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 By Dr. Frank Michalski, DC

Migraine Headache: 

You wake up and it hits. You go to bed and your head is pounding. You can’t sleep which makes it worse, lights begin to bother you, noises are painful, your head is throbbing and there is no end in sight!! Is this the start of a migraine? Let’s begin our discussion of headache disorders by first defining what a migraine headache is. 

Migraine: 

A neurological syndrome that results in altered bodily perceptions, with increased light sensitivity, sound sensitivity, head movement sensitivity, severe headaches and nausea.1 Other symptoms may include vomiting, numbness and tingling, vision loss, neck pain, fatigue and weakness.2 Migraines can last from 4 hours up to a few days. What causes a migraine? This question is not fully understood, but it is believed that activation of the trigeminovascular system results in migrane.2 

Come again? Irritation to the nerves can result in inflammation in the brain and blood vessels surrounding it. As the blood vessels dilate more inflammatory factors are released, continuing the vicious cycle. This irritation and inflammation results in a migraine. In short, the brain and the nerves surrounding it become irritated and inflamed, which results in headache (typically on one side of the head). 

Migraine Aura:

If you have ever suffered a migraine you may have experienced an ‘aura’. This is an increased sensitivity to smells, sounds and visual changes.5 It has been shown that ‘aura’ results from increased activity of glutamate, a stimulatory neurotransmitter.5 Think of glutamate as a chemical made in your body, that when released inappropriately, puts your senses into overdrive.5 Read below to learn how CBD may help prevent aura symptoms. 

What do Endocannabinoids have to do with migraine?

Recall from our previous discussions, CBD is one of a 100+ cannabinoids found in the cannabis plant. Your body naturally makes its own cannabinoids, called endocannabinoids. The two primary cannabinoids made by your own body are called AEA and 2AG. It is thought that endocannabinoid deficiency may be to blame for some migraines. Studies have shown that patients with chronic migraines have lower levels of AEA found in their cerebral spinal fluid.1 It is possible that lower levels of AEA result in activation of the trigeminovascular system and irregular pain response to external or internal irritants.1 This may imply when our ECS is out of balance, our pain centers are “out of balance”. Another study showed that female patients with migraines had elevated levels of FAAH, an enzyme that destroys/ breaks down AEA and your bodies own cannabinoids. Makes sense considering more females suffer from migraines than males. 

What is a tension headache?

A tension headache can last minutes or weeks. The pain is a pressing or tightening feeling, of mild to moderate intensity, bilateral in location, usually not made worse with physical activity.2 These are the most common types of headache. Sadly, many people with tension headaches overuse medication, which eventually may lead to migraine headache syndromes. It is believed that muscle tension in the neck results in oversensitive nerve endings in the neck, which results in headache. Keep reading to learn about more solutions for tension headache treatment!  

What triggers tension headaches and migraines:

• Chronic inflammation 
• Foods 
• Stress 
• Caffeine 
• Food additives 
• Medications 
• Lack of Sleep 
• Not eating around a regular cycle (this point is debatable) 
• Alcohol 
• Menstrual cycle and hormonal changes 

Migraine statics:

• 14.2 % of US adults have reported severe headache in the previous 3 months back in 2012.
• 19% of females and 9% of males will suffer migraine.
• Highest in females 18-44 years old (particularly among reproductive years) 
• Half of the population each year will experience a headache. 
• Migraine is experienced by roughly 1 out of every 7 US adults.
• Women are 2-3 times more likely to experience a migraine and 1.25 times more likely to experience a tension headache. 
• Migraine and headache are a leading causes of outpatient emergency visits. 
• Cost roughly 36 billion dollars a year in healthcare cost and missed work.    

What is the worst part? 

Many medications used to treat headache have serious side effects, even over the counter mediation. First and foremost, medication can lead to rebound headaches, or even turn acute headaches chronic. Take a moment to digest what I am about to tell you. 

In the US, misuse and overuse of acetaminophen, aspirin, ibuprofen, naproxen and others sends 200,000 people to the ER a year!!!!!  What are the symptoms of over the counter pain medication overdose; serious gastrointestinal bleeding, stomach ulcers, damage to the esophagus, intestine, liver and death!! GI specialists treat roughly two patients per week for gastrointestinal disorders due to over the counter pain medication misuse. 4   Medication over use is the most common reason infrequent migraines become chronic.5 

Can we do better? Can CBD help with this massive public health concern?

As previously mentioned, it has been shown in limited studies that people who have chronic migraines appear to have lower levels of naturally occurring endocannabinoids and elevated levels of FAAH, an enzyme that breaks down your body’s own cannabinoids.  By taking CBD you are helping promote balanced cannabinoid levels. CBD blocks FAAH from destroying your body’s own cannabinoids, this helps your ECS regulate pain better. 

CBD orally is best used in a preventative manner. It is recommended taking between 10-100mg daily for prevention. Start slow and work your way up to a desired serving size. In my offices we recommend 10mg up to 3x per day and increasing by 5mgs per serving as necessary. 

Some studies have demonstrated using up to 400mg daily with THC/CBD combinations. If people are seeking using cannabis and THC for acute migraine breakthrough, they must discuss this with a licensed physician. THC has shown benefit, although this is not meant for todays discussion.  

When using the CBD oil, a few drops are best administered in the inside of your cheeks near the back of the jaw. This is close to the region of the trigeminal nerve. This may show added benefit based on anecdotal evidence.5

Do not forget about the roll on and pain cream. 

Most people in my offices who suffer from headache benefit from both the roll on, cream and oral drops. Applying the roll-on CBD to the back of the neck, temples and above the eyes creates a cooling sensation that is great for those tension headaches. It is my experience that almost everyone who suffers from headaches has tight neck muscles. Many people even go for trigger point injections to break up the “knots in their neck”. What would you rather do, get Botox injections in your neck muscles or try a CBD roll on? What an excellent alternative if it works for you! 

Other considerations: 

As always, a focus should be decreasing inflammation. Try your best to begin light exercise and eating an anti-inflammatory diet. CBD works best in conjunction with a healthy lifestyle. Ask your naturopathic chiropractor or doctor for food allergy testing and hormone testing. These tests can play a role in figuring out the best lifestyle corrections. 

In my offices we use “treatment stacking” protocols in conjunction with CBD. Treatment stacking involves cold laser therapy (to the muscles in the back of the neck), IASTM or Garston protocol (to break up knots), traction (to decompress the disc spaces), and (if indicated) spinal manipulation. You should seek out a provider who offers these services immediately. This works wonders for people who have “knots”, disc herniations, and stenosis.

Disclaimer: 

If this is a new onset or different type of headache please seek consult with a neurologist, imaging may be warranted. Before seeking conservative care, red flags must be ruled out. Migraine and headache can be the symptoms of a much more serious condition, they always require proper work up. IF you are having the “worst headache of your life”, 10/10 pain, slurred speech, vision changes and other serious symptoms call an ambulance, this could be a TIA or stroke.   

*This content is strictly the opinion of Dr. Frank Michalski and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Frank Michalski nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.

In Good Health, 

Dr. Frank Michalski 

Michalskifrank8@gmail.com 

References:

1. https://www.ncbi.nlm.nih.gov/pubmed/20353780 :The endocannabinoid system and migraine. 

2. Chowdhury D. Tension type headache. Ann Indian Acad Neurol. 2012;15(Suppl 1):S83–S88. doi:10.4103/0972-2327.100023

3. CBD: What You Need to Know by Gregory L. Smith, MD MPH 

4. https://www.statnews.com/2017/10/09/pain-medication-over-the-counter/

5. CBD: A Patients Guide to Medicinal Cannabis by Leonard Leinow & Juliana Birnbaum 

6. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies.