Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20230027-en
Brazilian Journal of Pain
Review Article

Chronic headache and cannabinoids use: myths and truths

Cefaleia crônica e uso de canabinoides: mitos e verdades

Natally Marques Santiago; Yara Maria Lima

Downloads: 0
Views: 132

Abstract

BACKGROUND AND OBJECTIVES: The use of cannabis for medical purposes is known since ancient times. The endocannabinoid system is present throughout central and peripheral nervous system and plays a role in many important regulatory physiological processes like immune function, synaptic plasticity, pain and regulation of stress and emotion, among others. Due to its wide distribution and according to researches, cannabis can be indicated for symptoms management in different disorders such as chronic pain, headache, epilepsy, anxiety and other psychiatric disorders. The primary cannabinoids studied to date include delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), cannabigerol (CBG), and tetrahydrocannabivarin (THCV). The active ingredients in cannabis include flavonoids, terpenes, delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) and they are able to act within the endocannabinoid system and decrease nociception and also the frequency of the symptoms. The purpose of the article is to document the validity of how medical cannabis can be utilized as an alternative therapy for chronic headache management and enlighten about false beliefs regarding its use.
CONTENTS: Sixty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: “Cannabis”, “Medical Marijuana”, “Headache”, “Migraine”, “Cannabis and Migraine”, “Cannabis and Headache”. This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin.
CONCLUSION: Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.

Keywords

Cannabis, Endocannabinoids, Headache, Medical marijuana, Migraine disorders

Resumo

JUSTIFICATIVA E OBJETIVOS: O uso da cannabis medicinal é conhecido desde a antiguidade. O sistema endocanabinoide está distribuído no sistema nervoso central e periférico e atua como importante regulador em processos fisiológicos como função imune, plasticidade sináptica, regulação da dor e das emoções/estresse, entre outros. Devido à sua ampla distribuição e, de acordo com pesquisas, a cannabis pode ser indicada no manejo de sintomas em diferentes condições, como dor crônica, cefaleias, epilepsia, ansiedade e outras doenças psiquiátricas. Os canabinoides primários estudados são o 9-tetrahydrocannabinol (THC), cannabinol (CBN), canabigeral (CBG), e a tetrahidrocannabivarina (THCV). Os ingredientes ativos da cannabis incluem flavonoides, terpenos, delta-9- tetrahydrocannabinol (THC), canabidiol (CBD), e eles são capazes de agir dentro do sistema endocanabinoide e diminuir a nocicepção e a frequência dos sintomas. O objetivo deste estudo foi documentar a validade de como a cannabis medicinal pode ser utilizada como terapia alternativa para o manejo da cefaleia crônica, além de esclarecer sobre falsas crenças ligadas a seu uso. 
CONTEÚDO: Sessenta e quatro artigos foram selecionados por meio de pesquisa nas bases de dados Pubmed e Google Scholar. As seguintes palavras-chave foram usadas: “Cannabis”, “Maconha Medicinal”, “Cefaleia”, “Enxaqueca”, “Cannabis e Enxaqueca”, “Cannabis e Cefaleia”. A literatura mostra que o uso da cannabis medicinal reduz a duração e a frequência da enxaqueca e das cefaleias de origens não conhecidas. 
CONCLUSÃO: Pacientes sofrendo com enxaqueca e condições relacionadas podem se beneficiar da terapia com cannabis devido à sua conveniência e eficácia. 

Palavras-chave

Cefaleia, Cannabis, Enxaqueca com aura, Enxaqueca sem aura, Maconha medicinal

References

1 Butrica JL. The medical use of cannabis among the Greeks and Romans. J Cannabis Ther. 2002;2(2):51-70.

2 Russo EB. History of Cannabis and Its Preparations in Saga, Science, and Sobriquet. Chem Biodivers. 2007;4(8):1614-48.

3 Clendinning J. Observations on the medical properties of the cannabis sativa of India. Med Chir Trans. 1843;26:188-210.

4 Lewis M, Russo E, Smith K. Pharmacological foundations of cannabis chemovars. Planta Med. 2018;84(04):225-33.

5 Russo E. Hemp for headache: an in-depth historical and scientific review of cannabis in migraine treatment. J Cannabis Ther. 2001;1:21-92.

6 Ben-Shabat S, Fride E, Sheskin T. An entourage effect: inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. Eur J Pharmacol. 1998;353(1):23-31.

7 Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. Br J Pharmacol. 2011;163(7):1344-64.

8 Gurley BJ, Murphy TP, Gul W, Walker LA, ElSohly M. Content versus label claims in cannabidiol (CBD)-containing products obtained from commercial outlets in the state of Mississippi. J Diet Suppl. 2020;17(5):599-607.

9 Aggarwal SK. Cannabinergic pain medicine: A concise clinical primer and survey of randomized-controlled trial results. Clin J Pain. 2013;29(2):162-71.

10 Howlett AC. Efficacy in CB1 receptor-mediated signal transduction. Br J Pharmacol. 2004;142(8):1209-18.

11 Petrocellis L, Di Marzo V. An introduction to the endocannabinoid system: from the early to the latest concepts. Best Pract Res Clin Endocrinol Metabol. 2009;23(1):1-15.

12 Guindon J, Hohmann AG. The endocannabinoid system and pain. CNS Neurol Disord Drug Targets. 2009;8(6):403-21.

13 Di Marzo V, Piscitelli F, Mechoulam R. Cannabinoids and endocannabinoids in metabolic disorders with focus on diabetes. Handb Exp Pharmacol. 2011;203:75-104.

14 Pertwee RG, Howlett AC, Abood ME, Alexander SPH, Marzo VD, Elphick MR, Greasly PJ, Hansen HS, Kunos G, Mackie K, Mechoulam R, Ross RA. International Union of Basic and Clinical Pharmacology. LXXIX. Cannabinoid receptors and their ligands: beyond CB(1) and CB(2). Pharmacol Rev. 2010;62(4):588-631.

15 Ramikie TS, Nyilas R, Bluett RJ, Gamble-George JC, Hartley ND, Watanabe KM, Katona I, Patel S. Multiple mechanistically distinct modes of endocannabinoid mobilization at central amygdala glutamatergic synapses. Neuron. 2014;81(5):1111-25.

16 GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017;16:877-897.

17 Ashina M, Hansen JM, Do TP, Melo-Carrillo A, Burstein R, Moskowitz MA. Migraine and the trigeminovascular system-40 years and counting. Lancet Neurol. 2019;18(8):795-804.

18 Russo EB. Clinical endocannabinoid deficiency reconsidered: current research supports the theory in migraine, fibromyalgia, irritable bowel, and other treatment-resistant syndromes. Cannabis Cannabinoid Res. 2016;1(1):154-65.

19 Cupini LM, Costa C, Sarchielli P, Bari M, Battista N, Eusebi P. Degradation of endocannabinoids in chronic migraine and medication overuse headache. Neurobiol Dis. 2008;30(2):186-9.

20 Sarchielli P, Pini LA, Coppola F, Rossi C, Baldi A, Mancini ML, Calabresi P. Endocannabinoids in chronic migraine: CSF findings suggest a system failure. Neuropsychopharmacology. 2007;32(6):1384-90.

21 Mille, S, Matharu MS. Migraine is underdiagnosed and undertreated. Practitioner 2014;258(1774):19-24.

22 Evers S, Afra J, Frese A, Goadsby M, Linde A, May PS. Sándor PS. EFNS guideline on the drug treatment of migraine-revised report of an EFNS task force. Eur J Neurol. 2009;16(9):968-81.

23 Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1346-1353.

24 Pertwee RG. The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: Delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. Br J Pharmacol. 2008;153(17):199-215.

25 Katona I, Freund TF. Endocannabinoid signaling as a synaptic circuit breaker in neurological disease. Nat Med. 2008;14(9):923-30.

26 Greco R, Gasperi V, Maccarrone M, Tassorelli C. The endocannabinoid system and migraine. Exp Neurol. 2010;224(1):85-91.

27 Mailleux P, Vanderhaeghen JJ. Localization of cannabinoid receptor in the human developing and adult basal ganglia. Higher levels in the striatonigral neurons. Neurosci Lett. 1992;148(1-2):173-6.

28 Zhengjie L, Mailan L, Lei L, Fang Z. Altered periaqueductal gray resting state functional connectivity in migraine and the modulation effect of treatment. Nature. 2016; 6(20298):1-11.

29 Price TJ, Helesig G, Parchi D, Hargreaves KM, Flores CM. The neuronal distribution of cannabinoid receptor type 1 in the trigeminal ganglion of the rat. Neurosci. 2003;120(1):155-62.

30 Ferrari MD, Klever RR, Terwindt GM, Ayata C, van den Maagdenberg AM. Migraine pathophysiology: lessons from mouse models and human genetics. Lancet Neurol. 2015;14(1):65-80.

31 Paolucci M, Altamura C, Vernieri F. The role of the endothelia dysfunction in the pathophysiology and cerebrovascular effects in migraine: a narrative review. J Clin Neurol 2021;17(2):164-175.

32 May A, Burstein R. Hypothalamic regulation of cluster headache and migraine. Cephalalgia. 2019;39(13)1710-9.

33 Pini LA, Guerzoni S, Cainazzo MM, Ferrari A, Sarchielli P, Tiraferri I, Ciccarese M, Zappaterra M. Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial. J Headache Pain. 2012;13(8):677-84.

34 Rhyne DN, Anderson SL, Gedde M, Borgelt LM. Effects of medical marijuana on migraine headache frequency in an adult population. Pharmacotherapy. 2016;36(5):505-10.

35 Aviram J, Vysotski Y, Berman P, Lewitus GM, Eisenberg E, Meiri D. Migraine frequency decrease following prolonged medical cannabis treatment: a cross-sectional study. Brain Sci. 2020;10(6)360.

36 Lochte BC, Beletsky A, Samuel NK, Grant I. The use of cannabis for headache disorders . Cannabis Cannabinoid Res. 2017;2(1):61-71.

37 Kopruszinski1 CM, Navratilova E, Vagnerova B, Swiokla J, Patwardhan A, Dodick D, PorreCa F. Cannabinoids induce latent sensitization in a preclinical model of medication overuse headache. Cephalgia. 2020;40(1): 1-11.

38 MacCallum AC, Lo LA, Boivin M. “Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations. Eur J Int Med. 2021;10-18.

39 Baron EP. Compreehensive review of medicinal marijuana cannabinoids and therapeutic implications in medicine and headache:what a long strange trip its`been....Headache. 2015;55(6):885-916.

40 Bramer WM, Rethlefsen ML, Kleijnen, Franco OH. Optimal database combinations forliterature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6(1:1.

41 Castro F , Baraldi C , Pellesi L, Guerzoni S. Clinical evidence of cannabinoids in migraine: a narrative review. J. Clin.Med. 2022;11(6):1-9.

42 Chayasirisobhon S. Cannabis and neuropsychiatric disorders: an updated review. Acta Neurol Taiwan. 2019;29(2):27-39.

43 Connor JP, Stjepanovi D, Budney AJ, Le Foll B, Hall WD. Clinical management of cannabian withdrawal. Addiction. 2022;117(7):2075-95.

44 Cuttler C, Spradlin A, Cleveland MJ, Craft RM. Short-and long-term effects of cannabis on headache and migraine. J Pain. 2020;21(5-6):722-30

45 Kim PS, Fishman MA. Cannabis for pain and headaches primer. Curr Pain Headache Rep. 2017;21(4):19.

46 Pellesi l, Licata M, Verri P, Vandelli D, Palazzoli F, Marchesi M, Cainazzo MM, Pini LA, Guerzoni S. Pharmacokinetics and tolerability of oral cannabis preparations in pacientes with medication overuse headache (MOH). A pilot study. Eur J Clin Pharmacol. 2018;74(11):1427-36.

47 Poudel S, Quinonez J, Choudhari J, Au ZT, Paesani S, Thiess AK, Ruxmohan S, Hosameddin M, Ferrer GF, Michel J. Medical cannabis, headaches, and migraines: a review of the current literature. Cureus. 2021;13(8):2-6.

48 Russo E. Cannabis for migraine treatment:the once and future prescription? An hystorical and scientific review. Pain. 1998;76(1-2):3-8.

49 Zhang N, Woldeamanuel YW. Medication overuse headache in pacients with chronic migraine using cannabis. A case referente study. Headache. 2021;61(8):1234-44.

50 GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1211-59.

51 Stith SS, Diviant JP, Brockelman F, Keeling K, Hall B, Lucern S, Vigil J. Alleviative effects of Cannabis flower on migraine and headache. J Integr Med. 2020;18(5):416-424.

52 Peres MFP, Queiroz LP, Rocha-Filho PS, Sarmento EM, Katsarava Z, Steiner TJ. Migraine: a major debilitating chronic non-communicable disease in Brazil, evidence from two national surveys. J Headache Pain. 2019; 20(85):2-6.

53 Lucchetti G, Peres MFP. The prevalence of migraine and probable migraine in a Brazilian favela: results of a community survey. Headache. 2011;51(6):971-9.

54 Queiroz LP, Silva Junior AA. The prevalence and impact of headache in Brazil. Headache. 2015;55(1):32-8.

55 Steiner TJ, Stovner LJ, Jensen R, Uluduz D, Katsarava Z. Lifting the Burden: The Global Campaign against Headache. Migraine remains second among the world’s causes of disability, and first among young women: findings from GBD2019. J. Headache Pain. 2020;21(1):137.

56 Robbins MS, Lipton RB. The epidemiology of primary headache disorders. Semin Neurol. 2010;30(2):107-19.

57 Pini LA, Guerzoni S, Cainazzo MM, Ferrari A, Sarchielli P, Tiraferri I, Ciccarese M, Zappaterra M. Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial. J Headache Pain. 2012;13(8):677-84.
 


Submitted date:
08/07/2022

Accepted date:
02/13/2023

65553370a95395285b76fe03 brjp Articles

BrJP

Share this page
Page Sections