Could medicinal cannabis products be useful in treating chronic migraines?

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Research into the potential of cannabis and its derivatives as a medical treatment has increased in recent years as the demand for alternative therapies comes to the fore. We hear a lot about the use of cannabis-based products to treat conditions like epilepsy and chronic pain – but could medicinal cannabis be useful in treating chronic migraines?

Cannabinoids like CBD and THC have been found to interact with receptors in our body – known as endocannabinoid receptors (CB1 and CB2). These receptors are part of a larger network known as the endocannabinoid system, which also includes neurons called endocannabinoids.

This system is involved in a number of physiological and cognitive functions, including sleep and mood regulation and pain signaling. Indeed, a role for the ECS has also been suggested in migraine models.

A recent review aimed to build on this insight and see how a medicinal cannabis supplement could help treat chronic migraines.

What is Chronic Migraine?

While many people experience rare or even one-time migraines, acute migraines refer to a much more specific pattern of impairment. This condition is characterized by at least 15 “headache days” per month, with headaches with migraine symptoms occurring for at least eight days for more than three months.

Chronic migraines have been linked to significantly reduced quality of life, with patients often being forced to take a large number of medications such as pain relievers and other prescription drugs.

Other symptoms of chronic migraines may include increased sensitivity to light, sounds, or smells; Nausea and vomiting; Visual disturbances; and dizziness and vertigo.

It is still not fully understood what causes chronic migraines, however people often show changes in the brain and factors such as anxiety, depression, and other painful conditions can make symptoms worse. According to the Migraine Trust, about 2.5 out of 100 people with episodic migraines develop chronic migraines each year.

How could medical cannabis help?

The researchers wanted to study the effects of orally administered cannabinoid preparations in patients with chronic migraines. Between January 1, 2019 and December 31, 2019, a total of 32 patients were recruited who had not responded to the recommended first- and second-line treatments (due to ineffectiveness or adverse events) or for whom such treatment options were contraindicated.

Cannabis preparations have been prescribed as an off-label (blind) add-on treatment for chronic migraines. The researchers compared the monthly migraine days (MMD) at the start of the study (before starting treatment with medical cannabis) and again 3 months and 6 months after starting treatment.

The pain intensity was also measured using the numerical rating scale, the number of acute drug use (AK) and the number of days per month on which patients took at least one drug (NDM) and 3 and 6 months.

Did medical cannabis treatment help?

The researchers observed a number of interesting results after both 3 months and 6 months of cannabinoid treatment. While the total number of monthly migraine days (MMD) did not improve compared to baseline, a significant decrease in pain intensity values ​​was observed in both follow-up examinations.

AC and NDM also followed a downward trend, with patients taking fewer medications on fewer days after both 3 months and 6 months of treatment. In addition, the number of patients with nausea and / or vomiting decreased significantly after 6 months of cannabinoid treatment.

Side effects

While at least one adverse event occurred in a significant proportion of the participating patients (n = 14; 43.75%), the majority of the cases were mild and did not lead to treatment discontinuation. However, two patients (6.25%) experienced moderate dizziness and discontinued treatments – with side effects resolving after exposure.

The bottom line

This study showed that oral cannabinoid supplements are able to improve symptoms, including pain and nausea / vomiting, and the quality of life associated with chronic migraines. The authors note that these results were observed in a severely impaired population, who had migraines almost daily, who were taking more than one preventive drug per day, had a long history of illness, and had failed to respond to many preventive treatments in the past.

The researchers also note that the population sample had a high rate of psychiatric and rheumatological comorbidities, which may have reduced the effectiveness of preventive drugs and may also have affected the effectiveness of oral cannabinoid supplements.

The lack of a significant reduction in the number of monthly migraine days in this study may be associated with the severe impairment of the patients at the start of the study. However, these results reflect the central effect of the ECS as a regulator of pain perception, which is demonstrated by a significant reduction in pain intensity values.

Overall, these results suggest a potential role for oral cannabinoid supplements in patients with chronic migraines who are forced to resort to high levels of pain reliever medication. The authors of this study recommend further research – namely, randomized, placebo-controlled studies with large samples – to better understand the role of the endocannabinoid system in chronic migraines.