Many people think of cannabis as a way to alleviate pain. After my friend was in a bike accident, she took cannabis edibles to escape the. Marijuana use may affect how much pain people feel and the dose of painkillers they need following a traumatic injury, such as an injury from a. Now I know I'm not crazy when I say that I'm in even worse pain after vaping mmj. The other cannabinoids in the strain will have an impact!.
Can Pain Worsen Cannabis Paradoxically
Seguin, 19 William Gowers, a founding father of modern neurology, 30 and Sir William Osler, often considered the father of modern medicine.
When cannabis was deemed illegal by the U. To this day, there are few clinical investigations of the use of cannabis for headache; however, the studies that have emerged demonstrate potential efficacy. In addition, numerous pre-clinical investigations 18 have validated the role of endocannabinoids in preventing headache pathophysiology, which suggests a mechanistic role of cannabis in the treatment of these disorders.
Although the cannabis plant comprises more than cannabinoids, there has been little study of the individual effects of these cannabinoids on headache disorders; therefore, the present review will focus largely on the clinical potential of the cannabis plant as a whole. The present review has four unique aims: Search keywords included cannabis; cannabinoids; headache; migraine; cluster headache; medication-overuse headache; tetrahydrocannabinol; cannabidiol; clinical trial; placebo; and double blind.
Individual articles were selected based on historical, clinical, or preclinical relevance to cannabinoids or cannabis as a treatment for headaches. Historical reports, though not ideal forms of evidence, are important resources for understanding the potential use of cannabis in the treatment of headache disorders. Clinical publications between and provide valuable insights into the most effective practices, challenges, and benefits during an era when cannabis was commonly used to treat headache.
A summary of historical treatment practices using cannabis for migraines can be seen in Table 1. Historical sources indicate that cannabis was used as an effective prophylactic and abortive treatment for headache disorders. Other providers suggested that doses should be progressively increased until modest effects of intoxication were felt. Early reports of cannabis for the treatment of headache appear to be largely positive, with many patients experiencing a decrease in the frequency and intensity of their headache episodes.
In some cases, headache was cured entirely even after cannabis discontinuation. A common emphasis was placed on the importance of specific purity, preservation, and administration of the cannabis as well as patient adherence in the efficacy of treatment.
The schedule 1 classification of marijuana in has made rigorous clinical studies on the treatment efficacy of this substance difficult. Currently, there are no placebo-controlled clinical studies examining the use of cannabis for headache; nevertheless, there have been a number of other studies published that give insight into its therapeutic efficacy Table 2.
With one exception, 53 these studies did not include a control group, and given that the placebo effect can be altered by the context of treatment, 59 it is reasonable to expect a significant placebo response given the pre-existing public popularity and notoriety of cannabis. Moreover, self-reports and case studies may have a bias toward immediate improvement without awareness of possible dependence, rebound, or withdrawal responses, which are important concerns in headache treatment.
Nabilone, a synthetic cannabinoid mimicking tetrahydrocannabinol THC , has been shown to decrease analgesic intake while reducing MOH pain in a double-blind, placebo-controlled trial. Oral cannabinoid administration was chosen over an oromusocal THC spray, both because oral administration avoids the concentration peaks that can lead to euphoric effects and because chronic administration better overcomes individual differences in bioavailability. Although both substances showed improvement from baseline, nabilone was significantly more effective than ibuprofen in reducing pain intensity, analgesic intake, and medication dependence, as well as in improving quality of life.
This study also examined the safety of nabilone as a treatment for headache and found that patients only experienced mild adverse effects that disappeared after discontinuation of the medication. The results of this study are significant, especially given that MOH is exacerbated by many pharmacological treatments.
This study also highlights the potential value of cannabis in combination therapies, as a supplement to traditional treatments, or as a secondary treatment in refractory cases. Currently, a multicenter, double-blind, placebo-controlled study is being performed to examine the safety and efficacy of a dronabinol, or synthetic THC, metered dose inhaler for the treatment of migraine clincaltrials.
When published, this study could give valuable insights into the efficacy and risks of cannabinoids for the treatment of migraines. For example, the analgesic properties of cannabis seen in the treatment of neuropathic pain will likely apply to chronic headache, the antispasmodic properties seen in the treatment of multiple sclerosis could apply to muscle strain known to induce tension headaches, and the antiemetic properties seen in the treatment of chemotherapy-associated nausea might also palliate migraine-induced nausea.
Many individuals are currently using cannabis for the treatment of migraine and headache with positive results. In another California survey of patients, 8. Other studies have looked specifically at the change in the occurrence of headache disorders with use of cannabis. These results indicate that cannabis may be an effective treatment option for certain migraine sufferers. Reports from cluster headache patients 56 indicate that cannabis could have value in treating a portion However, cannabis was reported to provoke cluster headache attacks in some patients One possible explanation for this provoking effect is that cannabis is known to increase heart rate, increase blood pressure, and cause systemic vasodilation.
Interestingly, cluster headaches appear to show improvement with treatment using hallucinogens such as d-lysergic acid amide ergine or LSA , psilocybin, and lysergic acid diethylamide LSD. Case reports also give insights into the mechanisms behind the anti-headache action of cannabis. Smoking cannabis has been reported to relieve pain associated with pseudotumor cerebri, 57 a condition that is characterized by an increase in the intracranial pressure of an uncertain etiology.
This suggests that the therapeutic effect of cannabis in some headache conditions could be a result of reducing intracranial pressure. In fact, dexanabinol, a synthetic cannabinoid, has been found to relieve intracranial pressure and improve outcomes after traumatic brain injury. The pathophysiological mechanisms of many headache disorders are not entirely understood.
Nevertheless, preclinical data examining the effects of endocannabinoids on the neurological and vascular systems demonstrate the influence of endocannabinoids in modulating several major components of migraine pathogenesis Table 3 and Fig. Proposed model of the influence of cannabinoids on headache pathogenesis. Each branch corresponds to a mechanistic category listed in Table 3. Various genetic factors can predispose individuals to migraines.
For example, studies have shown that a decrease in expression of the cnr1 gene, which encodes the cannabinoid receptor type 1 CB1 receptor, is associated with migraine and trigeminovascular activation. These findings support the proposed theory that alterations in endocannabinoid function with reductions in endocannabinoids such as AEA may be one of the mechanisms underlying migraine. A feature of headache disorders is that they are highly associated with other comorbidities, including anxiety and mood disorders, allergies, chronic pain disorders, and epilepsy.
One of the first subjective indicators of a migraine is the occurrence of an aura, a perceptual abnormality that often precedes a migraine attack. A wave of electrophysiological hyperactivity followed by inhibition, known as cortical spreading depression CSD , is considered the neurobiological event underlying the migraine aura. CSD has been shown to be a result of excessive glutamate signaling, and one effect of endocannabinoids is the suppression of glutamate signaling via the inhibition of NMDA receptors.
Another component of most headache disorders is overactivation of the trigeminovascular system, the primary sensory nerve tree for the head. One of the most reliable triggers for migraine is NO. Studies have demonstrated the role of endocannabinoids in inhibiting NO. Moreover, vasodilation is not necessarily pathogenic for headaches, and endocannabinoid-induced vasodilation could desensitize the vasculature to known headache progenitors, such as NO.
The hematological properties within the dilated cranial blood vessels themselves may also play an important role in the pathophysiology of migraine. Endocannabinoid levels are reduced in the platelets of migraine patients, 80 and women with migraine show increased FAAH and EMT activation in their platelets. Cannabinoid compounds have been shown to stabilize platelets and prevent release of serotonin from platelets during a migraine. Endocannabinoids have a well-established role in the modulation of pain signals at the spinal level 81 and contribute to the descending modulation of pain through brainstem nuclei.
Headache disorders are common, painful, and disabling; moreover, treatment for these disorders is inadequate for many sufferers. Before cannabis was made illegal, many prominent physicians praised its use in the treatment of headache disorders.
Reports from this period emphasize the administration of consistent and uniform doses and the titration of doses to minimize intoxication. For prophylactic treatment, cannabis was typically given orally two to three times per day, for weeks or even months, 28 , 32 , 36—38 and for abortive treatment, cannabis was given at higher oral doses or smoked. Although there have not been any clinical trials of cannabis as a treatment for headache to date, reports indicate that cannabis is commonly used by patients to self-medicate for headache disorders.
A retrospective analysis has shown a significant impact of cannabis in treating migraine 47 and a clinical trial of a synthetic cannabinoid showed efficacy for MOH, 53 but properly designed placebo-controlled trials are needed to determine the true efficacy and complications of cannabis treatment for headache disorders.
Preclinical studies examining the role of the endocannabinoid system in migraine pathogenesis also suggest a potential therapeutic value for cannabis in the treatment of headache. It has been postulated that a general deficiency in endocannabinoid tone could underlie headache disorders. The studies presented in this review indicate the importance of further well-designed clinical trials of the efficacy of cannabis in the treatment of headache disorders. Because there are still many obstacles present in constructing double-blind placebo-controlled clinical trials of cannabis, the following list outlines various other potential future investigations and recommendations based on the findings presented in this review.
The present review examines the historical guidelines for cannabis treatment of headache, available clinical data on the use of cannabis for headache, and preclinical literature on the role of the endocannabinoid system in headache pathophysiology.
From this examination, various methodological recommendations are made for future studies and potentially novel treatment practices are considered. Although placebo-controlled clinical trials are still needed to appropriately determine efficacy, it appears likely that cannabis will emerge as a potential treatment for some headache sufferers.
Cite this article as: National Center for Biotechnology Information , U. Journal List Cannabis Cannabinoid Res v. Published online Apr 1. Lochte , Alexander Beletsky , Nebiyou K. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Headache disorders are common, debilitating, and, in many cases, inadequately managed by existing treatments.
Historical Use of Cannabis for Headache Historical reports, though not ideal forms of evidence, are important resources for understanding the potential use of cannabis in the treatment of headache disorders.
All patients experienced improvement, some were cured. Donovan 41 Migraine A: Usually lasting relief, sometimes curative. Greene 35 ; Russo 18 Clavus hystericus and migraine P: Waring 36 Migraine or sick headache P: Taken before each meal Women: Seguin cited in Russo 18 Migraine or sick headache A: Clinical experience Found to be the most effective drug for migraine. Can abort attacks in some cases.
Clinical experience Helpful prophylactically and abortively, even in cases of migraine refractory to other treatments. Mackenzie 38 Migraine P: Open in a separate window. A, abortive; P, prophylactic.
Clinical Studies on Cannabis Use for Headache The schedule 1 classification of marijuana in has made rigorous clinical studies on the treatment efficacy of this substance difficult. Subject population Type of study Significant findings Source 3 Chronic smokers Case series Migraines after cannabis cessation. Remission of headache with return to use in one patient. El-Mallakh 42 Patient with migraine Case report Women found superior relief of migraine with cannabis compared with beta-blockers, opiates, and ergots.
Petro cited in Russo 18 Patient with migraine Case report 18 years of treatment failure with standard pharmaceuticals, found success with smoked cannabis. Grinspoon and Bakalar 45 Patient with migraine Case report Successful treatment with cannabis that did not produce inebriation.
Terwur cited in Russo 18 Patients prescribed cannabis for migraine Retrospective study Migraine occurrences decreased from In one case, cannabis improved response more than dronabinol. In three cases, cannabis was used to abort headache in the prodromal phase.
Mikuriya 48 Patients seeking physician recommendation for medical cannabis Survey Use as treatment unknown. Cannabinoids and Headache Pathophysiology The pathophysiological mechanisms of many headache disorders are not entirely understood. Studies on the Role of Cannabinoids in Headache Pathogenesis. Mechanistic category Significant findings Source Systemic Variants in the cnr1 gene encodes for the CB1 receptor resulting in decreased expression of CB1 associated with migraine and trigeminovascular activation.
Could desensitize receptor and inhibit pathophysiological mechanism of headache. Underlying cause of headaches Various genetic factors can predispose individuals to migraines. Glutamate signaling One of the first subjective indicators of a migraine is the occurrence of an aura, a perceptual abnormality that often precedes a migraine attack. Trigeminovascular activation Another component of most headache disorders is overactivation of the trigeminovascular system, the primary sensory nerve tree for the head.
Platelet stabilization The hematological properties within the dilated cranial blood vessels themselves may also play an important role in the pathophysiology of migraine.
Modulation of afferent nociceptive signals Endocannabinoids have a well-established role in the modulation of pain signals at the spinal level 81 and contribute to the descending modulation of pain through brainstem nuclei. Discussion Headache disorders are common, painful, and disabling; moreover, treatment for these disorders is inadequate for many sufferers. The development of dosing and treatment guidelines for the use of cannabis in the treatment of headache disorders.
Physicians should consider discussing dosing strategies when recommending cannabis as headache treatment, with the aim of maximizing efficacy and minimizing harm. A focus on dose consistency through the use of oral cannabinoids or metered-dose inhalers could benefit future clinical trials by allowing for easier blinding and placebo control.
Moreover, the use of oral cannabinoids could have unique benefits in the prophylactic treatment of headache, because it could avoid concentration peaks and individual differences in bioavailability. Investigation of the anti-headache effect of cannabidiol CBD. This review found no available information on the use of CBD as a treatment for headache. Nevertheless, CBD has shown efficacy for headache-related conditions i. Identification of variables that could predict treatment receptivity in headache patients.
This could include stratification of headache disorders or patients based on sex, genetics, metabolic function, or neuronal biomarkers. Investigation of the long-term risks of cannabis treatment for headaches. This should aim at quantifying any side effects, withdrawal symptoms, dependence, refractory headaches, or negative outcomes from cannabis treatment for headaches.
Evaluation of other anti-headache drugs that target the endocannabinoid system. Evaluation of cannabis in combination treatment with analgesic or other anti-headache medications or as a second-line treatment in patients who are refractory to traditional medications.
Conclusion The present review examines the historical guidelines for cannabis treatment of headache, available clinical data on the use of cannabis for headache, and preclinical literature on the role of the endocannabinoid system in headache pathophysiology. Author Disclosure Statement No competing financial interests exist. Burden of migraine in the United States: The global burden of headache: Migraine and tension-type headache in children and adolescents.
Epidemiology of headache in a general population—a prevalence study. Hansen JM, Levy D. Headache Ashina M, editor; , Geppetti P, editor. The International Classification of Headache Disorders, 3rd edition. Leone M, Proietti Cecchini A.
Advances in the understanding of cluster headache. Munksgaard SB, Porreca F. Pathophysiology of medication overuse headache: Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Methadone and Suboxone may have a tendency to cause opioid-induced hyperalgesia in patients with chronic pain, but the risk is much lower for non-pain patients.
The dosage and length of time necessary to cause hyperalgesia varies from person to person, but technically it could occur after only one high-dose of an opioid. It should also be considered in the case of newly localized allodynia, or central pain sensitization that causes typically non-painful stimuli to seem painful. Although it may seem paradoxical, the best treatment for increased pain seems to be tapering off of the painkillers.
Another technique involves supplementing the opioid regimen with NMDA receptor modulators, which can make the receptors respond more appropriately to pain signals. These NMDA antagonists include methadone, ketamine, dextromethorphan, etc. Pharmacological targeting of pain pathology is difficult since the nervous system is so ubiquitous, but researchers are still working on it.
Opioid rotation is the act of switching between different types of opioids in order to prevent drug tolerance. The chains of habit are generally too small to be felt until they are too strong to be broken.
Every living organism has a natural rhythm. These rhythms are disrupted by illness, particularly drug and alcohol use. A drug can create false sleep. A drug can stimulate alertness. A drug can suppress appetite. Another can stimulate appetite. The science behind living rhythmically, strategies that promote and restore natural rhythms, and the role of sleep, nutrition, meditation, and exercise in the 21st century approach to healing oneself in recovery are all important aspects of your journey at Two Dreams.
Medical marijuana for urologic chronic pelvic pain
This discovery has implications both for the use of marijuana in pain to treat it with marijuana, because you could actually make it worse,". The available literature suggests that marijuana can reduce pain by 37%, or a in pain and at worse, offer a paradoxical slow exacerbation in pain intensity. Although clinical trials of cannabis for neuropathic pain have shown Tension- type headaches can not only originate in the central .. of the paradoxical (e.g., anxiogenic, hyperalgesic) effects of THC seen at higher doses.