As an activist/organizer in the medical marijuana movement, Pebbles Trippet had a vested interest in ending prohibition: she was a migraine sufferer for whom smoking the plant provided relief. Excruciating headaches had onset in childhood. Prescription pharmaceuticals failed her, one after another. When she began smoking marijuana in her 20s, she discovered that it alleviated her pain. Also, that it was a preventative if used steadily.
Trippet realized that even smoking leaf could fend off migraines. Friendly growers kept her supplied with low-THC trim –which is why Trippet, a longtime resident of Albion, was often in possession of pounds when her car was searched. She had an appeal pending in November, 1996, when California voters passed Proposition 215, legalizing possession of Cannabis for any use approved by an MD. Dr. Tod Mikuriya then testified in superior court that Trippet had a migraine diagnosis and was using the herb to fend off attacks. Pebbles then argued (pro bono, after dismissing her lawyer, who was named Stoner) that the new law implicitly legalized transportation. She beat the rap and re-enforced the law.
Fast forward to 2025. In last week’s New Yorker, Dr. Jerome Groopman, reviewing a book called “The Headache” by Tom Zeller, Jr., recounted his own saga of suffering. Groopman is a professor of medicine at Harvard Medical School who also writes for the New York Review of Books and the Wall St. Journal. His migraines onset some 2o years ago, when he was in his early 50s. He has since been prescribed, “various medications, sometimes in sequence, sometimes in combination. I began with tricyclic antidepressants, which, years ago, were found to be helpful for some migraine patients. But they affected my blood pressure—if I got up quickly from bed, it dropped to the point that I’d almost faint—and also made it hard to urinate. I moved on to verapamil, a drug that blocks calcium’s entry into the smooth-muscle cells around blood vessels, causing the vessels to relax and widen. It made my vascular tone and blood pressure plummet. Next was Topamax, an antiepileptic medication, whose nickname in medical circles is Dope-a-max, because it makes you feel stupid. Indeed, I felt as if my head were filled with potatoes; I could barely think and could speak only slowly. I then added propranolol, a beta-blocker that reduces the effects of adrenaline on the heart and the blood vessels. It also brought on a degree of fatigue and gloom that became intolerable, a known side effect of the medication. During acute migraine attacks, I took triptans, targeting the neurotransmitter serotonin, which ameliorated the headache in the short term by blocking pain receptors in the head. But triptans can be taken only in limited doses because of their risk of inflicting rebound headaches and their side effects of nausea, vomiting, and chest pain.
“One weekend… after stopping propranolol, I had an explosive series of unrelenting migraines, each episode dovetailing into the next. There was a brief respite of an hour or two between waves of auras and pain. I couldn’t leave my darkened room and feared I would be consigned to a life of debility. A neurologist prescribed high doses of prednisone, a corticosteroid, which broke the vicious cycle but induced severe anxiety and insomnia, so much so that I had to take lorazepam, a Valium-like benzodiazepine. None of these numerous medications were consistently beneficial…
“Drugs developed to block the effects of CGRP [calcitonin gene-related peptide] arrived for patients in 2018. I was initially prescribed Aimovig, an antibody that is self-administered by injection once a month. For eight months, I didn’t have a single migraine, having previously averaged one every few weeks…. Alas, for me, the effects of Aimovig gradually waned, and I became despondent. Fortunately, another CGRP-targeting drug came on the market: Emgality. This worked for me, too, but, again, the benefit wore off after about a year.”
Either CGRP is a well-known term for a type of protein released from nerve endings in the brain during a migraine attack, or the New Yorker copy editors have lowered their standards. But back to Groopman’s search for relief… He next saw “a pain specialist who recommended Lamictal, an antiepileptic medication that is also used for psychiatric conditions such as bipolar disorder. It suppresses electrical depolarization and has been shown to be highly effective in people who have migraine with aura but not in those who have migraine without aura, a fact that lends credence to the hypothesis that aura represents an epileptic-like event in the brain. The benefit for me was substantial and has been ongoing. Meanwhile, the pain specialist I was consulting encouraged me to add on a long-acting CGRP antibody called Vyepti, which is given every three months. Sometimes, during the week or two before my Vyepti infusion, I feel tingling in my neck, without the flashing light in my eye but with moderate one-sided head pain. I’ve come to think of this as a mini-migraine. Immediately, I take Nurtec, another CGRP blocker, which can abort a full-blown attack.
“The use of multiple medications is common among headache sufferers. One study cited by Zeller found that the average patient was taking at least four medications and that forty per cent were taking five or more. Lamictal, Vyepti, and Nurtec are all preventative. During a full-blown attack, I take triptans…
“Globally, some 1.2 billion get migraines, some forty million of them in the United States. Female migraine patients outnumber their male counterparts at, a ratio of about three to one… An important theme running through [Zeller’s] book is the scant attention these conditions now receive, given how many people suffer from them, and the difficulty that patients have in being taken seriously. There are far fewer caregivers and researchers tackling the headache conundrum than there are working on movement disorders such as Parkinson’s, degenerative diseases such as Alzheimer’s, and vascular maladies such as stroke.”
Cannabis does not get mentioned at all by Groopman in his New Yorker piece. Could it be that not one of the specialists he consulted over the course of 20 years mentioned Cannabis as an option in the treatment of migraine? Does the prominent professor consider the herb “beyond the pale?” His silence on the subject shows how successfully the neo-prohibitionists and their Big Pharma backers have chocked off the medical marijuana movement.
Migraine is one of the medical conditions for which cannabis provides relief for some people. This fact was reported in the medical literature prior to US prohibition in 1937. It was then almost totally forgotten by several generations of MDs. (The Cannabis leaf could be an emoji for cancel culture.) In the 1960s, a young psychiatrist named Tod Mikuriya searched for and found the relevant case reports in the National Library of Medicine archives. He included them in a book called Marijuana Medical Papers that he self-published after moving to Berkeley. Mikuriya met Pebbles Trippet while working on the state ballot initiative in 1971. They were comrades until his death in 2007. After the passage of Prop 215 in ‘96, it was Mikuriya who convinced a superior court judge that Trippet was using marijuana medicinally.
On December 30, 1996, Clinton’s Drug Czar, Barry McCaffrey, held a press conference to ridicule Dr. Mikuriya on national TV. He found it preposterous that one drug could impact disparate illnesses. An aide had made a poster headed “Dr. Tod Mikuriya’s (215 Medical Advisor) Medical Uses of Marijuana,” for McCaffrey to mock authoritatively. There was a misspelling: “Migrane.”
Mikuriya, at home in Berkeley, had taped the press conference at which he’d been slandered. Next morning he sent a fax to the Synapse office at UCSF.
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