Migraine and CBD Oil: Doctor Q&A With Stephen Silberstein, MD, FACP, FAHS

Dr. Stephen Silberstein touches on CBD oil as a potential treatment for migraine and current barriers to its use

Dr. Stephen Silberstein is the director of the Headache Center at Jefferson University Hospital in Philadelphia. At the 60th Annual Scientific Meeting in San Francisco, Dr. Silberstein spoke with us about cannabidiol (CBD) and its relationship to the treatment of migraine and headache disorders.

What is CBD oil, and how is it different from marijuana?
Marijuana contains both tetrahydrocannabinol (THC), an active chemical that has psychoactive properties, and CBD. Unlike THC, CBD oil has no psychoactive properties and is currently on the market and available for purchase in stores and online.

There is a debate in the field of headache medicine right now. Health care professionals are currently asking if patients are better off using the marijuana plant and its extracts, which are natural, or if they are better off using the specific chemicals that come from marijuana, like THC and CBD? It is frequently debated, and there are people on both sides of the fence.

Is CBD oil effective for preventive or acute treatment of migraine?
There is very little evidence that any of the components of marijuana are effective for the treatment of migraine and headache disorders. That does not mean they do not work, however. What it means is that they have not been studied.

What are some of the obstacles patients with migraine and headache disorders face when it comes to using CBD oil?
Some states are legalizing marijuana and its derivatives; however, marijuana is still a federal crime. So, theoretically, if you bought marijuana in a state where it is legal and you travel to another state where it is illegal, you could be arrested by that state or even by the federal government.

In addition, studying marijuana and its derivatives is extremely difficult. There is only one source of plants researchers can use, and they are at a research facility in Mississippi. They are not the best, most pure plants for study.

Accessibility to CBD oil is widespread. You can order it from Amazon and Walmart.com. What are the legal implications of CBD oil?
It is a complicated topic. I can legally prescribe THC and there is no problem with that, but I could not legally prescribe CBD oil until recently, because it has just been approved by the Food & Drug Administration (FDA) for the treatment of epilepsy. Now, we will have CBD and THC both available as prescription drugs, despite the fact that it is still illegal to use the plant, according to the federal government.

What research exists on CBD oil and marijuana as treatment options for migraine?
There are no studies that have been done on either marijuana or CBD oil as treatment options for migraine, and no studies are in the pipeline.

If a physician has a patient who wants to explore CBD oil as a treatment option for migraine, how would you advise him or her?
It depends on your state. If you are in a state where it is illegal, you have no local or federal protection. But if you are in a state where it is legal, either recreationally or medicinally, you have options. For example, in Pennsylvania where I practice, marijuana is legalized for medicinal uses. But physicians in the state of Pennsylvania cannot prescribe it. If they did, their license would be removed, as it is a federal offense.

In some states, it is legal for recreational use, so there is no physician intermediary. Every state is different, and it is extremely important to know the laws in your state.

How does CBD oil interact with common migraine medications?
Theoretically, it should not interact at all. It works on an entirely different mechanism. It might even prevent nausea and vomiting. I cannot think of any reason why it could not be used in conjunction with other migraine medications.

What are the side effects of CBD oil?
Practically none. Unlike THC, CBD oil has minimal, if any, side effects.

Stephen Silberstein, MD, FAAN, FACP, FAHS,is a member of the American Headache Society, a professional society for doctors and other health care workers who specialize in studying and treating headache and migraine. The Society’s objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders, and to share and advance the work of its members. Learn more about the American Headache Society’s work and find out how you can become a member today.