A new study found that a mix of CBD and THC was equivalent to or better than Verapamil for some cluster headaches, and even better for migraines, but there are some important caveats:

1) The benefits were only seen in a subset of clusterheads, those who had experienced migraines since childhood. Possible that those patients have some vascular or inflammatory condition that makes them susceptible to clusters, and the mix of cannabinoids helps there.

2) The dosage was relatively large - 200 mg of the cannabinoid mix daily as a preventive. CBD retails for about 10 cents or more per milligram in many mail order sites, THC is around 20 cents a mg in edibles in Colorado - cost of at least $20 for 200 milligrams. When acute pain sets in, patients took another 200 milligrams for pain control. CBD pills and patches often contain smaller amounts (5 mg to 25 mg). Some human studies for other conditions involved doses as large as 600 mg per day, with no toxicity observed.

3) No mention of terpenoids, and they probably were removed from the preparation. Different strains of cannabis have very different effects that cannot be explained by THC content - one may cause strong sedation and 'couch lock' while another may be stimulating. It seems that the varying terpenoid compounds in different strains are responsible for this - and that some terpenoids may be triggers for cluster headaches when a person is in cycle. Perfumes get their smell from various terpenoids. Limone (also found in citrus), linalool (also found in lavender) pinene (also in pine) and terpinolene (also in traditional turpentine) are examples of terpenoids. Some of these can be removed by baking the herb to remove the scent.

CBD is a 'non-psychoactive' component of hemp and marijuana that seems to work on the serotonin 1A receptor, not on the CB1 or CB2 cannabinoid receptor. CBD is useful for a range of conditions including anxiety, depression, PTSD, etc. It is not clear from the articles I read what the ratio of CBD:THC was in this trial. It is possible that varying the ratio could make the medicine more effective, but that remains to be seen.

This dose was taken orally, which is metabolized somewhat differently than when smoked or vaped. Vaping should be seen as generally preferable to smoking, as the partial combustion creates compounds that may trigger susceptible individuals.

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