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Medical Marijuana for Migraine & Headache Disorders

Considering treating your migraine or headache disorder with medical marijuana? It’s a complicated topic with a variety of perspectives, so I’ve tried to distill some of the most important information below. I hope it’s a helpful guide.

Marijuana’s Efficacy for Migraine or Headache Disorders

Because laws make research of medical marijuana very difficult, there have been no blinded studies on its use for migraine or headache disorders. Anything you learn about it for migraine or headache is based on anecdote (or extrapolated from a small amount of research on rats). I’ve asked multiple headache specialists for opinions and have been told repeatedly that patients are pretty much evenly split between those who get relief and those who feel worse after using it. My discussions with patients are along those same lines. Its strongest track record is with treating nausea, which can be as debilitating as the pain for some of us.

Efficacy of Different Strains

There are hundreds (may be even thousands) of different marijuana strains, all cultivated to have different effects and address different symptoms. If the marijuana that your brother’s friend’s cousin got for you didn’t help (or made you feel worse), a different strain may still be effective. You can look up many of the strains on Leafly by condition or symptom that they treat, including migraine, nausea, anxiety and insomnia. Leafly also displays the most commonly reported adverse effects of each strain. Not all of these strains will be available at your local dispensary, but dispensary employees can give you recommendations for which might be most useful for you.

Rebound Headache Risk

A couple headache specialists have told me that they don’t know for sure, but believe that marijuana has a similar risk for rebound (medication overuse) headaches as opioids do. It’s best to follow the same rules for opioids (no more than 10 a month) and use as little as possible each time.

How Much to Use

There are no set guidelines for how much to use, though starting with a very small amount is probably wise. Watch your symptoms carefully to see if you feel better, worse or about the same, then decide if you want to try more. If you smoke (or eat) too much, there’s a chance you’re not actually treating the migraine or headache, but getting so stoned that you don’t notice it very much. That may be what you’re going for, but remember that the more you use could increase your risk of rebound headaches.

Smoking/Vaporizing vs. Eating

The two main ways to use medical marijuana are to smoke it or to eat it. The differences are akin to those of oral triptans vs. injected triptans.

Smoking gets the marijuana into your system the fastest and you can quickly see if you need more. Smoking anything can be harmful, although a recent large-scale study found marijuana to cause less lung damage than tobacco. (Using a vaporizer has similar advantages to smoking, but is thought to be less potentially damaging to the lungs. Vaporizers are expensive, so you may not want to invest in one until you discover if marijuana is even helpful for you.)

If you eat marijuana, it will take longer to take effect and your digestive tract may not process a second dose in time for it to be effective. Gastric stasis (delayed emptying of the stomach, which is a migraine symptom) could also mean that you don’t absorb as much as you need when you need it. And, of course, if you vomit during your migraines, you may not absorb much at all.

A friend who was using Marinol (prescription THC capsules) for chemo-induced nausea told me its effects were highly variable. Sometimes it did nothing, other times it helped tremendously. It depended on how how long it had been since she’d last eaten and how effectively her digestive tract processed the drug that day.

Depression and Marijuana

Although depression is one of the many conditions that marijuana is purported to treat, some research indicates that people who use marijuana are more likely to be depressed than those who don’t. However, this could be coincidence rather than causation. As the Mayo Clinic says, “Marijuana use and depression accompany each other more often than you might expect by chance, but there’s no clear evidence that marijuana directly causes depression.”

Legality

Different states have different laws and restrictions governing the use of medical marijuana. Even if it is legal in your state, the regulations may make it undesirable. (In Arizona, for example, employers can check a database of all registered medical marijuana users… if you’re not OK with your employer knowing that, you probably don’t want to get registered.) In your research, check both official statutes and news articles. The official statutes provide the legal framework, while the news stories tell you how the law is being implemented. Whatever the laws, it’s better to investigate exactly what issues you might encounter rather than stumbling into a mess.

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Opioids a Major Topic at the American Academy of Pain Management’s Annual Meeting

Opioids were, not surprisingly, a major topic at the American Academy of Pain Management’s annual meeting, which was held last week. The three main areas discussed were opioid therapy and prescribing opioids, as well as the legal implications of both. The role of cannabinoids (more commonly known as medical marijuana) as a new class of analgesics was also considered.

I haven’t seen many news stories come out of the meeting. I’m hoping for more press releases now that the meeting is over. In the meantime, here are some morsels:

Opioid Prescribing At Forefront Of Pain Medicine Meeting
Opioid treatment is an essential component of pain care for many patients and can be delivered safely and effectively, according to Frederick Burgess, M.D., Ph.D., AAPM president, who estimates that 20 to 60 million Americans live with chronic pain.

“Knowing what the current drug diversion scams are can help physicians decide who is trying to take advantage of them,” says Burke, commander of the Warren County Drug Task Force in the Cincinnati area of southwest Ohio. “The vast majority of patients are not drug seekers and that is where the balance comes in. We do not want to deprive legitimate patients effective pain relief through legally prescribed medications because of the acts of a relative few.”

Scientific Research Highlights Of The American Academy Of Pain Medicine Annual Meeting
Despite media reports suggesting that the Internet is the primary source for illegally obtained prescription opioids, only a small percentage of opioid analgesic addicts who are seeking methadone maintenance treatment reported this as a direct source of their drug supply.

The most commonly reported sources for obtaining opioid analgesics included: dealers (79.96%), friends or relatives (51.3%), physician prescription (30.17%), emergency room visits (13.53%), theft (6.48%), forged prescription (2.48%), Internet (2.9%), and other (not specified) (2.7%).

. . .

[R]eports from the local sources indicated that hydrocodone and oxycodone (immediate-release and extended-release) were reported to be the most frequently abused and diverted opioid analgesics. . . .

Abstracts from the poster presentations are also available.

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Medical Marijuana Mess in Washington State

Schoolhouse Rock makes the law-making process seem straightforward. There’s no song to explain what happens when that law is full of holes, not all law enforcement officials understand (or choose to uphold) the law, and/or the law doesn’t coincide with federal laws. Instead, patients get tossed around in the unintended consequences and unaddressed problems of the law.

That’s the best summary I can write for this article from the Seattle Weekly. Whoever wrote the headline, Club Pot Med, had to be high at the time, but the fascinating article explores the crusade of Douglas Hiatt, a former public defender, whose career is dedicated to supporting patients by sorting out this law. The article explains,

“The mess that gets Hiatt out of bed each day exists because the state’s medical marijuana law is so broadly worded that cops keep busting legitimate patients, that judges state that the law doesn’t exist, and that newly diagnosed cancer patients, for example, are frequently left with no practical way to grow their own marijuana, as the law allows. They are a bit too sick, and it takes three to four months to go from seed to weed. That’s a lot of vomiting in the meantime.”

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Three Cheers for Montel Williams

Talk show host Montel Williams went before a New Jersey senate panel today to urge lawmakers to enact medical marijuana laws. Williams uses marijuana to control debilitating pain from MS and became an activist for it after an ATF officer stopped him at the Detroit airport for carrying drug paraphernalia.

I never would have guessed that I’d praise a talk show host publicly, but surprises are good. Celebrity is powerful and the more visible the fight for pain control is, the faster we’re likely to see some changes. Thanks for giving us voice, Montel!

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“Potheads and Sudafed,” a New York Times Editorial

“Potheads and Sudafed,” a NY Times editorial that ran yesterday, caught the attention (and raised the ire) of About.com’s headache page guide, Teri Robert. The article addresses issues raised by the FDA’s denial of medicinal marjiuana’s efficacy. Columnist John Tierney writes of the conundrum:

Officially, the D.E.A. says it wants patients to get the best medicine. But look at what it’s done to scientists trying to study medical marijuana. They’ve gotten approval for their experiments from the F.D.A., but they can’t get the high-quality marijuana they need because the D.E.A. won’t allow it to be grown. The F.D.A. actually wants to know if the drug works, but the D.E.A. is following the just-say-know-nothing strategy: as long as researchers can’t study marijuana, they can’t come up with evidence that it’s effective.

And as long as there’s no conclusive evidence that medical marijuana works, the D.E.A. and its allies on Capitol Hill can go on blindly fighting it. Representative Mark Souder, the Indiana Republican who’s the most rabid drug warrior in Congress, has been pressuring the F.D.A. to crack down on medical marijuana. Last week the agency finally relented: in return for not having to start busting anyone, it issued a statement stressing the potential dangers and lack of extensive clinical trials establishing medical marijuana’s effectiveness.

For more information about the DEA’s stance, see this post.

FYI: The article is only available on the Times site if you have a paid subscription, but you can probably use your public library card to read it in a full-text newspaper database online. (The database I used is called ProQuest and I accessed it trhough the magazine and newspaper section of the library’s databases. These specific details are only applicable through my library, of course, but I hope they help you navigate your library’s website.)