Abstract
Headache disorders are common, debilitating, and, in many cases, inadequately managed by existing treatments. Although clinical trials of cannabis for neuropathic pain have shown promising results, there has been limited research on its use, specifically for headache disorders. This review considers historical prescription practices, summarizes the existing reports on the use of cannabis for headache, and examines the preclinical literature exploring the role of exogenous and endogenous cannabinoids to alter headache pathophysiology. Currently, there is not enough evidence from well-designed clinical trials to support the use of cannabis for headache, but there are sufficient anecdotal and preliminary results, as well as plausible neurobiological mechanisms, to warrant properly designed clinical trials. Such trials are needed to determine short- and long-term efficacy for specific headache types, compatibility with existing treatments, optimal administration practices, as well as potential risks.
Highlights
IntroductionHeadache is a major public health concern, with enormous individual and societal costs (estimated at $14.4 billion annually) due to decreased quality of life and disability.[1] Each year, *47% of the population experience headache, including migraine (10%), tension-type headache (38%), and chronic daily headache (3%).[2] A sexual dimorphism exists for headache disorders, with women 2–3 times more likely to experience migraine[3] and 1.25 times more likely to experience tension-type headache than men.[4]
Headache is a major public health concern, with enormous individual and societal costs due to decreased quality of life and disability.[1]
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
Summary
Headache is a major public health concern, with enormous individual and societal costs (estimated at $14.4 billion annually) due to decreased quality of life and disability.[1] Each year, *47% of the population experience headache, including migraine (10%), tension-type headache (38%), and chronic daily headache (3%).[2] A sexual dimorphism exists for headache disorders, with women 2–3 times more likely to experience migraine[3] and 1.25 times more likely to experience tension-type headache than men.[4]. The present review will focus largely on migraine, tension-type headache, trigeminal autonomic cephalalgias ( cluster headache), and medicationoveruse headache (MOH). 4–72 h headache that is typically unilateral, pulsating, of moderate-to-severe intensity, and associated with photophobia and phonophobia.[5,6] Tension-type headache is classified as frequent, infrequent, or chronic, typically presenting with bilateral tightening pain of mild-to-moderate intensity and lasting minutes to days.[6,7] Cluster headache is defined as severe unilateral pain in orbital, temporal, and/or supraorbital locations, lasting 15–180 min and typically occurring frequently and at regular intervals.[6,8] MOH is a chronic condition (occurs more than 15 days per month) that develops from frequent use of anti-headache medications.[6,9]
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