Moskowitz Migraine Protocol

Moskowitz Migraine Protocol:
Utilizing Cannabis for Control of Migraine Headaches

Excerpted from: CBD: A Patient’s Guide to Medicinal Cannabis
~ Healing Without the High
, by Leonard Leinow c.2017

Recommended by Dr. Michael Moskowitz, MD, MPH
of Bay Area Pain Medical Associates, San Rafael, California

What is a Migraine Headache anyway?
A migraine is a headache disorder characterized by recurrent moderate-to-severe headaches that most often affect one half of the head. Migraines tend to be pulsating in nature and last from four to seventy-two hours or longer. Symptoms can be disabling: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell with the possibility of tingling or numbness in the extremities or face. Physical activity can exacerbate the pain. Migraines impact approximately one billion people globally and about 38 million men and women in the United States. Migraines are the third most prevalent illness in the world.  In many cases, migraines cause such severe symptoms that patients are unable to focus on work, children or other responsibilities. The underlying causes are not fully known. Some studies suggest migraines are aggravated by chronic dehydration.  Those encountering migraines may benefit from drinking ample, uncontaminated, pure water, regularly.  Migraines are commonly believed to involve the nerves and blood vessels of the brain but may also be caused by problems in the cervical spine. Depression, anxiety and sleep disturbances are common for those with chronic migraine.

How about pharmaceuticals?
Interestingly, medication overuse is the most common reason episodic migraine turns chronic. Furthermore, the healthcare and lost productivity costs associated with migraine are estimated to be as high as $36 billion annually in the United States. Although 25 percent of sufferers would benefit from preventive treatment, only 12 percent of sufferers receive it.

These numbers indicate that improved treatment options for this debilitating condition must be developed. Recent studies show migraine headaches may be due to endocannabinoid deficiency and abnormal inflammatory response. In fact, patients suffering from migraines have reported feeling as if the brain tissue itself is inflamed and physically bunping against the skull. The use of CBD and THC can augment endocannabinoid deficiencies and mitigate or reduce inflammation.

It is suggested patients work with a healthcare practitioner experienced in recommending CBD or medicinal cannabis, in order to develop correct dosage and delivery methods, fine-tuned on an individual basis. At the same time, educated and aware patients can be their own highly informed health consultants.

How about Cannabis?
Oral CBD products with a ratio of 20:1 CBD:THC or higher, administered as drops, capsules or edibles, can effectively address the pain. Most discussions of treating pain with CBD suggest that finding the right dosage is critical. Always start with a micro-dose to test sensitivity and increase the dosage until symptoms subside. Patients need to monitor their condition and experiment to find the right dosage.

For the most part, using CBD to prevent symptoms from manifesting is much easier than treating migraines after the onset of symptoms as, at that point, augmenting CBD with some quantity of THC is often necessary. A person without experience of THC should use caution and slowly titrate up to higher doses. A 1:1 ratio of CBD:THC to minimize psychoactivity. Specific anti-inflammatory strains of cannabis, high in CBD, such as Swiss Gold, Cashey’s Honey, Sour Tsunami and Harlequin can be excellent in reducing symptoms. Sour Diesel, while having a higher THC profile is another highly effective strain for reducing pain. Researchers have found inhalation a more effective and immediate delivery than ingestion, as cannabinoids get into the bloodstream more quickly and can last for three hours. Ingested products take thirty to sixty minutes before taking effect (faster on an empty stomach) and last six to eight hours.

Dr. Allan Frankel, a physician who treats migraine-suffering patients with CBD, states: “Every migraine patient I have seen has always suffered with anxiety and tight cervical muscle issues. So, whether it is a true migraine, cluster or other non-vascular headache, my recommendation is almost always modest doses of a high ratio CBD:THC capsule”

What’s the best way to use Cannabis to manage a Migraine?
Another method of delivery for migraines recommended by Dr. Michael Moskowitz involves rubbing in a few drops of alcohol-based tincture to the left and right temples and to the Occipital bone at the base of the skull. Also apply a few drops to the the inner cheek, at the Temporomandibular joint where sensory and motor branches of the Trigeminal nerve are located. (see adjacent diagram) Typically, an alcohol tincture of a high THC sativa strain, administered with a cotton swab or your finger works best and can be very fast acting.  Also, a 1:1 ratio of CBD:THC (sativa dominant strains are recommended) can be very effective, with results often occurring almost immediately. Even a high CBD, low THC, oil based infusion can be effective. None of these treatments cause psychotropic effects in the vast majority.

Other cannabinoids are also shown to relieve pain, including CBC, CBG, THCV and THCA.  Varieties high in beta-caryophyllene, myrcene and linalool provide additional pain relief and increase the effectiveness of other cannabinoids for analgesia.

For relief of immediate symptoms, as in a flare-up of pain, vaporizing or smoking work well.  The medication effect is immediate and lasts one to three hours, whereas most ingested products take thirty to sixty minutes before taking effect (faster on an empty stomach) and last six to eight hours.  Cartridge vaporizers filled with a CO2 concentrate of varying ratios of CBD:THC, are highly effective, as are whole plant herbal vaporizers.

It’s important to note clinical research on the effectiveness of cannabis on Migraine headaches is ongoing.  Preliminary results do indicate a high likelihood of effectiveness.  Anyone undertaking the use of cannabis for managing migraine symptoms must keep in mind the vast variability attributable to individual differences.   In other words, results will likely vary between individuals with regard to dose, strain and ingestion method.  So keep track of your experience and make adjustments accordingly.

Got Anxiety?
Anxiety developing after several bouts or migraine experience is known as an anticipatory symptom and can be treated with a minimal dose of CBD in the morning. The cervical muscle tension that can precipitate a migraine can similarly be treated with the same CBD regime. Dr. Frankel adds, “I have seen this nearly always works.”*

*Excerpted from: Leinow, Leonard – CBD: A Patient’s Guide to Medicinal Cannabis ~ Healing Without the Highc.2017,  pp. 139 – 142