This Is Your Brain

Everyone knows the symptoms associated with migraines: severe pain, nausea and vomiting, hypersensitivity to light/sound/smell, immobility and wanting nothing more than to rest in a dark and quiet room. The symptoms and stages can be different for different people and are sometimes different even from migraine to migraine, but the following 5 phases have been identified and largely agreed upon by the scientific community:

• Prodrome (a period of warning symptoms): Many symptoms can foretell an oncoming migraine. These include changes in mood (happiness, irritability, sadness) or sensation (funny tastes or smells). Many people experience fatigue and muscle tension before a migraine headache.
• Visual or auditory disturbances (auras): Some people develop scotomas (blind spots), see geometric patterns, experience hemianopsia (vision on only one side), or — less commonly — can even have auditory hallucinations.
• Headache: The fun part. Although migraine pain usually appears on one side of the head, 30-40% of migraineurs (as they are called) have them on both sides. Throbbing pain may occur. Over 80% of migraineurs feel nauseated, and many vomit. About 70% of people become photophobic(supersensitive to light) and phonophobic (supersensitive to sound). This phase may last 4-72 hours.
• Headache termination: Even if untreated, the pain will usually go away with sleep.
• Postdrome: Migraineurs may not feel like themselves for a period of time after the migraine stops. They might not be able to eat right away and problems with thinking and tiredness are common.

A type of primary headache, migraines are thought to be typically caused by abnormal brainstem activity that leads to arterial spasm (rapid contraction) in the cerebrum (main part of the brain) and dura (the covering of the brain). The vascular narrowing from the first wave of spasm decreases blood supply, which causes the aura that some people experience. After the first spasm, the same arteries become tired which causes them to become abnormally relaxed, increasing blood flow and giving rise to the actual migraine headache pain. Since migraines are localized by nature, the epicenter of the migraine is usually focused on one particular area of the brain. Some types of migraines can be more generalized in scope, affecting entire regions of the head.

Certain chemicals found in the brain (e.g. dopamine and serotonin) may be involved in causing migraines. These chemicals are called neurotransmitters (because they transmit signals within the brain. Neurotransmitters can cause blood vessels to act in unusual ways if they are present in abnormal amounts or if the blood vessels are particularly sensitive to them. Various triggers are thought to bring about migraine in people who have a natural tendency for having migraine headaches. Different people typically have different triggers:

• Certain foods: Especially chocolate, cheese, nuts, alcohol, and monosodium glutamate (MSG) can trigger migraines. (MSG is a food enhancer used in many foods, including Chinese food.) Missing a meal may also bring on a headache. More on these later.
• Stress and tension are also risk factors: People often have migraines during times of heightened emotional, mental, or physical stress.
• Birth control pills are a common trigger: Women may have migraines at the end of the pill cycle as the estrogen component of the pill is stopped. This is called an estrogen-withdrawal headache.

This Is Your Brain On Drugs

Drugs can be used either to cut migraine attacks short or to prevent long-term occurrence. Chemicals derived from ergot (e.g. Cafergot and Ergomar) work to dilate affected blood vessels that can reach deep into the brain where migraines are thought to originate and are effective in stopping an attack at the early stages. Once a headache is fully established, opioids (such as Tylox) can be used to relieve the pain. A relatively new migraine drug is sumatriptan (Imitrex). In general it has fewer side effects than ergotamines but it causes frightening chest pain in many patients. Furthermore patients must learn to give themselves subcutaneous injections because sumatriptan is not very effective when taken orally (not to mention the difficulty that arises in eating or drinking when your migraine is in full-swing). Other drugs prescribed for prevention of chronic migraine are methysergide (which is related to ergot derivatives), beta-blockers, calcium channel blockers, chlorpromazine(Thorazine), the steroid prednisone, Inderal, Elavil, Toradol… the list goes on.

Now before you jump to the conclusion that Big Pharma has solved the migraine problem (SPOILER: it hasn’t), it’s important to note several things. First of all, ten to twenty percent of sufferers get no relief from these drugs — and many more get incomplete relief or suffer serious side effects. On top that that, many migraine medications are addicting and can kill you — not a good combination. Do we even need to point out that marijuana does neither?

In fact, not only are there thousands of migraine patients who benefit from cannabis but cannabis has been cited by such historical medical luminaries as Sir William Osler, MD (considered to be pretty much the “father of modern medicine”) and Dr. Morris Fishbein (long-time editor of JAMA) as the best treatment for migraines (back in the days before Congress ignored the AMA and over the AMA’s objection, passed the Marijuana Tax Act).

Cannabis was a standard treatment for migraines from the mid-19th century until it was outlawed in the early 20th century in Canada and the US. It has been reported to help people through an attack by relieving the nausea and dulling the head pain, as well as possibly preventing the headache completely when used as soon as possible after the onset of pre-migraine symptoms, such as aura. There is some indication that semi-regular use may reduce the frequency of attacks.
– Wikipedia (Prevention of Migraines)

To be fair, there are very few formal studies that have been done on medical marijuana for migraines. In fact, to date there have only been a handful of peer-reviewed marijuana studies done, 12 of which were double-blind. While a lack of double blind studies does not negate literally thousands of years of anecdotal evidence telling us that marijuana helps with migraines and over one hundred years of support by prominent figures in medicine, scientific studies are certainly important in some places like the United States where such studies have not been allowed for largely political reasons. For example, Dr. Russo (a well respected neurologist, author, researcher and North American Consultant to GW Pharmaceuticals) tried for four years to get the federal government to approve just such a double blind research project. They refused. These are the same people who say that marijuana should not be legalized because there’s no data that says it has medicinal properties. The complain about there being no data, yet won’t allow said data to be obtained. Imagine that.

(Note: When aspirin was first used for treating headaches no double blind studies were done — yet we still believe that aspirin treats headaches, don’t we? Aspirin was based on centuries of use of willow bark by Native Americans and was grand-mothered in by the 1938 Food, Cosmetics and Drug Act and to the best of our knowledge has never received modern FDA approval because it never had to. Many experts say that if aspirin had to undergo the contemporary FDA approval process it would be far from a shoe in to receive that approval. Go figure.)

Migraines: Cannacooking vs Vaporizing

We want to make a special note and be the first to admit: the quickest method of migraine treatment is inhaling cannabis vapors from a vaporizer. Vaporizers provide almost immediate relief of symptoms and have saved the sanity of many. This is all well and good if you are at home where your vaporizer is… but how many of us are at home all day, every day? Migraines can happen anywhere, anytime. While there certainly are some high quality portable vaporizers on the market (we are big fans of both the Vapir NO2 and the Extreme Q), depending on where you are and what you are doing you can still find it difficult (or illegal) to medicate. Besides, isn’t an ounce of prevention worth a pound of cure, anyways? We advocate a two-pronged approach:

1. A good diet of healthy edibles for a daily preventative regimen and
2. Keeping a vaporizer handy for an emergency situation when something triggers a migraine that is beyond the scope of the edibles to control.

Dosing Your Marijuana Edibles

If you are wondering how much you’ll need to medicate with before you can break the migraine cycle, we regret to tell you there is no easy answer. Not only do migraines affect different people in different ways, but as we’re sure you know marijuana itself can affect people differently. Because of this, we advocate that you keep a headache log that includes information like when you have headaches, the symptoms and part of head affected, the severity, your diet that day, if you vaporized or ate edibles (and most importantly, if they helped), and things of that nature. It’s important to note that most people seem to find relief from an Indica rather than a Sativa, so if you like to switch up your strains be sure to note the strain names and types in your log.

Healthy Food, Healthy Brain

Speaking of tweaking your diet, let’s start with the diet basics. There are two types of food when it comes to migraines and headaches: trigger foods and helper foods. The goal here is to avoid the trigger foods, and eat a lot (and as many different kinds) of the helper foods as possible.

Headache Trigger Foods

These are the foods that can start the migraine reaction. Though not technically an allergy, these foods can cause something like an allergic reaction when it comes to migraines by influencing the release of serotonin — causing constriction and dilation of blood vessels — or by directly stimulating areas of the brain such as the trigeminal ganglia, brainstem, and neuronal pathways. Diet requirements are different in everyone, but there are some common foods to avoid.

According to a report by J Gordon Millichap, MD, published in the journal Pediatric Neurology, the list of foods, beverages, and additives thought to trigger migraines include:

• Cheese
• Chocolate
• Citrus fruits
• Hot dogs
• Monosodium glutamate
• Aspartame
• Fatty foods (i.e. use more cannaoil and less cannabutter)
• Ice cream
• Caffeine (withdrawal)
• Alcoholic drinks (especially red wine and beer — sorry for you Stoner Jerry fans!)

Monosodium glutamate (MSG) is sometimes added as a flavor enhancer in Chinese restaurants. It is also found in commercial soups, soy sauce, salad dressings, frozen dinners, soup mix, croutons, stuffing, some chips, and many other places. It can be disguised on food labels as sodium caseinate, hydrolyzed proteins, or autolyzed yeast.

Published surveys have found that the most commonly reported food triggers are cheese, chocolate, alcohol, bananas, and citrus fruit. In a survey of 429 people with migraine, 16.5% reported migraines triggered by cheese or chocolate, 28.4% reported sensitivity to all alcoholic drinks, 11.8% were sensitive to red but not white wine, and 28% were sensitive to beer. Another survey of 490 people with migraine published in the journal Cephalalgia found that the most common food triggers were chocolate, cheese (18%), citrus (11%) and alcohol (29%).

According to Millichap, certain chemicals in foods called amines (such as tyramine, phenylethylamine, and histamine) are thought to often be the culprits. Tyramine is found in higher concentrations in foods that have been fermented, such as:

• Aged or blue cheese
• Yogurt
• Smoked, cured or pickled meat or fish
• Red wine or beer
• Soy sauce, miso, tempeh
• Foods containing phenylethylamine include:
• Cheesecake
• Yellow cheeses
• Chocolate
• Citrus fruit
• Chocolate
• Cocoa
• Berry pie filling or canned berries
• Red wine
• Foods containing histamine include:
• Banana
• Beef, pork
• Beer
• Cheese, especially yellow ripened
• Chicken liver
• Egg Plant
• Fish, shellfish
• Processed meat, such as salami
• Sauerkraut
• Tempeh, tofu, miso, tamari
• Spinach
• Strawberry
• Tomato, tomato sauce, tomato paste
• Wine
• Yeast and foods containing yeast
• Pineapple
• Citrus fruit
• Chocolate

(Note: Two well-designed studies found no effect of tyramine on migraines. Another study of 39 children found that reducing dietary amines had no effect. Both children on a low-amine diet, high fiber diet and children on a high fiber diet had a significant decrease in the number of migraines and there was no significant difference between the groups. We suggest doing as much research as you can about anything food-science related. Who is right is up in the air right now — which is why you should be keeping a headache log and doing the science yourself.)

In addition to food, other dietary habits (like skipping meals and not drinking enough fluids) may also play a role in migraine development. In fact, the more you learn about migraines and diet the more you will comes to realize how complicated it all really is. For all we know, “a suspected food may not be a trigger 100% of the time,” explains Frederick Freitag, MD, of the Diamond Headache Clinic in Chicago — there are simply too many variables and everyone’s body and diet is different. Here are some complicating factors when it comes to doing dietary detective work:

• Often, foods are triggers only when they are combined with other triggers. This is largely a game of cause and effect. For example, they may act as triggers only when stress or hormonal changes are also at work and make the body susceptible.
• Whether you get a migraine from a food or beverage may depend on how much you consume. You might not have a problem with a small amount of cheese or wine, for example, but it might be a different story when you enjoy a larger portion. For this reason alone we suggest keeping a headache log that tracks what you eat and what activities you do along with any headaches you have.
• You may not get a headache for several hours to several days after eating a trigger food. Keep this in mind while keeping your log as it can be hard to find the connection between migraines and certain foods or beverages.

Headache Helper Foods

These are the foods that help your body relieve migraine pain directly (or at least help you cope). You will want to make special note of these foods and incorporate them into your cannarecipes as much as possible. Keep in mind that a good nutritious diet in general will always help fight migraines. Trust us, eating fast food all the time is the last thing you want to do if you suffer from migraines — the salt and fat content alone is probably enough to push your blood pressure into the migraine danger zone, not to mention all the additives.  The best advice is simply to eat a well balanced diet with plenty of fresh foods like grains, fruits and vegetables. But here are a few specific foods that you may want to introduce into your diet. These are believed by many to have the diet headache migraine connection, and may cut down on your pain:

• Peppermint
• Cayenne pepper
• Ginger (ginger is especially helpful!)
• Fish and fish oil (for the Omega-3 fatty acids)
• Foods rich in calcium (such as spinach, broccoli and kale)
• Foods rich in magnesium (again, such as spinach)
• Oatmeal
• Wheat
• Garlic

Before you get overwhelmed, here’s a great tip from Agnes Peg Hartnell, EdD RD and G Scott Tyler, MD: They suggest you start out by avoiding any food triggers for the length of time that you would normally get 3 headaches, then re-introduce foods one or two at a time a few days apart:

In general, allow three days between headaches before introducing a new ingredient (agent) for testing. And read labels no matter how many times you buy a food product. Manufacturers sometimes change ingredients without warning.
– Migraine Headaches and the Foods You Eat: 200 Recipes For Relief

To clarify by example, let’s say you normally get a headache once every week and decide it might be due to the huge amounts of cheese you’ve been eating (we can only assume you’ve also noticed a change in your digestive process as well). Cut cheese out of your diet for 3 weeks to ensure that you are “cleaned out” and track your headaches in a headache log. Then, after 3 weeks, continue to track them as you slowly reintroduce the trigger food into your diet one every 3 or so days. Again, remember that if you are testing multiple trigger foods to reintroduce them one at a time.