The use of cannabis to relieve headaches and migraines goes back hundreds of years. Use for this purpose is fairly common and many people believe it is effective but research is still sparse. Various studies back up the extensive anecdotal evidence about the effective use of cannabis in treating headaches and migraines but much more research still needs to be done.
The first randomized, double blind study
One randomized, double blind study was conducted in 30 outpatients who had headaches due to medication overuse. It was found that a synthetic cannabinoid called Nabilone was able to reduce pain intensity more effectively than ibuprofen. The quality of life of sufferers increased and they tended to take less other analgesics.
Washington State University Study
A study from Washington State University used data from sufferers of headaches and migraines who took cannabis to relieve the conditions.
Previous studies have asked patients to recall the effects of using cannabis in the past and this is the first study to use big data in real time. The cannabis used in the study was purchased by patients from Canadian producers and distributors.
The aim of the study
Researchers conducting the study published in the Journal of Pain wanted to find out whether inhaling cannabis decreased headache and migraine ratings. The researchers also wanted to find out whether an individual’s gender, the type of cannabis used or the dosage contributed to changes in the ratings.
They wanted to explore the interaction between CBD and THC in predicting change in severity ratings. They also wanted to explore tolerance to the effects of cannabis with long term use.
Medical cannabis app for tracking
Patients were able to track their symptoms before and after inhaling cannabis with a medical cannabis app. Almost 2000 patients recorded their symptoms when using different strains and dosages over a period of 16 months. Data was analyzed from over 12,000 sessions using cannabis to treat headaches and over 7,000 sessions where cannabis was used to treat migraines.
In the initial set up, individuals entered their basic demographic information and their medical conditions and symptoms. They would then open the app prior to using cannabis to manage their symptoms and select the condition they wanted to treat and the strain they were about to use from a list of over 1,000 strains. The CBD and THC content of the strains was pre-populated in the app.
Users would then rate the severity of the condition on a scale of one to 10 before using cannabis and identify the method of administration. They would also indicate the dose they were taking, such as the number of puffs if they were smoking. Twenty minutes after use, they were prompted by push notification to re-rate the severity of the condition.
Inclusions and exclusions
This study only tracked sessions where individuals inhaled cannabis (smoking, vaping, concentrates, dab bubbler, dab portable) due to the potential difference in onset with different routes of administration.
It also only tracked inhalation sessions for the individuals who re-rated their symptoms within four hours. Tracked sessions where THC and CBD values were entered by users rather than pre-populated were excluded due to concerns about the reliability and validity of the data.
Study limitations and strengths
One of the limitations of this study was the lack of a placebo-controlled group and another was a possible sampling bias as it likely over-represented individuals who find cannabis effective. Those who didn’t find it effective would be unlikely to continue to use cannabis and the app. It was also not clear what percentage of the samples represented new versus experienced users.
Strengths of the study are that the data was obtained from a large sample of medical cannabis patients in real time. The app was developed that could help patients to identify strains and doses that optimally reduce their symptoms.
Significant study results
The severity of headache and migraine ratings was significantly reduced after cannabis use. The inhaled cannabis seemed to reduce the severity of self-reported headaches and migraines by about 50% of patients. Men reported larger reductions than women which corroborates findings in previous studies.
Using concentrates seemed to reduce symptoms more than using cannabis flower. As almost no research has studied the health effects of using concentrates, this is a new finding. As concentrates are more potent than flower, attributing this effect to the potency seems logical but there are other factors that contradict this.
As the concentrate findings represented a minority of the complete data set, they could be less reliable. Concentrates are becoming more popular and increasingly available, so research on the health effects is urgently needed.
There appeared to be no impact of the cannabis strain on the therapeutic effect. No significant difference in pain reduction seemed evident among strains that were lower or higher in levels of CBD and THC either. As cannabis contains over 100 cannabinoids, it is, therefore, possible that different cannabinoids or other constituents such as terpenes could play a role in the relief of symptoms.
The results also showed no effect of dosage on change in severity, possibly because users need different doses to achieve the same effects, depending upon their body mass and experience with cannabis.
One of the pitfalls of common medications for headaches is that it can make them worse over time. There was evidence no of this with cannabis use. What was evident is that effectiveness appeared to diminish over time and patients seemed to need larger doses to get the effect they desired. This suggests that tolerance to the effects may develop with continued use.
Carrie Cuttler, the lead author on the paper, cautioned that further research is required as there may be slight overestimates of effectiveness due to the ‘placebo’ effect. She said she hoped this research would motivate researchers to do placebo-controlled trials. Ruling out placebo effects could offer a more controlled examination of the type of cannabis, dose as well as THC and CBD interactions.
Nabilone for the treatment of medication overuse headache: Results of a preliminary double-blind, active-controlled, randomized trial. https://www.jpain.org/article/S1526-5900(19)30848-X/fulltext