Approach to Cannabis and Optimizing Treatment for Migraine: Nathaniel Schuster, MD

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The pain management specialist and headache neurologist at the University of California San Diego Center for Pain Medicine provided perspective on how cannabis may be used in the management of migraine as more evidence is uncovered. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"For my patients, I would certainly tell them that until we know more, to use [cannabis] no more than 10 times a month. They need to be on really good therapies, and I would want to maximize their preventive therapies as much as possible before having somebody use these cannabinoids, ideally."

At the 2023 American Headache Society (AHS) Annual Meeting, held June 15-18, in Austin, Texas, data from a single-center, placebo-controlled study (NCT04360044) on the use of cannabis in patients with migraine was presented. In the crossover study, patients could treat up to 4 distinct migraine attacks, 1 migraine with each of the 4 treatments, in a randomized, double-blind order: tetrahydrocannabinol (THC) 6%, THC/cannabinoid (CBD) mix, CBD 11%, or placebo cannabis. Patients took 4 puffs of a vaporizer, with at least a 1 week washout period between treated attacks.

At the conclusion of the analysis, efficacy outcomes at 2 hours favored those on the 6% THC/11% CBD mix. In addition, the mix combination was better tolerated than THC dominant, with lower rates of euphoria and cognitive impairment, as well as lower subjective highness. The investigators concluded that results are unlikely explainable my unmasking given that THC dominant and CBD dominant had similar rates of pain and most bothersome symptom freedom at 2 hours, and that both were lower than that of THC/CBD.

This was the first placebo-controlled trial that showed the benefits of cannabis to treat migraine, adding to literature that contained mostly small-scale, retrospective studies. Lead author Nathaniel Schuster, MD, and colleagues concluded that future studies, including multicenter trials, are needed to test whether these results are replicable.

Schuster, a pain management specialist and headache neurologist at the University of California San Diego Center for Pain Medicine, sat down with NeurologyLive® at the meeting to discuss the complexities with prescribing cannabis for patients, and how it would work with ongoing medications. He provided commentary on the questions surrounding medication overuse headache, as well as why its promising to see benefits of cannabis while patients were on relatively low doses.

Click here for more coverage of AHS 2023.

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