A high percentage of cannabis users take the drug — particularly strains with high concentrations of Δ9-tetrahydrocannabinol (THC) and tetrahydrocannabinolic acid and low cannabidiol (CBD)/cannabidiolic acid content — to treat headache and probable migraine, according to a study published in The Journal of Headache and Pain.
Patients taking medicinal cannabis were asked to fill out an electronic survey regarding their cannabis use (n=2032). The survey sought to determine the study participants’ primary illness, reasons for taking cannabis, frequency and quantity of use, preferred types and strains (eg, hybrid, Indica, Sativa), methods of use, and prescription medications that were substituted with cannabis. The ID Migraine™ questionnaire was incorporated into the survey to determine migraine prevalence.
Nearly half of the cohort reported pain syndromes as the primary reason for cannabis use (42.4%; n=861), with chronic pain (29.4%; n=598), arthritis (9.3%; n=188), and headache (3.7%, n = 75) being the most frequently reported conditions. Cannabis was used to treat headache in 24.9% (n=505) of patients. According to the ID Migraine™ questionnaire, 68% (n=343) and 20% (n=102) of patients with headache gave 3 and 2 “yes” answers, respectively, corresponding to a 97% and 93% probability of having migraine, respectively. This finding translated to cannabis being used in the treatment of probable migraine in 88% (n=445) of patients with headache.
Patients with headache as the primary illness were more likely to prefer Sativa over strains with equal proportions of CBD and THC compared with patients with chronic pain and arthritis (chronic pain: odds ratio, 2.66; 95% CI, 1.52-4.66; P <.001; arthritis: odds ratio, 3.35; 95% CI, 1.57-7.12; P =.001).
Approximately half of the cohort (41.2%-59.5%) used cannabis as a substitute for prescription medications, with 40.5% to 72.8% of patients substituting cannabis for opioid medications. In patients with headache, substituted prescription medications were opioids (43.4%), antidepressant/antianxiety medications (39%), nonsteroidal anti-inflammatory drugs (21%), triptans (8.1%), anticonvulsants (7.7%), muscle relaxers (7%), and ergots (0.4%).
Considering many patients with headache in this study had comorbidities, the findings from the survey may not be specific to headache or migraine. In addition, the use of a survey for data collection represents a potential limitation of the analysis.
“Identifying differences in use patterns between migraine, headache, arthritis, and chronic pain syndromes may be helpful in optimizing crossbred cannabis strains, synergistic biochemical profiles, or dosing differences between these pain subsets,” concluded the study authors.
Baron EP, Lucas P, Eades J, Hogue O. Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort. J Headache Pain. 2018;19:37.