CANNABIS FOR MIGRAINES

Does cannabis have a place in a physician-guided treatment plan for migraine? Emerging research and the works of prominent 19th & 20th-century physicians including Sir William Osler (Father of Modern Medicine), Sir William Gowers (Father of Modern Neurology), and Sir William O’Shaughnessy (the first physician in recorded history to conduct a clinical trial of cannabis products), suggest it may.

Defined as a recurring disabling headache disorder involving at least five headaches lasting 4–72 hours; satisfying at least two of the following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, and aggravation by or causing avoidance of routine physical activity; nausea and/or vomiting or photophobia and phonophobia. Migraine is a complex headache disorder, which is most prevalent amongst females and affects more than 1 billion people worldwide. The underlying causes of this disease are multifaceted and are not yet fully understood. However, a growing body of evidence suggests one’s own endocannabinoid system may play a role. Dr. Ethan Russo’s endocannabinoid deficiency theory suggests a variety of diseases including migraine are caused, at least in part by a deficiency on one’s naturally produced endocannabinoids (AEA & 2-AG). By correcting this deficiency and restoring homeostatic levels with plant-based cannabinoids (phytocannabinoids) it is thought that we are then able to treat the underlying disease.

The results of a large-scale retrospective study conducted by our team here at the Dent Neurologic Institute’s Cannabis Research Center offer support to this theory. In the study we evaluated clinical outcomes of 316 patients who were diagnosed with chronic migraine by a board-certified headache specialist and certified to use medical cannabis products as part of New York State’s Medical Marijuana Program. In total, 177 (56%) subjects realized a decrease in the monthly number of headache days they experienced. With statistically significant reductions noted in both, the average number of monthly

headache days (24.9 to 16.1) and the average number of monthly migraine days (12.6 to 7.3). Of those prescribed opioid medications for migraine-related pain, 56% were able to reduce their consumption. In addition to these rather robust quantitative outcomes, the study population also noted improvement in a variety of subjective outcomes including headache severity (88%), sleep (40%),

... these results suggest medical cannabis therapy may have a role in [a] comprehensive treatment plan for migraines

anxiety (31%), and mood (26%). The improvement noted in these subjective measures is of particular importance as sleep disturbance, anxiety, and mood disturbance are prevalent among those that suffer from migraines and may help one to reduce consumption of secondary pharmaceutical interventions.

These results were most commonly achieved in patients that utilized two cannabis products: an oral tincture for prophylactic or preventive treatment and a vaporizer for acute or immediate treatment, which was not surprising. However, when evaluating the ratio THC:CBD or the chemovar of cannabis product used an interesting relationship was discovered, with benefit being associated with use of either type I chemovar products (High THC) or type III Chemvar products (high CBD) but not Type II chemovar products (equal THC and CBD). This result helps to underscore the complexity of migraine and is suggestive that migraine treatment needs to be tailored to individual patients.

These results suggest medical cannabis therapy may have a role in one’s comprehensive treatment plan for migraines when used under the guidance of a properly trained physician. Further research including prospective placebo-controlled randomized trials are needed to legitimize this plant’s role in modern medicine.

Laszlo Mechtler

MD, FAAN, FEAN, FASN, FAHS

Medical Director, DENT Neurologic Institute Chief, Neuro-Oncology Roswell Park Cancer Institute Medical Director, Jushi

Dr. Laszlo Mechtler is Professor of Neurology and Oncology at the State University of New York at Buffalo. He is UCNS certified in Neuroimaging, Neuro-Oncology and Headache Medicine. Dr. Mechtler is the Medical Director of the DENT Neurologic Institute. His training includes institutions such as MD Anderson and the State University of New York at Buffalo. He is a past president of the American Society of Neuroimaging (ASN) and the Hungarian Medical Association of America (HMAA). He was the guest editor of the 2009, 2014 and 2020 editions of Neurology Clinics on ‘Neuroimaging”. He served on the Executive Committee for BrainPAC through the American Academy of Neurology (AAN). He also serves as the Medical Director of Jushi, Inc. Dr. Mechtler has published some of the first major retrospective research trials on Medical Marijuana in Headaches and other neurologic disorders. Dr. Mechtler lectures both nationally and internationally and is recognized as a leader in the fields of Neuroimaging, Headache Medicine, Neuro-Oncology, and Medical Cannabis. He is the Director of the DENT Cannabis Clinic, which has more than 15,000+ patients certified through the NYS MMJ program and continues to grow each day. Dr. Mechtler is also the Founder/Medical Director for the MIND Institute in Budapest Hungary which opened in Fall 2020.