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Integro Medical Clinics: How cannabis can help manage migraine pain

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The experts at Integro Medical Clinics explain how cannabis medicines can help manage and alleviate the excruciating pain of migraine.

Migraine can be a devastating and utterly miserable condition that can have a profound effect upon the patient’s quality of life.

But medical cannabis can offer a really effective, side-effect free treatment option, as we see in our patients’ story with Mike.

A migraine is categorised as a moderate or severe headache felt as a throbbing pain on one side of the head. It is generally accompanied with symptoms such as feeling sick, vomiting and increased sensitivity to light or sound.

It’s a common health condition, affecting around one in every five women and around one in every 15 men and they usually begin in early adulthood.

No one knows exactly what causes migraines, although they are thought to be the result of temporary changes in the chemicals, nerves and blood vessels in the brain.

Many patients find they have a specific trigger such as certain food or drink, stress, tiredness or hormonal changes such as starting your period. Around half of all people who experience migraines also have a close relative with the condition.

There are several types of migraine, including:

migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights

migraine without aura – the most common type, where the migraine happens without the specific warning signs

migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop

The frequency of the occurrence of migraines really depends upon the individual. It can be several times a week to every few years.

There’s no one specific cure for migraines. Patients try pain medicines such as paracetamol and ibuprofen and triptans to help with the pain but these medicines are often ineffective.

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

Cannabis medicines have been found by certain patients to be incredibly helpful in the management of pain.

Dr Anthony Ordman, senior clinical adviser and hon. clinical director of Integro Clinics explains why: “Recent medical scientific research is showing that cannabis medicines can have several useful roles in the prevention of migraine, and also reducing pain if a migraine attack does occur.

“It is likely that substances in cannabis medicines (plant-derived CBD, THC and terpenes) all have roles to play and that they supplement the activity of the brain’s naturally occurring endocannabinoid system. This system may be under-active in people prone to migraine.

“There are three likely mechanisms by which cannabis medicines may be effective. Firstly, the natural stabilising or anticonvulsant effect of the cannabinoids suppresses the spreading abnormal wave of voltage depression in the brain’s cortical neurones. This wave precedes all migraine attacks and causes the aura familiar to migraine sufferers.

“Secondly, cannabis substances are thought to stabilise the mast cells of the immune system. In migraine, mast cells are involved in dilatation, or opening up of the blood vessels of the brain’s lining (dura), causing that familiar pulsating headache. Cannabis medicines may prevent this process from occurring.

He adds: “And finally, as in other painful conditions, if a migraine does occur, cannabis medicines are likely to block the transmission of pain messages in nerves running from the brain stem to the pain centres of the brain, to reduce pain itself.

A recent study showed that cannabinoids may reduce migraine severity by 49.6 percent without causing the ‘overuse headache,’ that other pain medicines such as paracetamol may cause.”

The patient’s story

Mike is a physically fit 37-year-old South African, who first experienced migraines as a teenager.

The pain he suffered was agonising and totally debilitating. It disturbed his vision, caused nausea and deep pain. Prior to the onset he experienced the aura of lights and would go blind in one eye.

An attack could wipe out days of his life whilst he recovered. For several days after the attack, he would feel befuddled and that his brain was not working properly.

Initially he looked into what could be causing the migraines worrying that he might have a brain tumour, but MRI scans thankfully showed that this was not the case. It was through luck and circumstance he stumbled upon cannabis as a medicine for his condition.

Mike was out playing golf in the hot sun and he became dehydrated. He felt the first symptoms of the headache begin so he paused for a rest under a tree and smoked some cannabis.

Instantly, he felt the pain begin to recede and he knew he had found a solution to his condition. He also wanted to point out that he was able to finish his round of golf and win. He came to the realisation that dehydration and hot sun were his major triggers.

Using cannabis would also mean that when a migraine did come it would last for a much shorter period of time and there was none of the post attack brain fog.

“I cannot recommend medical cannabis highly enough as treatment for migraine,” says Mike.

“It addresses all of the symptoms of the loss of vision, nausea and deep pain by addressing the inflammation in the blood vessels of the brain.”

Dr Ordman adds: “Integro Medical Clinics always recommend remaining under the care and treatment of your GP and specialist for your condition, while using cannabis-based medicines, and the Integro clinical team would always prefer to work in collaboration with them.”

If you would like further information, or to make an appointment for a medical consultation, please contact us at Integro Clinics:

Website: www.integroclinics.com
Email: Contact@integroclinics.com
Twitter: @clinicsintegro

Further help and support can be found at the following patient charities:

https://www.migrainetrust.org/ @MigraineTrust

https://www.nationalmigrainecentre.org.uk/ @NatMigraineCtr

https://headachemigraine.org/connect-with-others/ @CoalitionCHAMP

https://painuk.org/members/charities/migraine-trust/ @Pain_UK

Endometriosis

Does CBD affect endometriosis?

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Illustration of a female ulterus
Statistically one in 10 people with a fertile uterus suffer from endometriosis

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Always Pure Organics’ research assistant Alexandra Gkoutzidou explores the evidence behind the use of CBD to treat and manage the symptoms of endometriosis.

 

What is Endometriosis?

The endometrium is the lining of the uterus that hosts the zygote after fertilisation of the egg[3]. If the egg does not get fertilised, meaning does not embed itself to the endometrium, the endometrium sheds off, causing menstruation.

Then the endometrium will be reconstructed in expectation of the next zygote and shed off again if that does not happen. The endometrium, therefore, is destroyed and reconstructed every month.

When endometrium cells grow in different part of the uterus (other than the endometrium lining) or even the body, this is called endometriosis[2]. The endometrium cells will shed and regrow every month no matter their location in the body, causing lesions, painful periods (dysmenorrhea), pelvic pain, infertility, or subfertility.

Statistically one in 10 people with a fertile uterus suffer from endometriosis, but its cause is not clear yet.

The role of the endocannabinoid system

It appears that the endocannabinoid system (ECS) plays an important role in the normal processes of the female reproductive system[3, 9].

Studies show that proper regulation of the ECS is important to maintain a healthy regulated reproductive system. It has been observed that endocannabinoids’ and their degradative/oxidative enzymes’ expression fluctuate in the female reproductive organ in accordance with the stage of the menstrual cycle[5].

The levels of these endocannabinoids are raised to increase fertility during ovulation and then fall during the luteal phase of the menstrual cycle. Research has shown that this fluctuation of the ECS is not as well-regulated for people suffering from endometriosis.

The results have shown that people with endometriosis have low amount of CB1 receptors in the uterus and abnormal levels of endocannabinoids in their blood during their menstrual cycle.

Evidence shows that in the reproductive system, the use of cannabinoids operates in more than one way.

The way the cannabinoids operate in this system is related to both the amount of expressed cannabinoids and also in the phase of the menstrual cycle. The use of cannabinoids to treat endometriosis, is therefore a complicated case and in such cases it is important to consult a doctor instead of self-medicating, because high levels of the “wrong” cannabinoid, or even at the wrong time of the month could possibly affect ones fertility or cause other gynaecological issues.

What does the evidence say?

McHugh et al [4], researched the effect of THC and N-arachidonyl in the migration of endometrial cells in an animal cell culture. It was observed that while the above two cannabinoids induce migration of the endometrial cells, CBD prohibits it. While this research gives way to more in-depth research for the effect of CBD in human endometriosis, it does not provide sufficient data to claim that CBD is beneficial against endometriosis.

There are two clinical trials currently taking place, researching just that. The first is an open label phase II trial, studying an 1:1 ratio of THC and CBD administered to endometriosis patients to reduce hyperalgesia[6].

The second is a phase III double blind placebo study, where patients will receive norethindrone acetate, a type of hormonal treatment, in accompany with 10 or 20mg of CBD for the management of endometriosis pain[7].

Regardless, a lot of people are already using cannabis and/or CBD to treat the pain derived from endometriosis. Research that took place in Australia investigated the self-management strategies amongst Australian women with endometriosis [8]. This online research was published on social media and invited women to share their own methods of treating their endometriosis symptoms.

The authors suggested that the anonymity of an online research could increase engagement, due to the fact a lot of people use illegal substances to treat pain symptoms. The most common strategies used were self-care and lifestyle choices like heat, rest and meditation, but the most highly effective rated self-reported methods were cannabis, heat, hemp/CBD oil, and dietary changes.

Anecdotal evidence suggests that the use of CBD, THC and possibly other cannabinoids could help treat the pain related to endometriosis, but given the role the ECS has in the uterus there should be more in-depth research in order to realise the factual role CBD plays in endometriosis (if any). The pain sensory system is different to the reproductive system. The role of CBD in pain is well understood and the analgesic effect of CBD in endometriosis pain is probably related to it instead of an effect to the endometrial cells [5, 10, 11].

Nonetheless, CBD has been shown to have positive effects for patients with diseases related to ectopic movement of cells in the body, like cancer and psoriasis. Indeed, CBD has been shown not only to inhibit some cancer cells growth, but also to mediate these cell’s movement to other parts of the body (metastasis) [14, 15, 16].

Similarly, psoriasis is a disease which one of its symptoms is the over production of new skin cells too quickly, that causes the scales. In that case, CBD has been shown to positively affect the skin making it more elastic, better hydrated and reducing the amount of scales by promoting the balanced production of cells and minimising the ectopic production [12]. Similarly, CBD could possibly benefit the ectopic production of endometrial cells but it is yet to be researched.

The levels of cannabinoids in the uterus are strongly related to the phase of the menstrual cycle and they are formed so to increase fertility [9, 13]. Therefore, it is ill advised to use any cannabinoids if you are trying to get pregnant or have a related health problem without advising your doctor and testing whether the endocannabinoid levels are correct during your cycle. A well balanced ECS is the target so always follow the dosage directions.

 

References

[1] https://www.nhs.uk/conditions/endometriosis/

[2] doi: 10.1002/bies.201100099

[3] doi:10.1093/molehr/gas037

[4] DOI:10.1111/j.1476-5381.2011.01497.x

[5] DOI: 10.1089/can.2016.0035

[6] https://clinicaltrials.gov/ct2/show/NCT03875261

[7] https://clinicaltrials.gov/ct2/show/NCT04527003

[8] doi.org/10.1186/s12906-019-2431-x

[9] DOI: 10.1177/1933719114533730

[10] DOI: 10.11607/ofph.1274

[11] https://doi.org/10.1007/s40122-019-0114-4

[12] doi: 10.7417/CT.2019.2116

[13] DOI              10.1186/1471-2202-11-44

[14] DOI: 10.1007/s13105-018-0611-7

[15] doi: 10.17305/bjbms.2018.3532

[16] DOI: 10.3390/ijms2115540

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Case Studies

“CBD allows me to function” – biker ‘died’ three times after freak road accident

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Gary Brennan pictured with wife Shirley
Gary Brennan and wife, Shirley set up a trauma support service after the accident

After a serious motorbike accident, Gary Brennan almost lost his life, undergoing 54 operations to fix his broken body. Gary speaks to Cannabis Health about the “life-changing” accident and how CBD helps to manage the pain 11 years on.

On February 28th 2010, Gary Brennan collided with a car while riding his motorbike.

He broke both shoulder blades, tore his liver, crushed his kidney, shattered his pelvis fractured his spine and suffered from bleeding on the brain and a collapsed lung.

These are just some of the life-threatening injuries that he sustained in the accident.

So severe were his injuries that he was declared dead at the scene of the incident. Paramedics were able to resuscitate him before he was helicoptered to Leeds General Infirmary where he underwent emergency surgery.

During the operation, his heart stopped twice and his family were told that he may have just a few hours to live. He was put into an induced coma and relied on a life support machine to breathe.

Miraculously, Gary survived.

His condition stabilised enough to come out of the coma, but since then he has undergone a total of 54 operations.

When Gary’s condition stabilised enough to come out of the coma he was in excruciating pain. Having battled injuries that doctors deemed barely survivable, the 63-year-old was administered a plethora of drugs to keep the pain under control and has since undergone a total of 54 operations.

“The accident was life-changing to say the least,” Gary told Cannabis Health.

Gary Brennan underwent more than 50 operations

“I got through the operations and everything else, and then I got to the stage where I was lying in bed, zoomed out my head every day of my life with the drugs that I was taking.”

The cocktail of medications including morphine and ketamine kept the pain at bay but according to the father-of-four, it was “destroying” his brain.

Bed-bound, in pain and suffering from a relentless medication plan, Gary slipped into a period of depression and at one point considered suicide.

“I don’t say this lightly,” he said. “It brings tears to my eyes just thinking about it; that I actually even considered it having been a fit, active father-of-four and grandfather-of-six.

“But that was what the drugs were doing to me.”

Gary recalls waking up in the morning “groggy as hell” and in agonising pain until he took his medication.

“All it would do was numb my mind so that I didn’t feel the pain,” he added.

Knowing he had to find an alternative, he looked into CBD.

Although he was sceptical at first and questioned whether the benefits were merely a placebo effect, Gary found that CBD was helping reduce the pain while still allowing him to keep a “clear” head.

“Now I’ve got clarity, I’ve got a clear head, I can get out of bed in the morning. I still get the twinges but it’s not as severe pain,” he continued.

“The pain is always going to be there, but it’s handled in a different way. It doesn’t numb your brain, but the actual place that’s aching. It gives me relief and allows me to function.

“It changed my outlook on pharmaceutical drugs.”

Gary has now come off all prescription drugs apart from one, which he takes “now and then” to lower his blood pressure. Instead, he takes four capsules of CBD each day, equating to 720 milligrams.

Eleven years on from the crash, he has founded his own CBD brand, Brain Body Balance, and is working with US company, Ananda Scientific, to bring its patented Liquid Structure CBD formulation to the UK.

Ananda claims that the nano-sized technology makes its CBD formulation up to 20 times more bioavailable in the first 30 minutes than standard CBD. This is down to its “non-destructive” shell which contains the CBD and is able to pass through the gut and liver without being broken down. The shell only disintegrates when it reaches the small intestine, allowing for a greater amount of CBD to enter the bloodstream.

Ananda’s pharmaceutical-grade CBD is currently undergoing clinical trials to test its efficacy for treating pain, diabetes and mental health conditions including PTSD and anxiety.

Meanwhile, the nutraceutical arm of the company has launched over-the-counter products in the UK and the US through brands like Brain Body Balance.

Gary with one of his six grandchildren.

For Gary, producing a product with high bioavailability was a priority.

“I knew the product itself worked, but actually getting it into the bloodstream where it does its job is the hardest thing to do,” Gary said.

“You have to use stronger and stronger doses in order to get it into your bloodstream.”

Alongside his CBD venture, Gary set up the charity, Day One Major Trauma Support to limit the impact of trauma on patients and families in hospitals across Leeds and the wider Yorkshire area.

“When I was lying in hospital, the doctors would come around once a day and say, ‘how are you feeling, Gary?’, ‘can you feel your toes?’. Then they would say, ‘see you tomorrow’ and off they go,” he said.

“The nurse comes around, gives you your pills, then your family come in, pat you on the head and say it’ll be okay. Basically, that’s all you get.”

Aware of the lack of support, Gary set out to create a service that helped those like him who had suffered from major trauma. The charity provides financial assistance, legal advice and practical and emotional support.

Off the back of its success at Leeds General Infirmary, the charity will now be rolling out its services in all 27 major trauma centres in the UK.

Gary added: “Any help is there first-hand, no matter what, so nobody’s left in the lurch.”

 

 

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Pain

How cannabis medicines can help relieve back pain

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A new webinar will focus on how cannabis medicines can help relieve back pain

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A stand-alone webinar event will focus on the role that cannabis medicines can play in relieving back pain.

This new field of medicine can offer life-changing help to those patients who find that traditional pain medicines and clinical intervention are no longer helping or have unpleasant side effects.

The discussion will explore the potential benefits of the addition of cannabis medicines into a chronic pain management regime for this diverse patient group.

Dr Anthony Ordman

Including injury, wear and tear, musculoskeletal disorders such as scoliosis, axial spa or spina bifida or as a consequence of another underlying health condition such as multiple sclerosis, fibromyalgia, arthritis, Parkinson’s disease or cancer.

The healthcare professionals taking part have many years experience between them in complex pain management and expertise in the treatment of back pain for a variety of conditions.


The panel

Dr Anthony Ordman – consultant pain specialist at Integro Clinics and former president of the Pain Medicine Section of the Royal Society of Medicine

Dr Basil Almahdi – consultant pain specialist at Complex Spine Clinics London

Dr Brian Hammond, PhD – chiropractor & osteopath, CEO National Back Pain Association (BackCare)

Dr Basil Almahdi

The event, hosted by The National Back Pain Association (more commonly known as BackCare or BackPain UK) and Integro Medical Clinics will take place on Thursday 25 May from 7pm-8.30pm.

Click here to book your free place or email jessicasmith@integroclinics.com

For information and support visit Integro Medical Clinics and BackCare

 

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