Abstract
Objective: To examine the effects of medical cannabis (MC) on chronic migraine (CM).
Background: New York State (NYS) authorized cannabis for medically certified patients in 2015. No guidelines exist for the use of MC in CM patients. The limited body of literature for MC leaves providers underequipped and patients vulnerable.
Design/Methods: This retrospective chart review of patients with CM, per International Classification of Headache Disorders Third Edition, examined 316 patients ≥21 years of age with at least one month of MC through DENT Neurologic Institute.
Results: On NYS MC, 88.3% (279) patients reported improvement in their headache profile with an average MC exposure of 22.4±17.5 weeks. The average monthly migraine frequency change was significant with 42.1% decrease (24.9±7.16 to 16.1±10.7, p<0.0001). Over half of the patients (171) reported improvement in their headache frequency, with 55.0% (111) experiencing ≥50% reduction of headache days. Sleep improvement was noted in 38.3% (121), anxiety improvement in 30.7% (97), and mood improvement in 24.7% (78). Opioid medications for CM-related pain were reduced in 50% (14) after an average of 5.6 years of opioid use. Adverse effects (AE) were reported in 23.1% (73) with 4 (1.3%) discontinuing due to AE.
Patients taking a 20:1 ratio (tetrahydrocannabinol to cannabidiol) reported significantly higher occurrence of overall headache profile improvement than patients on a 1:1 ratio (p=0.039) and headache medication reduction (p=0.0059, RR 3.12). A high to low ratio carried a RR of 3.40 for mood improvement, with similar RR observed for anxiety (3.01) and sleep (2.17) improvements. There was no significant difference in AE among high to low, equal, or low to high ratios.
Conclusions: MC may play a safe role in CM management by helping to improve headache profile, anxiety, sleep, mood, and opioid reduction. Prospective studies are required to examine the role of MC in CM within a placebo-controlled environment.
Disclosure: Dr. Mechtler has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Teva, Promius, Allergan, Avanir, andAmgen. Dr. Mechtler has received research support from DENT Family Foundation. Dr. Bargnes has nothing to disclose. Dr. Hart has received research support from Dent Family Foundation . Dr. McVige has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Amgen, Avainir, Teva, Supernus, and GammaCore. Dr. McVige has received research support from Dent Family Foundation. Dr. Saikali has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Allergan, Amgen, Promius, Supernus, Teva, Assertio, Avanir, Cefaly, Egalet, Gammacore, and Pernix.
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