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The Exploration of Cannabis and Cannabinoid Therapies for Migraine

Current Pain and Headache Reports volume 27, pages 339–350 (2023)Cite this article

Abstract

Purpose of Review

There is increasing interest in the use of cannabis and cannabinoid therapies (CCT) by the general population and among people with headache disorders, which results in a need for healthcare professionals to be well versed with the efficacy and safety data. In this manuscript, we review cannabis and cannabinoid terminology, the endocannabinoid system and its role in the central nervous system (CNS), the data on efficacy, safety, tolerability, and potential pitfalls associated with use in people with migraine and headache disorders. We also propose possible mechanisms of action in headache disorders and debunk commonly held myths about its use.

Recent Findings

Preliminary studies show that CCT have evidence for the management of migraine. While this evidence exists, further randomized, controlled studies are needed to better support its clinical use. CCT can be considered an integrative treatment added to mainstream medicine for people with migraine who are refractory to treatment and/or exhibit disability and/or interest in trying these therapies. Further studies are warranted to specify appropriate formulation, dosage, and indication(s).

Summary

Although not included in guidelines or the AHS 2021 Consensus Statement on migraine therapies, with the legalization of CCT for medical or unrestricted use across the USA, recent systematic reviews highlighting the preliminary evidence for its use in migraine, it is vital for clinicians to be well versed in the efficacy, safety, and clinical considerations for their use. This review provides information which can help people with migraine and clinicians who care for them make mutual, well-informed decisions on the use of cannabis and cannabinoid therapies for migraine based on the existing data.

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Abbreviations

AEA:

Anandamide

CB1:

Cannabinoid 1

CB2:

Cannabinoid 2

CBD:

Cannabidiol (CBD)

CCT:

Cannabis and cannabinoid therapies

CGRP:

Calcitonin gene-related peptide

CNS:

Central nervous system

COMM:

Current Opioid Misuse Measure

DIRE:

Diagnosis, Intractability, Risk, Efficacy

FAAH:

Fatty acid amide hydrolase

FDA:

Federal Drug Administration

MOH:

Medication overuse headache

NO:

Nitric oxide

ORT:

Opioid risk tool

PAG:

Periaqueductal gray

SISAP:

Screening Instrument for Substance Abuse Potential

SOAPP:

Screener and Opioid Assessment for Patients with Pain

THC:

Delta-tetrahydrocannabidiol

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Authors and Affiliations

  1. Department of Diagnostic Sciences, Tufts University, 1 Kneeland St, Boston, MA, 02111, USA

    Brijesh Chandwani

  2. Attending, Orofacial Pain Service, St. Barnabas Hospital, Bronx, NY, USA

    Brijesh Chandwani

  3. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Brooklyn A. Bradley

  4. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Anna Pace

  5. Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA

    Dawn C. Buse

  6. Premier Neurology Medical Group, Beverly Hills, CA, USA

    Ravinder Singh

  7. Westport Headache Institute, Westport, CT, USA

    Deena Kuruvilla

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  1. Brijesh Chandwani
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Correspondence to Brijesh Chandwani.

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Chandwani, B., Bradley, B.A., Pace, A. et al. The Exploration of Cannabis and Cannabinoid Therapies for Migraine. Curr Pain Headache Rep 27, 339–350 (2023). https://doi.org/10.1007/s11916-023-01144-z

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