Christopher Grant is a construction worker and motocross rider. To look at him, you would probably think, “He’s quite the active guy, pulling off physically demanding activity and living a generally healthy life.” Yet, like many people with chronic conditions, Christopher doesn’t necessarily like to show the pain he’s in. “A lot of people don’t realize I’ve gotten really good with coping with it [migraines], to where I can act on the outside like this sort of social butterfly or whatever. But on the inside, I’m having the biggest fight with myself in the world.”
A patient is said to be suffering from chronic migraine if they experience migraines for at least 15 days of the month for three months or more. According to a study by American Migraine Prevalence and Prevention (AMPP), 17.1% of American women and 5.6% of American men suffer from episodic migraines (EM), whilst 1.3% of American women and 0.5% of American men suffer from chronic migraines (CM).
Living life with chronic migraines is not easy. There’s not only the extreme sensitivity to light and sound (no doubt made even more difficult when surrounded by machinery all day, as Christopher is), but also living with moderate to severe pain, a constant throbbing, pulsating sensation on the side of the brain affected by the headache, and a sharp pain usually focused on one particular part of the head. Physical activity can often make the migraine feel worse. The pain can usually last for hours or even days, and there is often a “lingering pain” after an episode is finished. Unsurprisingly, CM can be a debilitating condition, and cause huge social and economic problems for sufferers. Employers lose $13 billion per year and 113 million lost work days due to migraine.
To make matters even worse, there are few treatments for CM that are truly effective. For some types of headache, NSAIDs such as indomethacin may be prescribed, but come with many negative side-effects and are highly toxic. Opioid-based medications are not necessarily of huge use for migraines, and over-the-counter medications such as acetaminophen (Tylenol, an analgesic) and ibuprofen (an NSAID) are not necessarily going to work for everyone – over half (57%) of those who used ibuprofen for their migraines found relief, but particularly severe migraine sufferers require an alternative treatment. Other forms of treatment include triptans, which are serotonin agonists, but these can be expensive and are not necessarily covered by all insurance providers. Beta-blockers are also sometimes used for migraines.
Despite the fact that so many people suffer from headaches and migraines, little is known about what causes them. Several theories have been postulated, including:
- A central nervous system (CNS) disorder/an underlying neurological condition.
- Irregularities in the shape and size of blood vessels, or an issue with the flow of the blood itself. This means less blood, and therefore oxygen, can get into the brain.
- Chemical imbalances, with “the suggestion that migraine is a consequence of a central neurochemical imbalance that involves a low serotonergic disposition.”
- Genetic factors – having close family members with the same issue increases the chances of having migraines.
As for a little on the pathophysiology of headaches, they often result from the irritation and inflammation of the meninges (the three layers of protective tissue surrounding the brain and spinal cord) and blood vessels of the brain. Stress and anxiety can also cause headaches. Regardless of the cause or origin of the headache, their development usually involves overactivation of the trigeminovascular pathway, resulting in the release of vasoactive peptides such as calcitonin gene-related peptide (CGRP), substance P (a neuropeptide that acts as a neuromodulator and neurotransmitter) and vasoactive mediators such as nitrous oxide (NO).
Cannabinoids may help those with chronic migraine and persistent headaches as:
- THC can act as a vasodilator and increase the amount of blood and oxygen flowing into the brain.
- Many cannabinoids, including THC and CBD, have anti-inflammatory effects that could be useful for treating migraineurs.
- Cannabinoids may modulate serotonin release, blocking pain and vomiting in migraine sufferers. As migraine sufferers tend to have increased serotonin levels in the brain, consuming THC and CBD may inhibit the release of serotonin.
- There have also been significant differences in cerebrospinal fluid anandamide levels documented in migraineurs. Using cannabinoids may help “reset” the body’s anandamide levels in migraine sufferers, and thereby also have a knock-on effect on other receptors in the body, including serotonin receptors.
Now, this is not to say that cannabinoids are useful for everyone with migraines. Also, some people may respond positively to one cannabinoid-terpenoid profile, whilst another responds neutrally or negatively (some have noticed “rebound headaches” after cannabis cessation, but this could also arise due to the body not getting the endocannabinoids it needs). For Christopher, “Most days, it [cannabis] clears me up, and it’s like nothing’s wrong, you know what I mean? So it’s a very useful tool, that’s for sure.”