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Cannabis Use May Lead to Rebound Headaches in Chronic Migraine Patients

Presenter: Niushen Zhang, MD

Using cannabis to relieve migraine headache may predict the development of medication overuse headache in chronic migraine patients.

Medication overuse headache occurs as a consequence of regular overuse of acute headache medications in patients with pre-existing primary headache disorders. Cannabis is known to affect the brain’s endocannabinoid system, which plays a role in pain processing. Moderate evidence supports the use of cannabis for the treatment of chronic pain, however, emerging anecdotal clinical evidence shows the use of cannabis may lead to medication overuse headache.

“Many people with chronic migraine are already self-medicating with cannabis, and there is some evidence that cannabis can help treat other types of chronic pain,” said Niushen Zhang, MD, of the Stanford University School of Medicine. “However, we found that people who were using cannabis had significantly increased odds of also having medication overuse headache, or rebound headache, compared to people who were not using cannabis.”

Traditional preventive treatments for chronic migraine can include antidepressants, beta-blockers and anticalcitonin gene-related peptide agents. Abortive medicines, such as triptans and opioids, are commonly prescribed, but these medications carry the risk of adverse health outcomes. Mechanistically, endocannabinoids have been shown to have an inhibitory effect on serotonin receptors, which is shown to modulate pain and emetic responses.

Researchers conducted a retrospective study involving 368 adult chronic migraine patients with chronic migraine duration of a minimum of 1 year. Chronic migraine was defined as 15 or more headache days per month. A total of 150 patients used cannabis and 218 patients were not. The researchers extracted the following variables from each patient’s chart: diagnosis of medication overuse headache as dependent variable, and predictor variables as age, sex, migraine frequency, current chronic migraine duration, current cannabis use duration, overused acute migraine medications, and duration of current medication overuse headache.

Of the 368 patients, 212 patients had medication overuse headache and 156 patients did not. The researchers found that the people using cannabis were six times more likely to have medication overuse headache than those who did not use cannabis, with an odds ratio of 5.99 (3.45, 10.43),p< 0.0001.

Significant associations were also found between current cannabis use, opioid use, and medication overuse headache. The analysis revealed two major natural clusters. Cluster I patients were younger with less migraine frequency, higher medication overuse headache burden, more current cannabis, and opioid users than cluster II. Previous research has shown that opioids and cannabis can both influence the part of the brain called the periaqueductal gray, which has been linked to migraine.

In conclusion, Zhang said: “Cannabis use significantly contributes to the prevalence of medication overuse headache in chronic migraine. Bidirectional cannabis-opioid association was observed – use of one increased use of the other. It may be helpful to advise chronic migraine patients with medication overuse headache to reduce cannabis use in order to treat medication overuse headache effectively.”

A limitation of the study is that it was retrospective; longitudinal studies will be needed to further explore cause and effect of cannabis use and medication overuse headache in patients with chronic migraine.

Link to abstract: Medication Overuse Headache in Chronic Migraine Patients Using Cannabis: A Case-Referent Study

Niushen Zhang, MD, reported nothing to disclose.

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