Prolonged Medical Cannabis Use Reduces Migraine Frequency, Study Finds

Medical cannabis (MC) use results in long-term reduction of migraine frequency and is associated with less disability and lower anti-migraine medication intake, according to a study published in Brain Sciences.

Between 1% and 2% of the global population suffers from chronic migraine, and traditional preventive treatments can include antidepressants, beta-blockers and anticalcitonin gene-related peptide (CRGP) agents. While abortive medicines, such as triptans and opioids, are commonly prescribed to treat the condition, these medications carry the risk of adverse health outcomes.

“In recent years, the use of MC for the treatment of chronic pain in general has emerged, along with an increase in demand and use by migraine patients,” authors wrote. “Whilst the available evidence suggests involvement of the endocannabinoid system and a potential for MC treatment to be therapeutic in migraine, more research is required to demonstrate the efficacy parameters of MC treatment for migraine.”

Because most pharmaceutical science is based on a single-compound, single-target approach, MC treatment poses a challenge as it varies among multicompound and whole-plant treatment. Although tetrahydrocannabinol (THC) and cannabidiol (CBD) may be the most well-known cannabis-based treatments, “the cannabis plant contains hundreds of different active components, including phytocannabinoids, terpenes, and flavonoids,” researchers noted.

In this cross-sectional questionnaire-based study, researchers set out to investigate total doses of individual phytocannabinoids consumed by migraineurs and explore differences in dosage between subgroups of patients based on changes in migraine frequency. Questionnaires included assessments of Migraine Index Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and the Pittsburgh Sleep Quality Index (PSQI), along with migraine characteristics, age, gender, and other variables.

Variation in chemical constituents of plant material and between cultivators is common. To ensure consistency, only phytocannabinoids consumed with a minimum average concentration of 0.1 g per month were analyzed by researchers, after which monthly doses were calculated for each patient. Information on cultivator name, brand, and adverse effects was also collected.

A total of 145 Israeli migraineurs with an MC license completed an online questionnaire between August 2019 and February 2020. The majority of respondents (67%) were female with a median age of 45 (34 to 54) and were treated with MC for an average of 3 years. The sample was divided into nonresponders (<50%, n = 56), and responders (≥50%, n = 89), based on their reduction of monthly frequency of migraine attacks from pre&#8208;MC to the current post&#8208;MC period.

Data revealed:

• Responders were more likely to report lower MIDAS and HIT&#8208;6 questionnaires scores (18 [5-40] and 64 [60-69], respectively) than nonresponders (40 [26-80] and 68 [66-70], respectively) (0.50, 95% CI, 0.11-0.90; P <.05 and 0.66, 95% CI, 0.26-1.00; P <.001,respectively)
• Responders reported better sleep quality (9 [6—13]) than non&#8208;responders (11 [9-14]) (0.46, 95% CI, 0.03-0.89; P <.05)
• Responders consumed higher doses of the phytocannabinoid ms_373_15c and lower doses of the phytocannabinoid ms_331_18d (3.40, 95% CI, 1.10-12.00; P <.01 and 0.22, 95% CI, 0.05-0.72; P <.05, respectively)
• Of the 37% of the sample who reported adverse events (AEs), nonresponders reported higher incidences of any AEs (n = 26, 46%) than responders (n = 27, 30%) (0.46, 95% CI, 0.21-0.99; P <.05)
• Of the 45% of the sample who reported current consumption of pharmaceutical analgesic medications, nonresponders consumed significantly higher rates of weak opioids and triptans compared with responders

Due to the study’s design, investigators cannot determine whether reported improved sleep quality can be attributed to decrease in migraine attacks or as a direct result of MC treatment. Overall, MC resulted in long-term reduction of migraine frequency in over 60% of treated patients.

“Migraine is classified as a pain condition. Mechanistically, endocannabinoids have been shown to have an inhibitory effect on serotonin receptors in vivo, which is shown to modulate pain and emetic responses,” researchers explained. However, a future study with a larger sample size and more comprehensive approach will be useful in translating the findings to clinical settings, authors concluded.

Reference:

Aviram J, Vysotski Y, Berman P, et al. Migraine frequency decrease following prolonged medical cannabis treatment: a cross sectional study. Brain Sci. 2020;10(6):360. doi:10.3390/brainsci10060360