migraine and cannabis as a treatment

[Jmc 077]

Hello, I am a 34 year old male.  This is really a 2-part question.  I have been experiencing severe headaches since my mid 20's with very infrequent headaches before that.  It is still a huge mystery as to why suddenly I began having these headaches.  I will have very intense, pounding and diffuse pain deep in my head that lasts from 1/2 day - 3 days at a time.  I would have to say that left untreated, I have a headache 80% of the time, and a very severe and disabling headache 30% of the time.   I have been tried, in the past, on Inderal (bad choice), Topamax (far too expensive for the minor relief I got), Verapamil, and currently Elavil (for the past 2 years).  I must say that Elavil has offered the best treatment (hasn't reduced frequency much, but has helped with intensity) though it is far from completely effective.  I also have frequent BPPV. I have also found that the moderate use of cannabis will instantly cause a dramatic improvement in my pain far better than any other medication I've tried, however I restrict it's use to only the worst of the worst days due to the way that it aggrivates my vertigo.
1) What are you thoughts on my headaches and possible hidden diseases to look for
2) How can I fight vertigo which is aggrivated by cannabis.
THANK YOU SO MUCH FOR YOUR TIME.

[CCFNeuroMD JT, MD]

I am happy to address the questions that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a substitute for an office visit with a neurologist.  Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.

It sounds as though your headaches have already been addressed rather extensively with both neuroimaging and cerebrospinal fluid analysis.  It is somewhat reassuring that your testing has been negative thus far, although since I am unable to review your MRI/CT results, I cannot confirm these findings.  It also sounds as though you have tried multiple medications in the past including topirimate (Topamax), propranalol (Inderal), amitriptyline (Elavil), and verapamil.  Based on your symptoms, there is a possibility that you may be suffering from two or more different headache types, and although I cannot diagnose you without having seen you, please allow me to offer the following information.

Foremost, it would be important to understand more about your headaches- where are they located? Are they unilateral or bilateral? Do you have any preceding “auras”?  Do you have any visual symptoms?  Is there any associated photophobia, phonophobia, or osmophobia (respectively, sensitivity to light, sound, or smell)? What is the headache quality (i.e. sharp, stabbing, pulsating, dull, throbbing)?  Can you identify any headache triggers?  Do the headaches occur at a particular time of day?  Are there any other symptoms associated (runny nose, watery eyes, palpitations, etc.).  Is there a positional component?  Would you characterize yourself as having a lot of stress in your life?  Have you been taking any OTC medications in addition to your prescriptions?  Are symptoms responsive to caffeinated beverages?

Based on the symptoms you describe, the longer-lasting headaches may be of the tension-type.  Tension-type headache tends to be bilateral in location (often maximal at the temples), the quality a non-pulsating pressure often described as a belt squeezing around the head.  Symptoms are not typically aggravated by exertion.  Nausea, vomiting, photophobia, and phonophobia are not usually characteristic.  Headache is generally present for greater than half the month for more than 6 months (in chronic tension-type headache) and may be responsive to anti-inflammatory medications and/or antidepressants such as Elavil.

There is also a possibility that the debilitating headaches you describe are migrainous in nature.  Migraine headaches are common (more common I females than males), affecting as many as 10-20% of the population.  Typical features of migraine include unilateral location, pulsating pain quality, moderate to severe intensity, exacerbation by exertion, photophobia/phonophobia, and nausea/vomiting.  Migraine with aura describes a headache typically preceded by some other stereotyped phenomena, often jagged lines or flashing lights within the visual field or other sensory symptoms.  Duration is typically 4-6 hours, although symptoms can persist for longer periods of time.  In the acute setting, migraine headaches are often alleviated by abortive medications in the triptan family of drugs (i.e. Imitrex, Frova, Maxalt, Relpax, Zomig, Axert).  These medications work through stimulation of serotonin receptors and are effective in many patients with migraine headaches.  I must offer caution that this class of medications is contraindicated in people with uncontrolled hypertension, ischemic heart disease, history of stroke, and other medical conditions and they should therefore never be taken without consulting your physician.  Sometimes more potent headache medications can be given as an intravenous infusion to help break the headache cycle.  The vertigo you describe may very well be benign paroxysmal positional vertigo; however, migraine-associated vertigo is also a possibility.  

One further question to consider is whether you are experiencing rebound headaches or medication-overuse headaches. A history of headache, present every morning yet responsive to OTC analgesics is highly suggestive of rebound headaches, sometimes referred to as medication overuse headaches.  Similar headaches can also be experienced from chronic daily caffeine intake.  Medications that have proven effective in treating classical rebound headaches include tricyclic antidepressants (such as Amitriptyline) and calcium channel blockers.  However, for these medications to be effective, it is imperative that you discontinue frequent use of OTC medications.  For symptomatic relief, Topirimate may be effective in alleviating symptoms whereas a tricyclic antidepressant or calcium channel blocker taken on a daily basis is used for primary prevention.

As for the responsiveness of your headaches to cannabis use, there has been some report in the literature in this regard, although the mechanism of action is unclear and there is no concrete evidence available.   Being that cannabis is not legal in the US and can have many long-term adverse effects such as dysphoria, impaired fine-motor skills and coordination,  impaired judgement, and cognitive slowing, I do not condone its use.

Thank you for your questions and I hope the above information is of use.  Should your headaches continue, I urge you to seek consultation with a headache specialist who can better address your individual concerns.  

Best of luck!

[myiasdo]

Hi, I too have severe headaches all the time.  I also have MS.  Recently my neurologist suggested I take Vitamin B2, 100 mg. bid.  All I can say is why am I just hearing about this.  My headaches are so much better.  Don't know what to do with myself.  I did look up Vit B2 and low a behold it is used in the treatment of migranes and also MS.  I am just tickled pink about the relief I have had after years and years of ha's and simple Vit B2 helps.  Give it a try.  What your body doesn't use it's flushed out.  
Best wishes.

[Quixotic1]

Are you aware that BPPV is totally treatable?  The doctor that devised the cure, which is now accepted worldwide, is John Epley.  The medical establishment laughed at him for a decade until more and more ENT's tried his manuevers and they all obtained an almost 100% cure rate.  It is now the accepted and taught treatment in all med schools, and can be found in any standard Neurology, Emergency Medicine, Internal Medicine or ENT textbook.  I am a physician, have had BPPV and have been a patient of Dr. Epley.

If you would like I can give you references on the Maneuvers.  This isn't hocus pocus, fringe medicine or hype.  If they reposition the loose canaliths in the semicircular canals (of the inner ear) which are responsible for the paroxysmal attacks, then your other means of relief  would not be a two-edged sword.

Here's a news article about the man and the Epley Maneuvers:

http://www.aliveandwell.org/html/the_bigger_picture/cursing_the_cure.html

If you want actual references I'll be glad to post some or just do a search on Epley Maneuvers.

Quix

[donna80]

hey jmc.. this felt like da ja vu reading your post.. my nan suffers with the same as you, she smokes cannibus (shes 69 lol) it so helps her with the pain ...

she did a diary of her headaches and it turnt out that mayonaise was the cause of the worst days.. and the vertigo..

Have you tryed a diary?

[Jmc 077]

I would also add that I have had thorough testing, including CT+contrast, MRI+contrast, MRA, MR Venogram, and MRI of neck.  Those tests were done within a 3 week period 4 years ago, and just 1 year ago I had a repeat MRI+contrast.   I also had a spinal tap taken 4 years ago along with 20+ tubes of blood.  Everything has been absolutely normal.