Medical Marijuana and Migraine

A Patient's Journey
May 2, 2018
Michelle Tracy, aka The Migraine Warrior
Medical Marijuana and Migraine

As I stared at the film-like canisters on my bed, I could practically feel his eyes on me. I glanced over at the teddy bear in the black shirt on my bookshelf. Scrawled in white script across the front of his t-shirt was the acronym “D.A.R.E.” I sighed. Drug Abuse Resistance Education. I had received the bear as well as a certificate after my essay about how and why I would never use drugs, particularly marijuana, won a school-wide contest at the end of our D.A.R.E. unit. I remember being 12 years old and so proud when the police officer called my name. I reached over and plucked the disapproving bear off of the top shelf and chucked him into my closet. I glanced back at the unfamiliar things on my bed: a vaporizer, a grinder, a spoon, and two containers of marijuana that I had bought earlier in the day. How did I end up here?

In August 2004, the summer before my sophomore year in college, my mother drove me to the local emergency room after I was struck with the worst headache I had ever had in my life. The pain was so intense that I had been vomiting and both my parents and I had silent fears about whether I was having a brain aneurysm. After being examined by a kind emergency room doctor, I was told that I was likely just experiencing a severe migraine attack and I was given I.V. medications to treat the pain and nausea. I didn’t know it at the time but this doctor also had personal experience with migraine disease. He suggested that I make an appointment with a neurologist, which I did. That was the beginning of my journey with chronic intractable migraine disease.

Over the next several months, I began to have migraine attacks every day and spent a considerable amount of time in doctor’s offices, the emergency room, and my bed. My attacks became so frequent and so severe that I was eventually let go from my job as a preschool teacher. I was encouraged to drop out of college by almost all of my professors. Indeed, I did take 2 years off from my college before ultimately finishing my degree in 2010. It would be 5 years before I finally met the neurologist who would change my life.

After my most recent neurologist told me that “there was nothing else that could be done for me” and that I’d “just have to learn to live with the pain” I put out a desperate cry for neurologist recommendations on Facebook. I received a couple of messages suggesting that I see Dr. Brian McGeeney in Boston so I got in touch with him and found myself driving two hours to see him not long after. I explained to him that I wasn’t expecting much, that I understood that there really wasn’t anything else that could be done for me, and that I just really need help increasing my quality of life. He stared at me for a moment and then asked “Who told you that nothing else can be done for you? There is much that can be done for you!” It was at that moment that he gave hope back to me and my family.

Not long after I began seeing Dr. McGeeney, I asked him about medical marijuana as a treatment for chronic migraine disease. We determined that I would be a good candidate for a medical card and he began the certification process with the state. In the meantime, I discussed this new avenue of treatment with my primary care physician, my psychiatrist, my therapist, and my family. None of them knew a lot about marijuana as a medical treatment and though they were all ultimately supportive, they initially had a lot of questions and concerns. As someone who rarely drank and never used recreational drugs, I was also unsure. Like me, my parents had also never used recreational drugs, so I had no real frame of reference about marijuana and thus began reaching out to other migraine and cluster headache patients who had used it to help treat their diseases.

I slowly began to learn about the three major categories of marijuana: Indica, Sativa, and Hybrid. I learned that, generally, Indica strains are known to sedate and relax you while Sativa strains are known to have a more uplifting feeling, making you feel more social and/or focused. The Hybrids, a blend of Indica and Sativa, tend to somewhat balance each other out. Because I struggle with obsessive-compulsive disorder and panic attacks, my doctor suggested that I initially stick with Indica and Hybrid strains because they are somewhat less likely to have paranoia as a side effect. For some reason, I was convinced that marijuana was going to give a panic attack. Because of this, Dr. M suggested that I start out by vaping. Vaping involves heating the marijuana without burning it and inhaling the vapors. This is the quickest way to feel the effects of the marijuana while also being the quickest to wear off. This way, if I had any negative side effects, they would be short-lived.

I received a vaporizer for Christmas that year and soon after, my medical card arrived in the mail. I had had to fill out forms online and upload a photo of myself from the shoulders up, facing forward, without smiling, and without anything on my head or face (e.g. no hats, sunglasses, etc.) My eyes had to be open and there couldn’t be any logos visible in the picture. The card itself looked much like my driver’s license. I learned that I would be unable purchase marijuana from a dispensary (or even enter a dispensary) without this card. My parents couldn’t even come in with me. I had to do this on my own.

Soon after, I drove to a nearby town where the dispensary was located. I sat in the parking lot for awhile before going inside. I opened the front door to find myself in a locked entryway where a woman was sitting behind protective glass. She asked for my card and I slid it through the small opening in the window. She verified that it was my card and that I was who I said I was and pushed a button that allowed me into the dispensary itself.

I’m not sure what I expected but it was a beautiful space with high ceilings, comfy places to sit, friendly employees, and Grateful Dead music in the background. I immediately noticed that there were all different sorts of people there: an older man in a wheelchair, a younger woman using leg braces, and a wide array of other folks whose reasons for being there (like my own) were not visibly apparent. Though I could detect a smell, it wasn’t the same sort of smell that creeped out from under the doors of my roommates in college. An employee invited me to sit down and view the menu for that day. It listed all of the different types of marijuana available that day, as well as the different forms: plant, wax, edible, tincture, and topical. He asked what had brought me there and listened intently, nodding. He suggested two different strains: one Indica and one Hybrid that was low in THC and high in CBD. I agreed. Dr. McGeeney had explained this to me. THC is the main psychoactive component in marijuana. It is largely responsible for the “high” feeling associated with using marijuana. CBD (cannabidiol) is another component of the marijuana plant that is not psychoactive but has shown promise in treating pain and epilepsy.

As he led me to the counter, the dispensary employee told me that he had been using marijuana to manage his multiple sclerosis for quite some time and that, prior to using it, he had been unable to get around without braces and/or a wheelchair. He put a plastic container on the counter and asked me to pick out which buds I wanted. I gave him a blank look and said that they all looked pretty much the same to me and that he could pick out whichever ones looked good to him. He smiled and carefully put them into a film-like canister. He then put the containers into sealed bags and rang me up. I think I drove approximately 5 miles per hour the whole way home. Despite the fact that I was a legal medical marijuana patient who had done nothing wrong, I was convinced that I was going to be stopped by a police officer on the way home. It would be weeks before I would actually even try the marijuana.

Eventually, I found myself sitting in the living room, working my way into a panic attack while my mother Googled “how to vape” and while my typically soft-spoken and good-natured father shouted with exasperation “Just try the damn weed already!” I wasn’t so sure. I wondered to myself whether the marijuana had “expired” or “gone bad” since it had taken me so long to use it. I actually called the dispensary to ask them if it was still okay to use. Somehow, the person on the other end of the phone managed not to laugh at me while also reassuring me that my marijuana was fine. Not long after, I finally worked up the courage to give it a try.

It took a bit of practice but I soon got the hang of vaping. I’d typically only take 2-3 hits at a time but that was enough. It was, hands-down, the most effective anti-nausea medication I’d ever used. It lessened the excruciating neck and shoulder pain that accompanied my migraine attacks. It helped me sleep, calmed my restless legs, and lessened my anxiety and depression. While it didn’t help the head pain associated with my most severe migraine attacks, it did help with my milder and more moderate attacks and I also believe that it played a role in preventing some attacks altogether. I was definitely glad that I had marijuana in my migraine toolbox.

Despite the help it provided, I still found myself reluctant to use marijuana in the same way that I used other medications. There was a part of me that struggled to see it as a medication, even though my doctors and even the state laws in Massachusetts said that it was. It bothered me that it was still federally illegal and that I couldn’t bring it across state lines, even to another state where marijuana was medically and/or recreationally legal. Somehow, it felt less legitimate because there was no prescription and I didn’t pick it up at a pharmacy. I feared being seen as a stoner or someone who just wanted to get high, even as I advocated for the legalization of marijuana. I urged other patients who lived in legal states to discuss it with their doctors. Intellectually, I knew how helpful marijuana could be for a myriad of conditions. Emotionally, I still had hang-ups about using it: that 12-year-old D.A.R.E. kid kept showing up and shaking her head at me. Even to this day, there is a small part of me that convinces myself to reach for other medications and treatment options before I heat up my vaporizer. My hope is that my story might help someone else articulate their own mixed feelings, while also showing how marijuana can be effective in treating chronic migraine disease. One of my doctors confessed to me that she had initially hesitated when her patients broached the subject of medical marijuana with her. After hearing of my experiences, she changed her views. At least two of my doctors actually voted to legalize marijuana recreationally in our state based on my explanation of how it had worked in my life as well as my anxieties around using a drug that was still federally illegal. In voting to legalize marijuana at a state level, we believed that perhaps we might come closer to federal legalization or at the very least decriminalization.

These days, I’m looking into new ways to use marijuana, particularly as a tincture. Tinctures have no significant smell or taste and only require a few drops to be placed under the tongue. The marijuana stays in your system longer this way and therefore gives a more even dosage than vaping. I remain optimistic that there is even more help to be found as more research is conducted and as marijuana becomes even more socially acceptable. For now, I’m thankful that it’s both medically and recreationally legal in my home state and that I have the support of my doctors and my family. As I look back on my experiences as well as toward the future, I can’t help but note what a long, strange trip it has been.

- Michelle Tracy, aka the Migraine Warrior

You can read more about Michelle Tracy on her blog, The Migraine Warrior