A headache is a continuous or short-but-regular pain in the head, whether dull or sharp. Migraine affects more than 37 million Americans. Headaches and migraines cost the United States approximately $13 to $17 billion annually.
There are two groups of headaches: primary and secondary. Primary headaches are the most common type, and are not caused by another problem or condition; migraine headaches often fit into this group. Secondary headaches come as a result of another disease or condition.
Types of headaches include tension, sinus, thunderclap, and Chiari. Headaches are not a feature of all types of migraine.
Headaches/migraines are one of the most common conditions for patients seeking a medical marijuana card. Cannabinoids and terpenes in cannabis may help manage pain and stress associated with headaches and migraines.
Headache/migraine causes
Headaches are caused by overactivity of or problems with pain-sensitive structures in your head. Blood vessel spasms, dilated blood vessels, inflammation or infection, and muscular tension can stimulate pain-detecting nerves (nociceptors). Once a nociceptor is stimulated, it sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts. In the case of headaches, it would be pain-detecting nerves in the head.
There are a considerable number of conditions that can cause migraines and headaches. These include:
- Infections such as cold or the flu
- Stress
- Brain injury
- A neurological condition
- The side effects of another medication (e.g. antidepressants)
- Mood disorders like anxiety and depression
- High blood pressure
- Chronic pain associated with another condition or injury
- Chemotherapy
- Hormonal changes
- Sensory sensitivity caused by another condition, e.g. autism
- Environmental factors, such as regularly being exposed to high levels of noise pollution
Migraines do not always have head pain (e.g. migraine aura without headache), but most types do. Head pain in migraines can occur in specific parts of the head, as opposed to a general feeling all around the head. Meanwhile, headaches often result from irritation of the meninges and blood vessels. Nociceptors may be stimulated by head trauma or tumors, which can cause headaches.
We do not know much about cluster headaches, migraines, or tension headaches, including how they develop. Serotonin seems to be involved in many types of headaches.
Headache/migraine symptoms & health effects
The health effects of headaches and migraines can range from mild to severe, with some types being extremely painful and debilitating, e.g. cluster headaches. In 2016, headache was the fifth most common reason for emergency room (ER) visits overall, and third most common reason for females. 21.7% of females and 10.7% of men are affected by headache and migraine.
Headache and migraine is also associated with disadvantaged economic status. In 2018, approximately 40% of US adults with migraine were classified as “poor” or “near poor.” Nearly one in five had no health insurance, and a third had high school education or less.
Unlike most types of headaches, migraines often include symptoms such as nausea and/or vomiting; seeing spots or flashes; temporary vision loss; sensitivity to light and/or sound; tingling and numbness in the face and hands; pain in specific parts of the head, such as at the temples or behind the eyes or ears; and confusion.
Migraines without headaches were previously known as “acephalgic migraines” or “silent migraines” but are nowadays just termed “migraine aura without headache.” Other debilitating symptoms, like nausea, vomiting, and sensitivity to light and sound, are still present in migraines without headaches.
Migraine is often accompanied by depression, anxiety, fatigue, neck stiffness, yawning, and poor concentration.
Headache/migraine diagnosis
There is no lab test or imaging study that can be used to detect headache or migraine, although medical imaging may be used to rule in or rule out headaches caused by brain injuries or tumors. Based on screening diagnostic criteria, if you have the symptoms of headache associated with sensitivity to light, a decrease in function, and nausea, you likely have migraine.
There are many different types of migraine, each with their own diagnostic criteria:
- Migraine without aura: At least five attacks of headaches lasting between 4-72 hours in adults or 2-72 hours in children; pulsing headaches in one location in adults or two locations in children; moderate or severe pain intensity; nausea/vomiting; sensitivity to light/sound
- Migraine with aura: Aura that resembles the walls of a fort, often starting as a small hole of light, sometimes developing into bright geometrical lines and shapes; a headache; sensory symptoms such as numbness; speech and/or language problems; double and/or poor vision; poor balance
- Aura without headache: Some types of migraine are not accompanied by headaches. These most frequently occur in older people. The absence of headache makes the exclusion of other causes (such as a stroke or heart attack) difficult.
- Episodic migraine: Migraine occurring less than 15 days a month.
- Chronic migraine: Migraine occurring 15 days or more per month for more than 3 months.
- Menstrual-related migraine: Migraine occurring predominantly between 2 days before and 3 days after the start of menstruation for at least 2 out of 3 consecutive menstrual cycles.
Headache/migraine prognosis
Some types of headaches and migraines (e.g. migraine with aura) may reduce life expectancy by around 1-2 years, as well as increase the likelihood of suffering a cardiovascular event like a stroke or heart attack.
Headaches and migraine can also have a negative impact on a person’s quality of life (QoL), disrupting work, household chores and activities, recreational and social plans, and more.
Headache/migraine treatments
There are many treatments and medications that can help manage headaches/migraines of all types.
First-line treatments
The most common go-to medications are over-the-counter (OTC) pain relievers like acetaminophen (paracetamol, Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) acetylsalicylic acid (Aspirin) and ibuprofen (Advil, Nurofen).
Other treatments
Should the headache and/or migraine prove to be debilitating and resistant to first-line treatments, other medications may be prescribed.
Prescription medications include triptans like:
- Almotriptan (Axert)
- Eletriptan (Relpax)
- Zolmitriptan (Zomig)
Anticonvulsants like:
- Gabapentin (Neurontin)
- Sodium valproate (Depakote and Depakote ER)
- Topiramate (Topamax, Topiragen, Qudexy DR, and Trokendi-XR2)
And, when nausea and vomiting accompany the headache/migraine, antiemetics like:
- Dolasetron (Anzemet)
- Domperidone (Motilium)
- Metoclopramide (Primperan, Maxolon)
In some instances, opioid analgesics like codeine may be prescribed.
Adjunctive therapy & alternative treatments
Non-medication interventions include ensuring that you drink enough water, get enough sleep, exercise regularly, increase your magnesium intake, and reduce your nitrate and nitrite intake.
Herbal remedies include peppermint, ginger, lavender, gingko biloba, feverfew, and butterbur.
A mind-body technique called “biofeedback” may also be used to control the body’s functions, such as breathing patterns, muscle responses, and heart rate. This can be used to reduce anxiety, tension, and pain associated with headache and migraine.
Cannabis for headache/migraine
Products derived from the cannabis plant have been used on various types of headaches and migraines, with varying results. However, there does seem to be a link between the endocannabinoid system (ECS) and the detection of many kinds of pain, including headaches. Many people use cannabis to manage headaches and migraines.
Phytocannabinoids like CBD may also affect serotonin levels, which could be a key reason why cannabis may help manage headaches/migraines. Other compounds, like the terpenes beta-caryophyllene, limonene, and myrcene, may help manage pain and stress arising due to headaches and migraines.
Cannabis also contains several anxiolytic, antidepressant, anti-inflammatory, antioxidant, analgesic, antiemetic, and stress-relieving compounds that can help alleviate not just migraine headaches but also any nausea and vomiting, appetite reduction, insomnia, anxiety, and depression associated with them.
However, it should be noted that some studies and reports suggest that, for some patients, cannabis may have little or even negative impact on their headaches. For example, in a study on cluster headaches, some subjects reported relief, while others reported worsening of their condition. Interestingly, when it comes to cluster headaches, psilocybin may be of particular use due to its action on serotonin receptors.
What patients say about cannabis for headache/migraine
Additional information for patients
There are several charities in the US that provide advocacy, resources, and support services for those with headaches and migraines. These include:
- American Headache Society
- American Migraine Foundation
- Headache Advocacy Network aka Coalition for Headache and Migraine Patients (CHAMP)
- National Headache Foundation
Headache/migraine FAQs
How long does a migraine headache last?
Headaches related to migraines typically last between 4 and 72 hours in adults and 2 and 72 hours in children if left untreated.
Seek immediate medical attention if you’re experiencing the worst headache you’ve ever had, lose vision or consciousness, have uncontrollable vomiting, or if your headache lasts more than 72 hours with less than 4 hours pain-free.
What foods should I avoid if I suffer from headaches/migraine?
Consuming lots of alcohol, caffeine, and foods like sweets, artificial sweeteners, and heavily salted foods (such as cured meats) should ideally be avoided for those with headaches and migraines.
What triggers headaches or migraine?
Headaches and migraines may be triggered by a variety of causes, including:
- An infection such as a cold or flu
- Stress
- Caffeine withdrawal
- Changes in hormone levels during a woman’s menstrual cycle or with the use of birth control
- Insomnia and changes in sleep patterns, such as not getting enough sleep
- Drinking alcohol
- Exercise, especially overexertion
- Loud noises or bright lights
Resources
- The prevalence and impact of migraine and severe headache in the United States: Updated age, sex, and socioeconomic-specific estimates from government health surveys: https://pubmed.ncbi.nlm.nih.gov/33349955/
- Aura without Headache or “Silent Migraine”: A Guide: https://americanmigrainefoundation.org/resource-library/silent-migraine/
- Migraine with aura and risk of cardiovascular and all cause mortality in men and women: prospective cohort study: https://www.bmj.com/content/341/bmj.c3966
- The Use of Antioxidants in the Treatment of Migraine: https://pmc.ncbi.nlm.nih.gov/articles/PMC7070237/
- Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature: https://pmc.ncbi.nlm.nih.gov/articles/PMC8459575/
- Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science: https://pubmed.ncbi.nlm.nih.gov/30152161/
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