100 Migraine Drugs, A to Z: cannabidiol

Medical marijuana (MM) is now legal in 30 states. Most states approve its use for specific medical conditions and severe pain and nausea, which are symptoms of migraine, are usually on the list.

I’ve been prescribing MM since it was legalized in the State of NY four years ago. My estimate is that one out of three patients find it useful. Some take it daily for the prevention of migraine attacks, but the majority use it as needed, whenever an attack occurs. MM sometimes relieves all of the symptoms of migraine, but sometimes only pain or only nausea. Some patients find that it helps them to go to sleep and when they wake up, the headache is gone. A few patients have told me that they take it regularly for insomnia and that it often works better than prescription drugs, such as zolpidem (Ambien) and does not cause side effects. The calming effect of MM is also useful when dealing with a very upsetting and debilitating condition such as migraine.

Most states require an analysis of the amount of active ingredients in every MM product by an independent laboratory. The two main ingredients are tetrahydrocannabinol (THC) and cannabidiol (CBD). This is one of the advantages of going the legal route – you know that the product will be the same each time you buy it. However, my patients have told me that they prever products from one or another dispensary even when using products with the same concentration of THC and CBD. This can be explained by the fact that all MM products contain other supposedly inactive ingredients, which in fact may also have various positive or negative effects.

CBD oil made from hemp is legal to buy without a doctor’s prescription and is available for purchase online. For many it works well by itself to relieve pain, nausea, and inflammation. THC is responsible for the sedating and calming effect. However, even a small amount of THC often makes CBD more effective. Raphael Mechoulam, a Hebrew University professor who discovered THC, calls this the entourage effect.

Many patients take low THC/high CBD products during the day to avoid euphoric and cognitive effects, while at night they might take a high THC/low CD combination.

For faster onset of actionvaping MM is optimal, while for the prevention, taking a pill or a tincture can be more convenient. These are the three types of products that are approved in NY.