuana, cannabis remains illegal at the federal level.
Even though CBD is widely sold in the U.S., everywhere from the smallest pet shop to national chains like CVS, purchasing CBD is only legal at the federal level if the product is derived from hemp and contains less than 0.3 percent THC. Federal provisions allow CBD to be sold as long as the stores do not make any health claims about the CBD and what it can cure or treat. The FDA can pursue any seller that does so, but the truth is they have limited staff to pursue enforcement actions. The agency has issued warning letters to some violators.
The picture gets even more complicated because individual states have imposed further restrictions. Some states, like Iowa and Texas, have even conducted raids on CBD stores.
A portion of the FDA’s mandate is to ensure the safest dose of any medication. The rapid proliferation of hemp based CBD products has put the agency in a tough spot. In 2018, federal lawmakers legalized hemp, and that opened the floodgates to CBD to an even greater extent. The FDA does caution against using off the shelf CBD products because they are not regulated. Indeed, independent lab tests have demonstrated the presence of other potentially harmful chemicals like solvents, synthetic cannabinoids, toxins and pesticides in some CBD formulations.
There are currently no studies looking at the effects of pure CBD or CBD-rich hemp extracts on headaches. Having said that, studies of whole cannabis, which contains THC and CBD, are promising:
Some doctors suspect that migraines are caused by a deficiency in one of the human body’s endocannabinoids. Humans recognize CBD as “one of its own” and the plant cannabinoid binds to the body’s endocannabinoid receptor. This is why researchers think CBD may be very effective for migraines. In fact, some research indicates that CBD works in the same manner as the triptan or opiate medications, activating the same pathways in the brain. CBD may be just as effective for some people as prescription triptans or opiates.
The first scientific study on CBD’s effectiveness against migraines was published decades ago in 1985. In that study, researchers showed that a THC/CBD combination inhibited the release of the chemical serotonin that contributes to migraine symptoms. More recent studies shed more light on CBD’s potential effectiveness against headaches and migraines. A study in the European Journal of Neurology showed that CBD was more effective than the standard prescription migraine medications, and best of all, CBD had fewer side effects.
In a 2016 study of 127 patients who suffered from migraines and severe cluster headaches, patients were given a high CBD/low THC dose and experienced 55 percent less pain. The other patient group took a common antidepressant called amitriptyline, which doctors also commonly prescribe for migraines. Patients who took CBD had fewer headaches.
These findings suggest that CBD could be one of many ingredients in cannabis that contribute to headache relief. However, it’s far too early to recommend CBD on its own and more studies are needed.
There are many factors to consider when trying to determine the form of CBD that will work best for you. First and foremost, you want to consider what you’re using CBD for, and always make sure you get a quality product.
Topical CBD treatments have been shown to be very effective for migraines. These creams, oils, and gels are easy to apply and fast acting. If you are taking migraine medications, CBD theoretically should not interact with them at all since it works via an entirely different mechanism when compared to common migraine prescription and over the counter medications. However, always consult your physician before combining CBD with any medication you are taking.
There have been no human studies to date regarding the best dosing method for migraine. In general, there are five forms of CBD.
Unfortunately, the market today is flooded with CBD products. While many are excellent formulations from very reputable vendors, many products are of questionable quality. Here are some tips for how consumers can locate truth within the product packaging to ensure you choose a quality product:
While more human research is definitely needed, CBD is receiving lots of clinical attention for many ailments, including migraines. Without CBD, patients must rely on conventional migraine medications, which have some pretty awful side effects. Doctors have been taught a methodology to apply when prescribing migraine meds. First, they try an over the counter drug like Excedrin Migraine, a mixture of aspirin and acetaminophen along with a small dose of caffeine. These drugs are relatively safe if not taken too often, but can cause stomach ulcers or kidney damage if taken more frequently.
However, most people who suffer from severe migraines need a much stronger class of drugs known as triptans (Imitrex and Treximet are examples). These drugs increase the levels of certain brain chemicals and constrict the brain’s blood vessels. They are known to cause dizziness, drowsiness, chest tightness or even nausea.
Some doctors prescribe mild opioids like Oxycontin for migraines, but with opioid deaths quadrupled in the last two decades, this is certainly not a viable long-term option. Finally, doctors might prescribe a class of drugs called ergotamines (Ergomar, Migranal) which can cause debilitating complications like stroke and heart attack. Some of these pharmaceuticals have been linked to birth defects in pregnant women.
CBD is fully natural, plant derived and non-hallucinogenic. When more migraine research has been performed, CBD may prove to be just as effective as these other medications.
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