Review Explores the Current Role of Medical Cannabis in Migraine Treatment

Results of a literature review published in Cureus revealed medical cannabis use was associated with a decrease in the duration and frequency of migraines and headaches of unknown origin.

Moreover, migraineurs and patients suffering from related conditions may benefit from medical cannabis therapy due to its convenience and efficacy, authors wrote.

“Cannabis has been used since ancient times to manage various conditions, including acute pain, anxiety, cancer pain, chronic pain, depression, headaches, and migraines,” they added. It is thought that the cannabinoid system mitigates migraine though the glutamine, inflammatory, opiate, and serotonin pathways—both peripherally and centrally—while cannabinoids have also demonstrated dopamine-blocking and anti-inflammatory effects.

Despite these findings, updated research is lacking within the United States, due in part to few randomized controlled studies. To address this knowledge gap and document the validity of how medical cannabis can be utilized as an alternative therapy for migraine management, researchers analyzed 34 articles from PubMed and Google Scholar.

All studies included in the review were published between 1987 and 2020, and investigated outcomes among adults aged 18 and older.

Among the investigations that explored the benefits and efficacy of medical cannabis use, one prospective clinical trial published in 2020 focused on 68 migraineurs who smoked or vaped medical cannabis inflorescences. These individuals “reported better migraine symptom reduction, less negative headache impact, better sleep quality, and decreased medication consumption,” the authors explained.

Additional surveys, retrospective studies, and literature reviews yielded mixed findings regarding the effectiveness of medical cannabis on headaches and migraines. However, “there is a consensus for the indication of medical marijuana therapy when first and second-line treatment fails,” they noted.

Adverse reactions to the treatment reported in studies included dizziness, dry mouth or eyes, nausea, vomiting, and psychosis.

When it comes to the form medical cannabis takes, one cross-sectional survey found the primary use was via smoking, followed by vaporization and dabs. In addition, “the dried cannabis flower may be an effective medication for the treatment of migraine- and headache-related pain, but the effectiveness differs according to characteristics of the cannabis plant, the combustion methods, and the age and gender of the patient,” the authors said.

Another survey showed males preferred smoking and vaporizing medical cannabis more while females ranked edible, tincture (oil-based), and topical cannabis as preferred first-line methods.

The current review concluded that finding an ideal dose of a medical cannabis product can be difficult due to the treatment’s variation among users. “Some studies have shown that tetrahydrocannabinol (THC) + cannabidiol (CBD) had a good outcome when used as prophylactic or when given in acute attack,” the researchers said. However, more controlled studies are needed to better understand the route and dose of THC/CBD for migraineurs.

The number of studies included in this review and the lack of standardization mark limitations. However, results do indicate the use of medical cannabis can be expected to increase as more and more states legalize the substance.

Overall, both long- and short-term effects of medical cannabis were reported, and the treatment was associated with decreasing daily analgesic intake, dependance, and level of migraine pain intensity. More positive effects than adverse effects were reported by migraineurs.

“Careful questioning and discussing with the patients about the use of marijuana, its risks, and benefits should be documented and researched,” the authors concluded. “More information about the doses, frequency, methods, and forms of marijuana consumed, as well as alcohol use, illicit drug use, and prescription drug use, should be explored to form the definitive treatment goal for migraine and headache patients.”

Reference

Poudel S, Quinonez J, Choudhari J, et al. Medical cannabis, headaches, and migraines: a review of the current literature. Cureus. Published online August 24, 2021. doi:10.7759/cureus.17407