Medical Cannabis for Headache Pain: a Primer for Clinicians

Abstract

Purpose of Review Public acceptance of Cannabis sativa L. (cannabis) as a therapeutic option grows despite lags in both research and clinician familiarity. Cannabis-whether as a medical, recreational, or illicit substance-is and has been commonly used by patients. With ongoing decriminalization efforts, decreased perception of harms, and increased use of cannabis in the treatment of symptoms and disease, it is critical for clinicians to understand the rationale for specific therapies and their medical and practical implications for patients. In view of the opioid crisis, overall patient dissatisfaction, and lack of adherence to current chronic pain and headache therapies, this review provides up-to-date knowledge on cannabis as a potential treatment option for headache pain. Recent Findings Research into the use of cannabinoids for disease treatment have led to FDA-approved drugs for seizures, nausea, and vomiting caused by cancer chemotherapy; and for decreased appetite and weight loss in people with HIV/AIDS. For a wide variety of conditions and symptoms (including chronic pain), cannabis has gained increasing acceptance in society. The effects of cannabidiol (CBD) and tetrahydrocannabinol (THC) in pain pathways have been significantly elucidated. An increasing number of retrospective studies have shown a decrease in pain scores after administration of cannabinoids, as well as longterm benefits such as reduced opiate use. Yet, there is no FDA-approved cannabis product for headache or other chronic pain disorders. More is being done to determine who is likely to benefit from cannabis as well as to understand the long-term effects and limitations of the treatment. Summary Cannabis can refer to a number of products derived from the plant Cannabis sativa L. Relatively well-tolerated, these products come in different configurations, types, and delivery forms. Specific formulations of the plant have been shown to be an effective treatment modality for chronic pain, including headache. It is important for clinicians to know which product is being discussed as well as the harms, benefits, contraindications, interactions, and unknowns in order to provide the best counsel for patients.This article is part of the Topical Collection on Hot Topics in Pain and Headache * Robert A. Duarte

Medical Students’ Attitudes, Knowledge, and Beliefs about Medical Cannabis: A Qualitative Descriptive Study

“…Recent attention has been given to the efficacy of medical cannabis (MC) for symptom management (e.g. as an anti-emetic and analgesic for pain) for post-traumatic stress disorder (PTSD), Crohn's disease, ulcerative colitis, Alzheimer's disease, multiple sclerosis, muscle spasms, and epilepsy among other medical conditions [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Well-controlled clinical trials indicate that MC can be an effective option (as a single or add-on treatment) in treating non-responding chronic pain in certain adults, but this type of evidence is lacking for other conditions [16][17][18][19].…”

Exploring Novel Therapeutic Targets in the Common Pathogenic Factors in Migraine and Neuropathic Pain

“…We underline the difference of characteristics of these two painful conditions as follows quality of the pain (throbbing in migraine and burning in NP), the associated symptoms of migraine (nausea/vomiting, photophobia and phonophobia) which are absent in NP, the action of triptans (very effective in migraine, ineffective in neuropathic pain), the effect of nonsteroidal anti-inflammatory drugs (effective in migraine, ineffective in pure neuropathic pain). These two different clinical entities meet via their common pathomechanisms, like hyperexcitability and sensitization, which involve neuropeptides (mainly calcitonin generelated peptide, CGRP), the glutamatergic system and microglia activation, pro-and antiinflammatory cytokines and transient receptor potential (TRP) ion channel alterations and involvement of the endocannabinoid system [5][6][7][8][9][10][11][12][13][14][15][16].…”

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

“…In addition, higher concentrations of cannabinoid psychoactive compounds further complicate recreational and illicit use compared to the prior century [18][19][20]. As mentioned earlier, legal and societal background determines the likelihood that anesthesiologists will encounter individuals consuming cannabinoids for various reasons [12,28,37,38,64]. However, the increased prevalence of cannabinoid compounds is such that accidental intake has been reported in all ages, including newborns [65][66][67][68].…”

“…Similar ambiguity is seen in human studies. The consensus is that cannabinoid compounds have direct and indirect nociceptive activity [64,79,248,250]. This pain modulation is particularly effective in chronic pain syndromes associated with neuropathic pain and inflammation [113,163,[249][250][251][252].…”