“Migraine is a disabling neurovascular disorder with limited therapeutic options, especially for patients unresponsive to current treatments targeting calcitonin gene-related peptide (CGRP) signaling.
The endocannabinoid system (ECS) has emerged as a promising alternative for migraine modulation, offering analgesic, anti-inflammatory, and neuroimmune-regulatory effects through its main ligands, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), and their degrading enzymes.
This review provides an updated map of endocannabinoid components in central and peripheral migraine-relevant regions, highlighting their spatial distribution and functional regulation in animal models.
We summarize the available preclinical evidence supporting the anti-nociceptive effects of endocannabinoid-degrading enzyme inhibitors and cannabinoid receptor agonists/antagonists, with particular emphasis on the therapeutic potential of multi-target compounds. Moreover, we explore non-canonical ECS pathways, including TRPV1, D2 dopamine receptors, serotonergic and ion channel interactions, and their roles in modulating CGRP release and trigeminovascular signaling to treat migraine pathophysiology.
Finally, we propose two sleep-related directions for treatments involving ECS modulation of circadian rhythms and glymphatic clearance. Although human translational data are limited, the ECS offers a multifaceted framework for developing next-generation therapeutics targeting migraine pathophysiology.”
https://pubmed.ncbi.nlm.nih.gov/41549028
“As alternative treatments, instead of using highly addictive painkillers, such as opioids, there is a great need for alternative, effective and safe medications. Despite potential negative psychoactive side effects and potential medication-overuse headache risk, medical marijuana has been shown to decrease the frequency of migraine headaches, suggesting a perspective for cannabinoids in treating migraine. The use of cannabis to relieve pain dates to ancient civilizations.
Cannabis has been used for millennia in ayurvedic medicine for the management of pain, nausea, and anxiety, as well as to promote appetite and sleep.
The cannabis plant has complex natural compounds, including, in addition to the generally safe cannabidiol (CBD), the psychotropic delta9-tetrahydrocannabinol (THC), and dozens of poorly characterized components. Recent studies have pointed to the therapeutic potential of a combination of CBD and THC in preclinical migraine models and in a clinical trial. These CBD and THC findings point to the importance of targeting the body’s endocannabinoid system (ECS). Thus, the stage is set for testing the enhancement of ECS signaling pathways that might provide analgesia with minimal adverse effects.”
“Current evidence shows that the ECS is embedded in multiple migraine-relevant pathways areas across the CNS and PNS. Preclinical studies demonstrate that enhancing endocannabinoid tone via inhibition of endocannabinoid-degrading hydrolases reduces migraine-like pain and neuroinflammation. Beyond these analgesic strategies, targeting cannabinoid receptors, modulating their activity, and influencing their modulation of circadian regulation and glymphatic clearance further highlight the therapeutic potential of engaging the ECS.”
https://www.neurotherapeuticsjournal.org/article/S1878-7479(26)00003-6/fulltext