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March 10, 2021
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Cannabis use affects rate of medication overuse headache in patients with migraine

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Cannabis use "significantly contributes" to the prevalence of medication overuse headache among patients with chronic migraine, according to study results scheduled for presentation at the American Academy of Neurology Annual Meeting.

"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," study author Niushen Zhang, MD, clinical assistant professor in the department of neurology & neurological sciences at Stanford University School of Medicine, said in a press release.

Migraine
Cannabis use increased medication overuse headache in patients with chronic migraine. Source: Adobe Stock

"However, we found that people who were using cannabis had significantly increased odds of also having medication overuse headache, or rebound headache, compared [with] people who were not using cannabis."

Although moderate evidence exists to support cannabis use for treating chronic pain, Zhang and colleagues noted emerging anecdotal evidence suggests that cannabis may play a role in medication overuse headache.

To assess this potential link among patients with chronic migraine, the investigators used the Stanford Research Repository Cohort Discovery Tool to conduct a retrospective cohort between 2015 and 2019. They analyzed data from 368 adult patients with chronic migraine who had a minimum chronic migraine duration of 1 year. Of these patients, 150 used cannabis and 218 did not use cannabis.

From each patient’s chart, Zhang and colleagues obtained data on the diagnosis of medication overuse headache as the dependent variable, as well as predictor variables including age, sex, migraine frequency, current chronic migraine duration, current cannabis use duration, overused acute migraine medications and duration of current medication overuse headache. They identified variables that predicted medication overuse headache while controlling for remaining predictors using logistic regression. Further, they performed agglomerative hierarchical clustering to examine natural clusters using all predictor variables.

Among patients with chronic migraine, the researchers identified 212 with and 156 without medication overuse headache. Zhang and colleagues found that current cannabis use significantly predicted cases with medication overuse headache (OR = 5.99; 95% CI, 3.45-10.43). Moreover, they observed significant associations between current cannabis use, opioid use and medication overuse headache. Agglomerative hierarchical clustering showed two major natural clusters, with the first cluster containing younger patients with less migraine frequency and higher medication overuse headache burden, as well as more current cannabis and opioid users, compared with the second cluster.

“It may be helpful to advise [chronic migraine] patients with [medication overuse headache] to reduce cannabis use in order to treat [medication overuse headache] effectively,” Zhang and colleagues wrote.