Journal Club: Medical cannabis for headache and migraine

Estimated reading time: 3 minutes

Issue six of the Journal Club, published by Grow Pharma, explores the latest research around medical cannabis in managing headaches and migraines.

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For this edition of the journal club, the focus is on headaches and migraines. 

Recently, Poudel et al [1] published a comprehensive review of the literature evaluating the potential role of medical cannabis in managing headaches and migraines. In its conclusion, the authors stated that the data is “encouraging”, with “beneficial long-term and short-term effects” and comparatively fewer adverse events being reported. In this issue of the Journal Club, two of the most recent trials discussed in the review are highlighted.

The first study is a cross-sectional trial aiming to investigate the association between medical cannabis (MC) treatment and migraine frequency. 145 migraine patients were included with a median MC treatment duration of three years.

Migraine index disability scale (MIDAS), headache impact test (HIT-6), and Pittsburgh sleep quality index (PSQI) questionnaires were used to assess outcomes. Since initiating MC, 61 per cent of patients reported a >50 per cent decrease in monthly migraine attacks (“responders”), with the remainder considered “non-responders”.

Overall, responders reported lower current migraine disability, less negative headache impact, lower rates of opioid and migraine medication (triptans) consumption, and improved sleep compared to non-responders.

However, due to the study design, it is not possible to determine whether improved sleep quality was due to the decrease in migraine attacks or directly due to the MC treatment effect. In summary, this study showed that MC treatment resulted in long-term reduction of migraine frequency in the majority of patients, and this was accompanied by lower intake of antimigraine medications.

The second study utilised the Strainprint app to track the impact of cannabis usage on headache and migraine severity and frequency. In total, 12,293 sessions where cannabis was used to treat headache and 7,441 sessions where cannabis was used to treat migraine were analysed.

Patients reported reductions in headache and migraine severity in 88-90 per cent of sessions, with a mean decrease of 47.3 per cent and 49.6 per cent for headaches and migraines, respectively. Interestingly, although cannabis reduced migraine severity regardless of the type, dose, THC, or CBD content, reductions in headache severity were significantly greater with concentrates than with flowers.

Furthermore, reductions in headache ratings diminished as a function of time/cannabis use, suggesting tolerance may develop with repeated use. In contrast, time/cannabis use was unrelated to change in migraine ratings, suggesting that cannabis remains an effective treatment for migraines with repeated use.

In summary, cannabis reduced self-reported headache and migraine severity and frequency in the majority of patients. Further research should aim to determine the optimal delivery method, dose, and strain for managing migraines and headaches with medical cannabis.

For an up-to-date overview of medical cannabis research in headache and migraine treatment, refer to Poudel et al1. 

If you are a doctor and would like to discuss either of the clinical papers featured in this edition of the journal club or the broader medical cannabis literature, please reach out on [email protected]

Read more from the Journal Club on endometriosis, sleep and insomnia and chronic pain 

References:

1 Poudel.S et al. Medical cannabis, headaches, and migraines: a review of the current literature (2021). Cureus 13(8):e17407

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