CBD / Medical Cannabis

Summary:
Cannabinoids such as cannabidiol (CBD) and tetrahydrocannabinol (THC) are used by some migraine patients to reduce pain, nausea, and inflammation. Their role in migraine remains controversial.

Biological Plausibility

The endocannabinoid system regulates pain, mood, and inflammation—all relevant to migraine. Animal models suggest possible modulation of cortical spreading depression and trigeminal activation, but human data is less clear.

Evidence

Evidence is mixed and mostly observational. Some retrospective and survey studies suggest fewer attacks or reduced severity, but controlled trials are scarce and inconsistent.

Effect Size

Subjective relief reported in 30–40% of patients, especially in acute settings. Long-term use may lead to tolerance, rebound headaches, or cognitive side effects.

⚠️ Risk

Moderate. THC may impair cognition, cause dependence, or worsen anxiety in susceptible individuals. CBD is better tolerated but can interact with medications.

Cost

$$$

Scores

  • Benefit: 1
  • Burden: 4
  • Ratio: 0.25

Clinical Takeaways

  • May offer benefit for acute relief in select patients.
  • Lack of dosing standards and regulation limits generalizability.
  • Should be approached cautiously and never replace core treatments.

Key References

  • Rhyne DN, et al. *Effects of medical marijuana on migraine frequency in an adult population.* Pharmacotherapy. 2016.
  • Cuttler C, et al. *Short- and long-term effects of cannabis on headache and migraine.* J Pain. 2020.
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