The pain management specialist and headache neurologist at the University of California San Diego Center for Pain Medicine discussed the different forms of cannabis and the need to conduct larger, multicenter studies to better understand its effects in migraine. [WATCH TIME: 3 minutes]
WATCH TIME: 3 minutes
"We need to have some long-term research prospectively following patients to see whether this [cannabis] leads to the development of medication overuse headache, and at what rates."
At the 2023 American Headache Society (AHS) Annual Meeting, held June 15-18, in Austin, Texas, Nathaniel Schuster, MD, presented the first randomized, double-blind, placebo-controlled crossover trial (NCT04360044) assessing cannabis as a potential treatment for migraine. Prior to this study, the benefits of cannabis in this patient population had only been extrapolated from retrospective trials and surveys, none of which employed a placebo as control.
In the crossover study, patients treated up to 4 distinct migraine attacks, 1 with each of the 4 treatments, in a randomized, double-blind order. The treatments included tetrahydrocannabinol (THC) 6%, THC/cannabinoid (CBD) mix, CBD 11%, or placebo cannabis, with all cannabis flower provided from the NIDA Drug Supply Program. Patients applied treatment within the first 4 hours of a migraine attack, at the most moderate to severe stage. Efficacy outcomes at 2 hours after attack showed that 4 puffs of vaporized THC/CBD mix flower was the most efficacious, demonstrated by effects on pain relief, pain freedom, and freedom from the most bothersome symptom.
Schuster, a pain management specialist and headache neurologist at the University of California San Diego Center for Pain Medicine, believes future studies are needed to test whether these results are replicable. In addition, he and his colleagues concluded that additional research should examine the use of other cannabinoids, including natural cannabinoids, synthetic cannabinoid receptor agonists, and other synthetic treatments that modulate the endocannabinoid system. At AHS 2023, Schuster sat down to discuss whether there are significant differences in efficacy based on the type of cannabis, as well as the future directions for research in this field.