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Cannabis use linked to more rebound headaches in migraine sufferers

Cannabis use linked to more re...
Observational research suggests an association between cannabis use and medication overuse headaches
Observational research suggests an association between cannabis use and medication overuse headaches
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Observational research suggests an association between cannabis use and medication overuse headaches
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Observational research suggests an association between cannabis use and medication overuse headaches

New research from scientists at Stanford University School of Medicine suggests cannabis use can be linked to higher rates of "rebound headaches" in migraine sufferers. The research is observational and retrospective, but it is yet another finding questioning how helpful cannabis is for chronic migraine patients.

The researchers focused on a particular condition known as medication overuse headaches. These are headaches known to occur in relation to chronic overuse of migraine pain medication. The condition is more informally called rebound headaches, because the headaches often bounce back as soon as medications wear off.

The new research looked at retrospective longitudinal data from 368 chronic migraine sufferers. Over half had been diagnosed with medication overuse headaches. Those using cannabis were found to be six times more likely to suffer from rebound headaches.

“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,” says Niushen Zhang, one of the researchers working on the project. “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.”

The work is yet to be published in a peer-reviewed journal. The researchers plan to present the findings at the upcoming American Academy of Neurology’s 73rd annual meeting, to be held virtually next month.

The researchers are cautious to note this research does not offer any evidence cannabis use is a causal factor in medication overuse headaches. This was only an observational study correlating the two factors and more direct clinical work is needed to understand a causal connection.

Importantly there is also no information on how subjects were consuming cannabis. Speaking to Healthline, Dustin Suluk, owner of a medical cannabis company, suggests rebound headaches can be more common in subjects who smoke cannabis.

“For chronic headaches especially and for more frequent migraine, the best approach is to take cannabis by mouth to prevent headaches and reserve inhalation for rescue from more severe episodes only,” says Suluk, who did not work on this new research.

The Stanford researchers behind this new investigation do note the relationship between cannabis use and rebound headaches was more prominent in subjects who were also using opioids to manage their migraines. Since both cannabis and opioids affect a brain region implicated in migraines called the periaqueductal gray, it is reasonable to hypothesize stopping cannabis and opioid use may help those suffering from medication overuse headaches (MOH).

“Bidirectional cannabis- opioid association was observed – use of one increased use of the other,” the researchers conclude. “It may be helpful to advise [chronic migraine] patients with MOH to reduce cannabis use in order to treat MOH effectively.”

Source: American Academy of Neurology

1 comment
paul314
In observational studies like this it's very important to figure out the direction of causation (if any). You could get similar results here, for example, if people with the most intractable symptoms turned to cannabis and/or opoids because of dissatisfaction with more conventional medications. (There was a sorry period in migraine medicine where some specialists assumed that patients who didn't come back had all been cured, rather than considering they'd given up on the doctor...)