Today we are going to discover how CBD can be a good therapeutic option for all those who suffer from headaches. Thanks to its analgesic, anti-inflammatory and soothing properties on both physical and mental levels. CBD can be of great help not only to alleviate the symptoms associated with headaches, but also to reduce their frequency and/or intensity in a stable way and significantly improve the quality of life.
Headache is a common and complex disorder of the nervous system that chronically affects between 4 and 12% (1)(2)(3) of the world's population, and can occur episodically to almost anyone throughout life.
There are several types of headache with different symptoms, the most common of which are:
As can be seen, both the symptomatology and the causes of headaches and migraines are quite different, thus implying a different therapeutic approach.
In addition to the two main ones, there are different headaches related to flu and ailments, premenstrual syndrome, dental problems, intoxications (also excess of analgesics)... (3)
A very thorough study by Ethan Russo (4) on the history of Cannabis use for headaches describes and documents how this plant has been used for centuries as a symptomatic treatment for migraines and headaches in all cultures, from Islamic, Indian and Chinese to Greek and Roman. In particular, between 1842 and 1942, it was part of Western pharmacopoeia, being the treatment most commonly prescribed by leading doctors to treat migraine symptoms.
Today, recent discoveries about the Endocannabinoid System have made it possible to understand more about the mechanisms involved in headaches and the role that phytocannabinoids, in particular CBD, can play in each specific case.
Although much remains to be discovered, it is being hypothesized that complex disorders such as migraine, fibromyalgia and irritable bowel syndrome (characterised by chronic inflammatory states that cause pain and other associated symptoms), could be caused by a deficiency of the Endocannabinoid System. A good response to cannabinoid treatment can therefore be confirmed (5).
Thanks to scientific discoveries made in recent years (6), it has been possible to establish a close relationship between the mechanisms that can cause headaches and migraines and the Endocannabinoid System (ECS):
To learn more about this system read our article on the Endocannabinoid System.
These studies seem to confirm the hypothesis that disorders such as migraines may have their origin in ECS dysfunction(9), showing how a therapy based on indirect stimulation of endocannabinoids (through inhibition of FAAH) seems to be very promising (10) and, consequently, placing the use of CBD in a fundamental position.
Although there are still no clinical trials on the use of Cannabis for migraines, most of the clinical evidence in humans can be seen in single case or small group studies, as well as anecdotal cases and surveys (6). These studies show positive results in the use of THC (11). Most of them refer to self-administrated use of inhaled Cannabis or through medication, with its synthetic counterpart. Thanks to current advances in studies on the properties of CBD and the link between ECS and the mechanisms of action of migraines and headaches, it has been found that the use of Cannabidiol could be much more effective.
In particular, a study presented in 2017 at the 3rd Congress of the European Academy of Neurology showed the effectiveness of a combination of THC and CBD in 40% of the cases studied. More recent research has demonstrated the effectiveness of the use of Cannabis in different disorders characterised by chronic pain, showing good results especially with the use of CBD-rich products (12).
According to Dr. Peyarube in an article in the Canna Foundation:
"My clinical experience with these patients is in line with these findings and has allowed me to confirm a very good response to treatment with repeated doses of CBD, requiring very low doses of THC, so that their adverse effects are almost non-existent, and if they do occur, they tend to disappear by lowering the doses of THC. After a treatment with cannabinoids, the frequency of migraine attacks tends to be considerably reduced. In some cases I have even observed their extinction, at least during the time of clinical follow-up".
We have seen that CBD can be a very valuable tool for treating headaches and associated symptoms, thanks to its properties:
Although headaches and migraines share the same main symptomatology (headache), they are usually caused by different mechanisms and therefore recommendations and routes of administration may vary.
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"It's the best thing I have tried, both for pain and migraines. Without a doubt today, it is my choice, to enjoy life."
-María
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It is important to remember that CBD is a natural compound that modulates other physiological systems, i.e. it is made "available" as needed in order to restore the body's balance in a natural and stable way. This means, above all, that the assumption of a higher quantity does not correspond to a greater or better effect.
Therefore, there is an optimal dose for each person to take, and the way to get to know it is to start with a minimum amount (about 10 mg of CBD distributed in 3 daily intakes) and gradually increase it (for example, about 10 mg of CBD every 2 or 3 days depending on the response) until the effect is noticed. Once the dosage has been found, it will remain relatively stable over time, as CBD does not cause tolerance (i.e. it is not necessary to increase the dosage over time to obtain the same effects).
In any case, it is always best to consult a specialist who can accompany you in the follow-up, advise you on a quality product (as the market is not regulated in Spain) and also know the legal regularization framework in your country of residence.
As we have seen, headaches are caused by muscle tension related to bad posture and/or emotional stress, so CBD could be useful especially with sublingual and/or topical administration.
Migraines, unlike headaches, usually involve more complex physiological mechanisms that lead to a release of inflammatory substances and also to an associated symptomatology that is highly incapacitating, therefore CBD could be useful especially with sublingual administration and/or inhalation.
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Según los estudios realizados hasta hoy en día, el CBD no es una sustancia tóxica ni siquiera si es administrado de forma crónica o en altas dosis. Si quieres saber más consulta nuestro artículo sobre el report de la OMS sobre el uso de Cannabidiol.
Los efectos adversos suelen ser de intensidad moderada-leve e incluyen: cansancio, somnolencia, sequedad de boca, mareos y disminución del apetito
Hay que tener precaución especial en caso de combinarlo fármacos analgésicos, antiinflamatorios o hipotensores, tanto si el CBD es administrado de forma sublingual o inhalada. En cambio el uso tópico es seguro, ya que su acción es local y externa. Tampoco es apropiado utilizarlo en personas embarazadas o en etapa de lactancia.
Bibliografía:
Los cannabinoides son sustratos que están cada vez más presentes en la práctica clínica. El CBD es, junto al THC, uno de los dos principales fitocannabinoides del cannabis (existen más de 120) siendo este de carácter no psicotrópico, a diferencia del THC. En el informe del Comité Experto en Drogodependencia de la Organización Mundial de la Salud (OMS), describen que el CBD no se han evidenciado efectos adversos significantes ni potencial de dependencia y tiene un gran potencial terapéutico.(1)
Nos centraremos en el sueño, un elemento fundamental para la salud y el bienestar dada su función de regulación metabólica y del ánimo así como del desempeño cognitivo. Hoy en día, los trastornos del sueño son la queja número uno reportada en los Estados Unidos, y es un problema grave de salud pública. (2) Los trastornos del sueño son motivo de consulta en la práctica general y en psiquiatría. Más del 50% de los pacientes en la práctica general se quejan de insomnio cuando se les pregunta sobre sus patrones de sueño.(3) Dormir bien ya no solo es importante por el cansancio mental y físico diario sino porque puede tener grandes consecuencias a largo plazo. La deprivación de sueño puede verse relacionada con alteraciones en:
Además, ciertas patologías tienen mayor riesgo ( 75-95 %) de sufrir problemas de sueño.
Entre ellas, encontramos:
Existen múltiples trastornos del sueño afectando cada cual a un momento y estructura específicos, siendo los más característicos:
En todos ellos se ve alterado el sistema endocannabinoide (ECS), por lo que afecta a su capacidad de regulación del ciclo sueño-vigilia. (2)
Como norma general, se recomienda dormir entre 7 y 8 horas sabiendo que según cada etapa del desarrollo los valores pueden variar. De base, es importante prestar atención y modificar en caso de que fuese necesario todas aquellas conductas que nos perjudiquen a la hora de dormir bien. Esto se puede conseguir evitando una serie de patrones como:
Cuando todas estas conductas se hayan corregido, si continuasen nuestros problemas, sería momento de pensar tomar algo extra. Normalmente, los fármacos recomendados para los trastornos del sueño son los llamados hipnóticos, entre los cuales se encuentran: las benzodiacepinas y los inductores del sueño no benzodiacepínicos. Además, se pueden recomendar los antidepresivos según el perfil de sueño que tenga el individuo. Como bien se conoce, los hipnóticos no se recomiendan durante largos periodos de tiempo debido a sus potenciales efectos adversos, lo cual complica considerablemente el tratamiento dado que suelen ser recetadas para problemas crónicos.
Es por esa razón que el CBD puede ser una opción muy interesante para complementar nuestro tratamiento y mejorar nuestra calidad y duración del sueño.
En los últimos años, se ha abierto una puerta al uso del CBD para tratar los problemas de sueño. Varios estudios parecen indicar buenos resultados acerca de la capacidad de relajación y mejora de la calidad del sueño que ofrece esta sustancia.
Project CBD, realizó varios surveys (Cultivating Wellness) para entender los usos más típicos del CBD y la mayoría de las personas que utilizan el CBD lo utilizan para aliviar el dolor, la ansiedad y mejorar la calidad de su sueño. (12) En el estudio, se reflejó como el CBD ayuda tanto a quedarse dormido como a mantener el sueño y reduce el cansancio al despertar.
El sueño está regulado por el sistema endocannabinoide (ECS) dada su acción homeostática del ritmo circadiano. Este proceso incluye a:
Además está a la vez influido por múltiples factores (véase: la alimentación, el estrés, el horario laboral, los viajes, la medicación, etc).
Cada noche, los endocannabinoides activan el receptor CB1 del ECS del Sistema Nervioso Central (SNC) incluyendo zonas dedicadas a la regulación del sueño. Esto controla la liberación de neurotransmisores y reduce el exceso de actividad neuronal ayudando al manejo del dolor, la inflamación, la ansiedad, apetito y la calidad del sueño. CBD aumenta la actividad de endocannabinoides donde el receptor CB1, y puede que toma un papel fundamental a la hora de regular el ciclo sueño-vigilia como otros muchos procesos anteriormente mencionados. (13)
Actualmente se investiga a varios niveles sobre el efecto del CBD en el sueño. Un ejemplo descrito en la US National Library of Medicine revela que el uso de CBD durante el primer mes del estudio mejoró los parámetros de sueño (66%) y redujo la ansiedad (79%). Los niveles de ansiedad, muy relacionados con la calidad del sueño, se mantuvieron reducidos a largo plazo. (14)
Una revisión sistemática de varias fuentes de datos como PubMed, Scopus, Web of Science, Embase, CINAHL and PsycInfo databases indica que a pesar de no haber suficiente evidencia sobre los beneficios del CBD en el tratamiento de trastornos del sueño, parece haber evidencia preliminar prometedora sobre el tema en cuestión. Los ejemplos más característicos que se han estudiado en la práctica son los siguientes; alteración ritmo circadiano (hipersomnolencia), insomnio relacionado con la ansiedad y estrés post-traumático, sindrome de piernas inquietas, trastornos del comportamiento del sueño REM y la somnolencia diurna. (14)(15)(16)
El CBD ayuda a regular el ciclo vigilia-sueño afectado frecuentemente en casos de horarios laborales nocturnos, desequilibrios horarios por viajes… Las alteraciones del ritmo circadiano pueden manifestarse tanto a modo de insomnio como de hipersomnolencia según el tipo de alteración horaria que presenten. En ambos casos, hay evidencias prometedores que indican que el CBD pueda sería beneficioso.(15)
Así mismo, reduce la ansiedad que puede acabar manifestándose como dificultad para iniciar o mantener el sueño. En concreto, permite que la gente que sufre ansiedad concilie el sueño de manera más inmediata y que se evite el despertar temprano en casos depresivos. Según relata Project CBD, en un estudio de 1521 individuos, el tiempo transcurrido hasta adquirir el sueño se redujo de 1 hora a 20 minutos y los despertares nocturnos se redujeron a un tercio con el uso de CBD. Incluso se está estudiando sus posibles beneficios en casos de alteración del sueño por estrés post-traumático. (12)(14)
Además, parece actuar en la fase REM de movimientos oculares rápidos del sueño y normalizar la latencia del sueño REM, es decir, el tiempo que tarda un paciente entre que se queda dormido y entra en fase REM, normalmente unos 90-120 minutos. Regular la fase REM podría ayudar a casos de pesadillas, síndrome de las piernas inquietas o incluso en el trastorno del comportamiento del sueño REM.(14)(16)
Por si fuera poco, las investigaciones también apuntan a que el CBD puede ser beneficioso para los casos de somnolencia diurna. Los pacientes afectados sufren episodios de sueño intenso durante el día con la necesidad de dormir y gran dificultad de despertar. En esta dirección, se está empezando a estudiar qué tipo de efectos produce el CBD en trastornos del sueño relacionados con la respiración.(14)(16)
Como ya hemos mencionado, no existen claras indicaciones validadas a la hora de consumir CBD. En principio, recomendamos que cada persona adapte su consumo a nivel individual comenzando por pequeñas dosis.
A modo general, los expertos coinciden en adoptar un uso diario y regular para maximizar los efectos del CBD. Todo ello, bajo consulta médica en caso de estar tomando un medicamento para asegurar que no haya riesgo de interacciones.
La forma más común es el uso sublingual. En Canadá, donde el Cannabis medicinal es legal para consumo ingerido, tienen la motto “Start low and go slow,” es decir empieza con poco e ir poco a poco. ¿Por qué? Pues por que cada cuerpo es único y nuestro ECS también lo es. Entonces la dosis no es estándar como los medicamentos típicos.
Los expertos recomiendan una dosis partida (es decir 3 veces al día, mañana, mediodía y noche) y un uso diario y regular para lograr los efectos. En el caso de sólo padecer trastornos del sueño sin otras comorbilidades, ciertos estudios han optado por tomar una cápsula de CBD por la noche después de cenar.(14)
Por lo general, ciertos estudios como uno publicado por la US National Library of Medicine, comienzan por administrar dosis de 25 mg/d. De aquí, como hemos dicho, sería cuestión de ir evaluando día a día el efecto y escuchar nuestro cuerpo y en caso de ir modificando, siempre poco a poco. Lo importante es tener en cuenta que nuestro cuerpo sufre al generarle grandes cambios por lo que variar de manera significativa y abrupta la dosis nunca será beneficioso. De todos modos, hay bastante margen de acción pues incluso hay estudios como uno publicado en British Journal of Clinical Pharmacology que indican que el rango terapéutico se encuentra entre <1 y 50 mg/kg/d, dosis que se podría consider muy elevada para un primer momento.
Una dosis sublingual puede variar para una variedad de pautas:
Varias fuentes científicas certifican que el CBD interacciona con otras hierbas y suplementos hipnóticos tales como la melatonina, causando un mayor grado de sedación e hipnosis. A pesar de la poca evidencia y de resultados concluyentes sobre los claros efectos de la sinergia de ambas sustancias, la interacción entre ambas parece darnos alguna clave para plantear en el futuro nuevas investigaciones al respecto.(18)(19)
Cierto es que aunque la investigación se esté acelerando y avanzando en este sentido, las fuentes de revistas y artículos científicos no cuentan con suficiente evidencia como para dar certeza de las indicaciones. Por ello, debemos fomentar la investigación al respecto y el análisis crítico para crecer todos juntos en conocimiento.
Si estás tomando otros medicamentos consulta con tu médico para asegurar que no haya interacciones con el CBD. Sobre todo es importante descartar interacciones con otros fármacos metabolizados a nivel hepático, proceso que resultaría en un incremento del fármaco a nivel plasmático (de la sangre). Aún no estando clara la dosis de CBD exacta para la aparición de interacciones, se supone que son casos con dosis elevadas de CBD y en ningún caso con riesgo vital.
Su acción a nivel del sistema endocannabinoide y otros sistemas neuroquímicos permite su empleo para tratar el sueño con un perfil de seguridad y tolerabilidad favorables. A día de hoy no se ha evidenciado ningún caso letal por intoxicación de cannabis dado su bajo índice de toxicidad.
En todo caso, existen una serie de posibles efectos adversos dosis e individuo dependientes. Estos suelen ser de intensidad moderada-leve e incluyen: cansancio, somnolencia, sequedad de boca, cefaleas, mareos y disminución del apetito.
Además, como afirma la Fundación Canna, según los datos que se manejan hoy en día, es probable que el CBD no genere tolerancia. Esto implicaría que no es necesario aumentar la dosis de consumo para conseguir un mismo efecto a lo largo del tiempo. (20)
Bibliografía:
Having to deal with an important and/or new situation, facing a critical day at work, struggling to get through university exams, taking care of your home and family, going on a date, going through a break-up, meeting your manager or going to a job interview, dealing with situations that have caused stress in the past....
When people find themselves in these circumstances, It is common to begin to feel fear, an overwhelming sensation, shortness of breath, nausea, and stomach pain. These discomforts may be linked to excessive stress that leads to symptoms of anxiety. According to preclinical trials, CBD has potential as a natural remedy to reduce such symptoms.
The term anxiety can refer not only to a more chronic disorder but also to its symptoms that can appear acutely. It is a natural adaptive mechanism that puts us on alert in compromising situations, being suitable to prevent dangerous situations and to keep us focused in circumstances where we have to give 100%.
Problems arise when there is an excess of stress and there are not enough tools to handle it, so people can feel overwhelmed and with a sense of resignation in a situation that exceeds their own capabilities.
All this can be worsened in people who have lived through traumatic experiences of different degrees. The symptoms may be associated with similar experiences or simply with stimuli that are associated with those memories, which can provoke panic attacks that often represent another traumatic event, thus extending the cycle and leading the person into an incapacitating situation.
The person suffering from anxiety may feel particularly vulnerable or helpless and there may be a deterioration in psychosocial and physiological functioning.
Symptoms related to episodes of anxiety are:
If anxiety is persistent and intense, it can prevent the person experiencing it from carrying out a normal day-to-day life.
CBD (Cannabidiol) is the second most abundant cannabinoid among the phytocannabinoids found in Cannabis Sativa L. plants. Unlike many other cannabinoids, CBD is non-psychotropic and has a different beneficial and therapeutic profile than other psychoactive cannabinoids, recognised by the World Health Organization (WHO).
One of the properties of CBD is that it is anxiolytic. It acts in our body through the receptors of the endocannabinoid system, regulating the activity of the amygdala and the insula, whose activities are related to the emotions and symptoms linked to anxiety disorders and stress, such as fear, disgust or sadness, but also to love and happiness. Its role as a regulator and modulator of the activities of these brain structures is therefore significant.
Stress by definition is not always negative, as it produces hormones such as adrenaline, dopamine, or serotonin, which influence the energy of a person, increasing their vigor and confidence to face a problem. However, when stress is continuous or unmanageable, the body generates different hormones such as cortisol, which produces feelings of exhaustion and irritability or even lack of motivation. CBD stimulates specific receptors capable of modulating serotonergic and dopaminergic activity to promote a physiological balance whose effect on the psychological level is anxiolytic and antidepressant.
Existing preclinical evidence strongly supports CBD's potential as a treatment for anxiety disorders. This is because CBD exhibits a range of effective properties for some symptoms, including anxiolytic, antipsychotic, panicolytic and anti-compulsive actions, a decrease in fear, and prevention of long-term anxiogenic effects due to stress.
These preclinical studies have shown that CBD interacts with receptors that regulate fear and anxiety-related behaviours, specifically the cannabinoid receptor type 1 (CB1), the serotonin receptor 5-HT1A and the transient receptor potential (TRP) vanilloid type 1 (TRPV1).
CBD, administered consistently on a regular basis, reduced acute stress-induced increases in heart rate and blood pressure, as well as the delayed anxiogenic effects of stress (those occurring within 24 h of the stress-inducing event). CBD has also been shown to enhance the extinction of fear responses in addition to blocking the reconsolidation of adverse memories.
In summary, it can be seen that CBD is a complete and integral therapeutic tool, capable of acting on a physical, psychological and emotional level, while representing one of the most suitable treatments for anxiety and stress disorders.
CBD, unlike other substances that have a more direct impact (stimulating or inhibiting), is able to indirectly modulate and enhance the endocannabinoid system, so that all the physiological processes necessary to re-establish the homeostasis (balance) of the body are set in motion.
Every person has a different body that is characterised by a unique and personal balance. Therefore, each person will have their own specific ways of coping with different problematic situations such as anxiety, thus requiring the most personalised treatment possible.
For these reasons, it is difficult to establish an effective amount of CBD for anxiety in general, as it is necessary to find the most appropriate dosage for each person. In addition, anxiety can be triggered for highly personal reasons and each individual often resorts to very different therapies and tools, making each therapeutic journey very specific.
This is why the various clinical studies that have been conducted (2)(7) and are being conducted (8) tend to use a dosage that can vary from 30 mg (9)(10) to 800 mg daily(11), as well as using different routes of administration.
Inhaled route: the effect is immediate and maximum from the beginning, so the inhaled form can help to alleviate acute episodes of anxiety and/or panic or feelings of anguish.
Sublingual: this is the most recommended form for medium/long-term treatment and to provide relief in more chronic situations such as an ongoing anxious state.
Topical: can provide relief in areas of the body that tend to tense up during episodes of anxiety, such as the cervical and pectoral muscles.
Anxiety can affect other factors in our lives such as sleep, leading to insomnia. CBD treatment for anxiety is recognised and according to studies, if the dosage is stable over the long term, it has therapeutic potential to improve sleep.
To find out more you can take a look at our article, reviewed by Viola Brugnatelli, on the effects of CBD on sleep.
Can CBD abuse lead to intoxication? What happens if i take high doses of CBD?
CBD has been found to have a bell-shaped response curve, meaning that higher doses are not necessarily more effective, but rather quite the opposite. It is therefore essential to find the right dose for the individual. To do this, it is recommended to start with a low dose and gradually increase it until the effects appear.
According to the Canna Foundation, the possible adverse effects of CBD are: "tiredness, drowsiness, dry mouth, dizziness and decreased appetite,” which diminish when the dose of CBD is reduced or administration is suspended.
To learn more about the effects, take a look at our article, "What are the side effects of CBD.”
Due to its psychoactivity, THC can cause an anxiogenic effect (i.e. it produces anxiety), especially in people who are prone to anxiety. Therefore, its use is not recommended for people who suffer from episodes of anxiety.
Has CBD been scientifically proven to help with anxiety and depression?
The simple answer is: No. There are preclinical trials, such as those cited above, that show it to be effective, but more research is needed. The range of conditions for which CBD has been evaluated is diverse, consistent with its neuroprotective, anti-epileptic, anxiolytic, antipsychotic, analgesic, and anti-inflammatory properties.
Much more research and clinical studies are needed to evaluate CBD as a possible treatment for anxiety and depression. This does not mean that it would not help, but properly controlled clinical trials are needed to support the use of CBD to treat anxiety or depression.
Thanks to preclinical results and other research around the world, the regulatory and bureaucratic frameworks have increased their acceptance of the use of cannabinoids as a therapeutic alternative. In countries such as the USA, Sweden and Canada, CBD is permitted for ingested use.
Still, much remains to be known about the complex endocannabinoid system and how it interacts with the different cannabinoids. The key to this progress is the destigmatisation of the cannabis plant and the encouragement of clinical trials.
Bibliography:
