Historical Uses

As noted by Russo in his excellent historical review,98 cannabis has been used for the prevention and relief of migraine headaches for over a thousand years in Chinese, Indian, Egyptian, Greek, Roman, and Islamic medicine. The earliest reference to cannabis in migraine treatment dates from ninth-century Persia and recommends inserting cannabis juice into the patient’s nose, thus avoiding its rejection by vomiting. As cited by William Dymock, a later Persian source additionally claimed that cannabis was good for “deterging (washing) the brain.”99 A twelfth-century herbalist and abbess, Hildegard von Bingen, wrote of cannabis in her Physica, “Whoever has an empty brain and head pains may eat it and the head pains will be reduced. Though he who is healthy and full of brains should not be harmed by it—He who has an empty brain shall be caused pain by indulging in hemp. A healthy head and a full brain will not be harmed.”100 Extracts of Cannabis indica for oral administration were available from most apothecaries in the West, beginning in the 1840s. Oral cannabis extracts became Western medicine’s drug of choice for migraine from the mid-nineteenth century until the early 1940s. From the 1870s onward, prestigious medical journals including The Lancet, the Journal of the American Medical Association, and Merck’s Archive all printed articles recommending cannabis in migraine treatment. The 1912 Merck Manual entry on migraine gives cannabis as the sole medicinal option. A 1919 Eli Lilly catalogue lists, “Cannabis Indica, Extract” as a treatment for migraine and neuralgia at doses up to 1 gram. By the 1930s, physicians began to complain about the wide variance in potency found in pharmaceutical cannabis extracts. This inconsistent level of quality and the first marijuana laws encouraged the ultimate removal of cannabis from the Western pharmacopeia in 1941. The final appearance of cannabis as an established treatment for migraine in the West appears in a 1942 issue of the Journal of the American Medical Association.101 Over the next 50 years of prohibition, most Western physicians forgot that cannabis had ever been used to treat migraine. In China, India, and Southeast Asia, despite prohibition in the West, cannabis remained a common treatment for migraine headaches. In the 1990s, Russo attempted to gain permission from the National Institutes of Health (NIH) to conduct clinical trials with cannabis on migraine patients. Although NIH and the FDA approved Dr. Russo’s research protocol, the National Institutes of Drug Abuse blocked the study. In 2004, Russo published a hypothesis that a deficiency of endocannabinoids in some patients underlies the pathophysiology of migraine, fibromyalgia, and irritable bowel syndrome, thus coining the term Clinical Endocannabinoid Deficiency (CECD).102 THC seems to be the primary anti-migraine agent in cannabis, although other phytocannabinoids may be of use.