New systemic review about medical cannabis and migraine

What is migraine?

Migraine is a common disorder that is characterized by recurrent headaches lasting from four to seventy-two hours. These headaches can be accompanied by aura, which is a visual disturbance that precedes or accompanies the headache. Migraine headaches are often triggered by environmental and hormonal factors and can be treated with medications such as triptans, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, ergots, opioids, and antiemetics. However, many of these medications have side effects, which has led to a halt in the research and development of new anti-migraine drugs.

As an alternative treatment option, some people with migraines have turned to medical cannabis.

In 2022, a group of researchers from the California Institute of Behavioral Neurosciences and Psychology conducted a systemic review of nine studies that included a total of over 5,600 subjects. Here is the summary of their reports:

Mechanism 

THC, a component of medical cannabis, works on the cannabinoid receptor one (CB1R) to repair pathways in the brain that are related to migraines. It does this by activating the endogenous G-protein-coupling receptor (GPCR) and inhibiting the G-protein-coupling receptor 55 (GPR55), which may help to calm the brain and reduce migraines. This is thought to be due to the role of magnesium levels and glutamate in the brain during migraines. 

The endocannabinoid system, which is a network of signaling pathways in almost all cell types that helps to maintain balance in the body, may also be involved in the development of migraines and has lower levels of a neurotransmitter called anandamide in people with chronic migraines.

Studies and discussion

Several studies have examined the effectiveness of medical cannabis in the treatment of migraines. 

• In a retrospective study of 121 patients in Colorado, 103 patients experienced a reduction in the frequency of their migraines over an average of 21.8 months while using medical cannabis. 
• A survey study by Cuttler et al. found that inhaled cannabis reduced the severity of migraines by 47.3% and the frequency of migraines by 49.6% over a period of 16 months. 
• In a study by Stith et al., 94% of participants experienced symptom relief within two hours of using dried cannabis flowers for their headaches and migraines. 
• A cross-sectional study by Gibson et al. found that people with migraines who used cannabis for relief reported having more severe migraines, but an Israeli cross-sectional study by Aviram et al. found that medical cannabis reduced the frequency of migraines over an average of three years in a self-report survey of 145 migraine patients. These patients also reported less current migraine disability and negative impact, as well as lower rates of opioid and triptan intake. 
• In a retrospective chart analysis of 316 patients with chronic migraines, the patients reported that medical cannabis improved their condition in various ways. 
• Okusanya et al. also found that medical cannabis decreased the frequency and number of days with migraines after 30 days, as well as decreased nausea and vomiting associated with migraines.

Dosage

The recommended dosage of medical cannabis varies and can be difficult to determine. One study found that 200 mg of THC and CBD was effective in reducing migraine pain by 55%. Mechtler et al. concluded that the dosing of cannabis in migraine patients is an individualized process that is influenced by the underlying endocannabinoid tone. Building a strong patient-physician relationship is crucial for the success of cannabis therapy, and the dosage should be gradually adjusted in one- or two-week intervals. Follow-up visits are also important to consider any dosage adjustments, and oral cannabis formulations can be used for prophylactic treatment of chronic migraines.

Safety

The safety of medical cannabis in the treatment of migraines has been studied in several research studies. 

• A retrospective chart review of 121 patients using medical cannabis for migraines in 2016 found that the medication was well-tolerated and had a significant impact on the frequency of migraines. 
• Mechtler et al. also studied the safety profile of medical cannabis in migraine patients and found that it can cause drowsiness, lightheadedness, cognitive deficits, stomach issues, euphoria, psychosis, and an exacerbation of headaches. 
• In a study in 2022, 43.75% of patients who used an oral cannabinoid preparation reported mild side effects. Additionally, the use of medical cannabis has been linked to medication overuse headaches. 

Overall, the evidence suggests that medical cannabis is generally well-tolerated in the treatment of migraines, but it is important for patients to be aware of potential side effects and to discuss them with their healthcare provider.

Conclusion

In conclusion, the review study suggests that medical cannabis is a well-tolerated and safe treatment option for migraines. However, it is important to note that the study only included studies on adult humans and used articles published in the last six years, and therefore may not provide a complete understanding of the treatment of migraines with medical cannabis. Additional research is needed to fully understand the efficacy and safety profile of medical cannabis in the treatment of migraines.

References used in the review