For many patients with migraine, cannabis served as a substitute for other pain medications, including opioids.
Pain is often the most common reason for use of medicinal cannabis. A recent study aimed to identify patterns of cannabis treatment in patients with migraine and headache compared to patients with arthritis and chronic pain, while also analyzing preferred cannabis strains, biochemical profiles, and prescription medication substitutions with cannabis.
The study used an electronic survey for medicinal cannabis patients with headache, arthritis, and chronic pain. Demographics, patterns of cannabis use, including methods, frequency, quantity, preferred strains, cannabinoid and terpene profiles, and prescription substitutions were also recorded and analyzed. In order to assess cannabis use for migraine among patients with headache, the ID Migraine questionnaire was used to predict the probability of migraine.The questionnaire included 3 questions, asking if the headaches interfered with the ability to work, made the participant feel nauseated or sick, and made them sensitive to light; if the participant answered "yes" to 3 questions, there was a 97% chance they had migraine, and if they answered "yes" to 2 questions, there was a 93% chance they had migraine.
“There have been a multitude of studies showing benefit in many forms of chronic pain, but there have been no studies attempting to differentiate which types and strains of cannabis along with associated compositions of cannabinoids and terpenes may be more effective for certain subsets of pain,” the study noted. “This information would be of great clinical use in providing direction for treatment recommendations by healthcare providers.”
A total of 2032 patients were included in the study, and 21 illnesses were treated with cannabis. Chronic pain (29.4%) was the most frequently reported illness for which medical cannabis was used. Arthritis accounted for 9.3%, and headache accounted for 3.7%. Of the 505 patients who answered the ID Migraine questionnaire, 68% gave 3 “yes” responses and 20% gave 2 “yes” responses; therefore 88% of headache patients were treating probable migraine with cannabis.
Additionally, hybrid strains were found to be preferred among all pain subtypes, with “OG Shark” as the most preferred strain in the ID Migraine and headache groups. The researchers also found that many pain patients substituted prescription medications—most commonly opiates and opioids—with cannabis.
For headache patients, prescription substitution included opiates/opioids (43.4%), anti-depressant/anti-anxiety (39%), nonsteroidal anti-inflammatory drugs (21%), triptans (8.1%), anticonvulsants (7.7%), muscle relaxers (7%), and ergots (0.4%).
“Most patients in the pain groups reported replacing prescription medications with medicinal cannabis, the most common of which were opiates/opioids across all pain groups,” noted the study. “This is notable given the well-described 'opioid-sparing effect' of cannabinoids and growing abundance of literature suggesting that cannabis may help in weaning from these medications and perhaps providing a means of combating the opioid epidemic.”
The researchers noted the need for future studies for further confirmation and additional insight into the clinical benefits of cannabis for treating headache and migraine.