A recent study published in the Journal of Pain (“Short- and Long-Term Effects of Cannabis on Headache and Migraine”) analyzed a large set of data allocated from cannabis users via the StrainprintTM app to determine if there was a correlation between cannabis use and a decrease in headache and migraine-related pain.1

An Overview of Headaches and Migraines

A migraine is a particular type of diagnosis, whereas a headache is a commonly-occurring symptom that can arise as a manifestation of any number of diagnoses. Headaches are not specific to any specific demographic, whereas migraines are more prevalent within a particular subset of the population. Migraines are the second most common type of headache, occurring predominantly in women aged 30-40 years, affecting approximately 18% of females and 6% of males.2,3,4

The pathophysiology (how they arise and develop, and to what severity they reach) of migraine headaches still remain somewhat of an enigma. Risk factors include, but are not limited to, genetics, gender, hormonal changes (particularly in women), stress, weather, poor sleep patterns, and particular types of food and beverages. A “typical” migraine will arise through four stages, in chronological order: prodrome, aura, headache, postdrome. A typical migraine headache will be “pulsing” in nature, unilateral (one-sided), accompanied by nausea, photophobia (sensitivity to lights), and phonophobia (sensitivity to sound), have a duration of 4-24 hours and be disabling in its intensity. Not all migraines will manifest through these four stages, nor will all migraine headaches present with this set of symptoms.

Acute migraine attacks are currently managed through pharmacological means such as ibuprofen, aspirin, and a class of drugs called “triptans” (ex. Sumatriptan). Medication for nausea is also employed, as needed, during these episodes.

The Study

The authors of this study sought to determine if cannabis consumption, particularly inhalation, had any effect on decreasing pain severity in those who suffered from headaches and migraines, and to what extent that effect occurred. The study also sought to determine if other variables such as gender, cannabis concentrate vs. flower, THC, CBD, and dose influenced this effect at all. The purpose of this study was to provide insight on a subject (effectiveness of cannabis use on reducing headache and migraine severity) of which, up until now, has been relatively unexplored.

This study had three objectives:

  1. To examine if inhaled cannabis would affect decreasing headache and migraine severity ratings (as recorded by users in the StrainprintTM app).
  2. To look closely at variables (those mentioned above), which had been identified as potential influencers in regards to decreased headache and migraine severity.
  3. To determine if tolerance to the palliative effects of cannabis had developed and if this had any impact on the severity reduction of headaches and migraines.

Methods

Data that had been collected from StrainprintTM was used in this study. StrainprintTM is an application in which users of medical cannabis can chart changes in symptoms that they are suffering from. These changes in symptom severity are logged concerning the particular strain and dose of cannabis they are consuming. The dose is recorded as the number of inhalations taken per session, and users select the strain from a list of over 1,000 pre-logged strains within the app. The THC and CBD levels of each of these strains are also included within the app.

For this particular study, only users who inhaled cannabis and had indicated they were using it to treat headaches or migraines were selected. 1,306 headache patients (who had used the app 12,293 times to track changes symptom severity) and 653 migraine patients (who had used the app 7,441 times to track changes) were chosen as relevant candidates for further analysis.

From the pool of data gathered, multiple forms of statistical analysis were used to address the objectives of this study.

Results

In regards to the first objective, it was shown that headache patients reported decreased overall severity. When a closer analysis was done in relation to gender, it was revealed that there was a significant difference in severity reduction between men and women, with men reporting a more significant decrease in severity. Conversely, women reported a significantly higher increase in headache severity than men when using cannabis. Both men and women were equal in terms of reporting no overall change in severity.

Concerning the first objective in relation to migraine patients, trends also displayed an overall decrease in severity. Both men and women reported a similar change in severity reduction and exacerbation. In this instance, it was found that significantly more men than women reported no overall change in severity.

In regards to the second objective, overall reports indicated that headaches of greater severity were associated with more significant reductions in severity post cannabis use when compared to headaches of lower severity. Cannabis in concentrated form was noted to result in a greater reduction in headache severity as compared to cannabis flower. Men reported an overall greater decrease in headache severity than women. There were no indications throughout the study that THC & CBD concentration, as well as dose taken per session, had any effect on headache severity.

Concerning the second objective in relation to migraine patients, there was an overall reduction in migraine severity ratings. Similar to that, which was observed for those with headaches, migraines of greater severity were associated with more significant reductions in severity post cannabis use as compared to migraines of lower severity. There were no other variables of note that had any significant impact on the decline in migraine severity ratings.

In regards to the third objective, there was evidence that suggested a degree of tolerance to the palliative effects of cannabis use for headache reduction due to repetitive use over time. It is interesting to note that dose increased per session throughout time for patients using cannabis flower. However, the opposite was true for patients using cannabis concentrate. However, it is of importance to note that despite the increase in tolerance, there was no significant change observed in headache severity.

The same was true in the case of migraine patients, who revealed no significant changes in migraine severity reduction as a direct function of concentrate or flower dose-increase over time, i.e., tolerance. In contrast to the headache group, there was no significant increase in tolerance noted in both flower and concentrate use.

Downsides and Limitations

It was suggested in the study that the analysis conducted on data collected from cannabis-concentrate users was less reliable than that collected from cannabis-flower users. In the case of headaches, for example, concentrate users represented only 3.4% of total episodes. Because of this significantly smaller sample size, it is difficult to draw substantial conclusions on trends charted from this data set.

Another cause of potentially decreased validity of this study lies within the composition of cannabis itself. Cannabis contains hundreds of other cannabinoids apart from THC and CBD, meaning that these chemicals have the potential to influence study results by buttressing the palliative effects of cannabis felt in headache and migraine patients. However, because the entire litany of chemical compounds that make up cannabis was not included in this study, it is impossible to say if they did, in fact, have any influence in skewing the final results.

The authors pointed out that this study was also limited by the fact that there wasn’t a placebo control group included. Placebo groups help to add to the validity of studies like this by offering insight into whether the results obtained are unique to the medication/therapy/product etc. being tested. The authors postulated that without a placebo group to compare to, these results might be tainted by an “expectancy effect.” This could occur if cannabis-users in this study expected cannabis to alleviate their pain before use, which could affect the ratings they logged onto the app.

Study authors also astutely identified potential limitations within the StrainprintTM app itself. One of which being that the sample size used in this study was quite possibly over-representative of those individuals who have found positive results in the reduction of pain severity by using cannabis. It was speculated that those individuals who did not find any benefit in cannabis-use for this purpose would have little reason to continue to use the app. Additionally, the app did not contain data indicating which users were experienced and which were new to using cannabis. Therefore, the ability to assess the “tolerance” objective of this study comes into question as it is essentially impossible to determine which users have already developed tolerance before using the app.

Final Thoughts

Despite its limitations, this study has many strengths that can support the findings presented. All-in-all, it was found that inhaled cannabis reduced both headache and migraine ratings by approximately 50%. Also of note is the finding that cannabis-use, within the realm of this study, did not lead to “medication-overuse headache.” Headache can occur due to the overuse of conventional headache and migraine medication, and it appears as if these results suggest the contrary in terms of cannabis.

Because this study is the first foray in attempting to examine the relationship between cannabis-use and headache/migraine pain mitigation using a select set of metrics, the results obtained here can only be further validated by studies of similar nature in the future. However, the effort which the authors took in charting out a blueprint to assess this relationship is admirable. This study was a thorough, detailed effort in examining a mass of data to chart trends that can only be expanded upon and added to by other researchers in time to come.

Bibliography:

  1. Cuttler, Carrie, et al. “Short- and Long-Term Effects of Cannabis on Headache and Migraine.” The Journal of Pain, 1 Nov. 2019, doi:10.1016/j.jpain.2019.11.001.
  2. Chawla J. Migraine Headache. In: Migraine Headache. New York, NY: WebMD. http://emedicine.medscape.com/article/1142556-overview#a5. Updated June 22, 2016. Accessed April 2, 2017.
  3. Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education; 2015.
    Jenkins B, McInnis M, Lewis C. Step-Up to USMLE Step 2 CK. Lippincott Williams & Wilkins; 2015.
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