Can Cannabis Reduce Migraine Pain? Here’s What the Science Says

Learn about the science behind using medical cannabis to manage migraine, including expert opinions, real-life perspectives, and research.

A Real-Life Example of Cannabis Use for Migraine

Nancy Thompson, a 55-year-old Canadian citizen, is among those seeking alternatives. Thompson has had migraine attacks since she was a teenager, and once they became frequent (occurring six to seven times weekly), her general practitioner sent her to a neurologist, who prescribed a variety of treatment strategies.

“We tried a bunch of different things, including an anti-seizure medication and Botox, and for me, they just weren’t doing much of anything. The Botox we considered a success because I would go one day a week without a migraine,” she says.

Desperate for a solution, she and her husband decided, albeit reluctantly, that she should try cannabis.

“I was very apprehensive of it. I had absolutely no idea what would happen,” Thompson says.

Thompson had a positive experience. With her neurologist’s blessing, a doctor’s prescription, and guidance from a licensed medical cannabis producer, she started vaping cannabis flower. Within three weeks, she went one day without any migraine symptoms, followed by two, and then by three, and then an entire week.

When her migraine symptoms do manage to break through, she says, their duration is slightly shorter. More importantly, “the pain is nowhere near as bad, that’s for sure, and I can usually get away with just some Tylenol or Advil, go lie down, and within a few hours, I’ll be better,” she says. Thompson also has prescription rescue medication (including a triptan and a buffered aspirin with caffeine) just in case she fails to find relief with cannabis alone.

The link between medical cannabis and migraine is not new. Cannabis has a long history of use in treating severe headache-like pain, with one of the earliest mentions of it dating back to the second millennium BC. Throughout the centuries that followed, medical cannabis shifted in and out of fashion before regaining its place in modern Western medical toolboxes in the 1840s.

“From 1848 through 1948, cannabis was one of the most commonly used drugs for treatment of migraine,” says Lazlo Mechtler, MD, the medical director of the Dent Neurologic Institute, the Dent Headache Center, and the Cannabis Clinic in Buffalo, New York.

“Unequivocally, cannabis was one of the drugs of choice back then.”

Because of cannabis’s Schedule 1 status, it has traditionally been difficult for researchers to obtain special licenses and access the supply of federally endorsed cannabis for their studies.

That’s why most research examining cannabis in migraine treatment has been observational (meaning that outcomes are measured without introducing a specific treatment or intervention), and why many doctors have been hesitant to recommend cannabis to their patients.

The study found that a combination of THC and CBD was most effective, compared with THC only, CBD only, and a placebo. “We found that the THC plus CBD combination was more effective than placebo for a variety of measures that we studied, while THC was more effective than placebo for fewer measures. CBD overall was not statistically superior to placebo,” he explains.

Observational studies — especially those published within the past few years — have also consistently shown the benefits of medical cannabis for some people with migraine, including reduced migraine severity or monthly frequency, and have shown that cannabis can be safely substituted for ineffective pharmaceutical drugs.

While the clinical trial above may well serve as an opening for controlled clinical research, what’s the best rule of thumb for people seeking relief now? First off, bringing a clinician into the fold is vital, as cannabis has risks and benefits to consider.

“Most people who have migraine have it for many years, and most people never talk to a doctor about it, so most are not using the optimal standard of care — evidence-based treatments, which are now much better than they were even a few years ago,” notes Schuster.

“Work with a doctor,” he says. “If you haven’t seen a doctor in the last couple of years, certainly see your doctor again. Migraine is a medical condition that warrants medical treatment.”

An important question to consider when choosing a doctor is whether that person has direct experience in guiding patients on how to use cannabis as migraine treatment.

“Medical schools haven’t taught cannabis or the endocannabinoid system for years, and only recently have physicians had exposure to that knowledge,” Dr. Mechtler says. “I started a cannabis clinic, so what I’ve done is take cannabis off the streets to a form of medical cannabis under the control of a clinician,” he adds. So far, Mechtler says that he’s treated more than 13,000 patients.

While many clinical studies have been conducted using inhaled cannabis, Mechtler does not recommend smoking it, noting the risks in people with asthma or lung disease.

Instead, people with migraine who wish to try cannabis should consider vaping or tinctures, he says. Either formulation quickly delivers cannabis to prevent or stop a migraine attack early in its tracks, since it bypasses the liver and absorbs directly into the bloodstream.

• Chemovar type 1 (THC-dominant)
• Chemovar type 2 (combined THC and CBD)
• Chemovar type 3 (CBD-dominant)

The decision is a personal one, and a doctor’s guidance should support it. “Some people respond to a one-to-one ratio, some people to just THC, and some people to just CBD,” Mechtler says. “But you have to consider age, other medical conditions, type of migraine, frequency, and severity.”

The trial-and-error approach also involves trying one chemovar for a period of time, then returning to the doctor for follow-up, ideally every three months for at least the first year of use.

• Whether or not medical cannabis is helping to relieve pain
• A report of side effects
• The frequency and timing of cannabis use
• Current dosage (including the need for higher doses to achieve the same effect)

This way, the physician can adjust the dosage based on individual outcomes and, in particular, be on the lookout for potential side effects. Schuster has advised that his studies have seen beneficial effects from a low dosage. “It is important for people with migraine to know that the potencies we studied were low dosages, THC 6 percent and CBD 11 percent, which are much lower than the potencies commonly available at U.S. dispensaries,” he elaborates. “Patients do not need to use much cannabis to have anti-migraine benefits.”

• Hallucinations and illusions
• Depression and low mood
• Impaired short-term memory
• Reduced cognitive function, attention, and focus
• An altered sense of time and senses
• Lethargy and drowsiness
• A feeling of reduced motivation
• Possible substance use disorders
• Dry mouth and dry/red eyes
• Increased heart rate
• Blood pressure fluctuations
• Dizziness and fainting
• Impaired coordination and balance
• Slowed reaction time
• Respiratory irritation and cough (if smoked)
• Chronic nausea/vomiting
• Diarrhea and decreased appetite (specifically from high CBD) or just increased appetite (specifically from THC)
• Altered adolescent brain development
• Reduced fertility hormones and sperm production
• Low birth weight in infants
• Drug interactions
• Increased risk of traffic accidents

Schuster also explains that his study only examined the effects of cannabis on four different migraine attacks throughout a year, which doesn’t show the effect of frequent use. “We were not studying routine or frequent use of cannabinoids,” he states. “There is still a question whether frequent use of cannabinoids may make migraine attacks more frequent.”

Thompson says that since she started using medical cannabis, she has experienced occasional memory lapses (for example, searching for a word while speaking) but that overall, it’s been a life-changer.

“The difference in my life is so incredible. My kids have their mom back. My husband has his wife back. I’m back in the world, able to work and do things again,” she says.

For Thompson, cannabis has been a gateway toward getting her life back on track. But success (and side effects) vary from one person with migraine to another, which is why Mechtler considers it to be just one part of the migraine toolbox.

“I strongly believe that you don’t give patients one option,” he says, “but you have multiple different tools — one for acute migraine, one for nausea, and one could be a cannabis product. That gives power back to the patient.”

Schuster also backs conventional migraine treatments. “People with migraine should discuss standard-of-care medications such as triptans and gepants as well as migraine preventive treatments with their physician before self-treating with cannabinoids,” Schuster recommends.

• Many people with migraine are exploring cannabis as an alternative treatment option, with studies showing potential benefits in reducing migraine severity and frequency, although the effects can vary.
• Randomized controlled trials and observational studies suggest that cannabis might be effective for acute migraine treatment, but further research is necessary.
• Given that medical cannabis can present side effects such as hallucinations and impaired cognitive function, individuals with severe conditions like migraine should engage healthcare professionals before use.
• People can try medical cannabis as one part of a comprehensive migraine management strategy, along with conventional medications for preventing and treating migraine attacks.