Abstract Details

Title Medical Cannabis for Chronic Migraine: A Retrospective Review

Topic Headache

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-015

Objective

To examine the effects of medical cannabis (MC) on chronic migraine (CM).

Background

New York State (NYS) authorized cannabis for medically certified patients in 2015. No guidelines exist for the use of MC in CM patients. The limited body of literature for MC leaves providers underequipped and patients vulnerable.

Design/Methods This retrospective chart review of patients with CM, per International Classification of Headache Disorders Third Edition, examined 316 patients ≥21 years of age with at least one month of MC through DENT Neurologic Institute.

Results

On NYS MC, 88.3% (279) patients reported improvement in their headache profile with an average MC exposure of 22.4±17.5 weeks. The average monthly migraine frequency change was significant with 42.1% decrease (24.9±7.16 to 16.1±10.7, p<0.0001). Over half of the patients (171) reported improvement in their headache frequency, with 55.0% (111) experiencing ≥50% reduction of headache days. Sleep improvement was noted in 38.3% (121), anxiety improvement in 30.7% (97), and mood improvement in 24.7% (78). Opioid medications for CM-related pain were reduced in 50% (14) after an average of 5.6 years of opioid use. Adverse effects (AE) were reported in 23.1% (73) with 4 (1.3%) discontinuing due to AE.

Patients taking a 20:1 ratio (tetrahydrocannabinol to cannabidiol) reported significantly higher occurrence of overall headache profile improvement than patients on a 1:1 ratio (p=0.039) and headache medication reduction (p=0.0059, RR 3.12). A high to low ratio carried a RR of 3.40 for mood improvement, with similar RR observed for anxiety (3.01) and sleep (2.17) improvements. There was no significant difference in AE among high to low, equal, or low to high ratios.

Conclusions MC may play a safe role in CM management by helping to improve headache profile, anxiety, sleep, mood, and opioid reduction. Prospective studies are required to examine the role of MC in CM within a placebo-controlled environment.

Authors/Disclosures
Laszlo Mechtler, MD, FEAN, FASN, FAHS, FAAN (Dent Neurologic Institute) PRESENTER	Dr. Mechtler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Impel Pharma. Dr. Mechtler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Mechtler has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Dr. Mechtler has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Genomate Health. The institution of Dr. Mechtler has received research support from The Harry Dent Family Foundation, Inc. The institution of Dr. Mechtler has received research support from Alpheus medical. The institution of Dr. Mechtler has received research support from Shiratronics. The institution of Dr. Mechtler has received research support from Abbvie Inc. The institution of Dr. Mechtler has received research support from Amgen. The institution of Dr. Mechtler has received research support from Eli Lilly Company. The institution of Dr. Mechtler has received research support from H. Lundbeck HS. The institution of Dr. Mechtler has received research support from Pfizer. Dr. Mechtler has received personal compensation in the range of $100,000-$499,999 for serving as a Ownership interest with Neurology Practce Consortium GPO. Dr. Mechtler has a non-compensated relationship as a Board member with International Headache Society that is relevant to AAN interests or activities.
Vincent H. Bargnes III	Mr. Bargnes has received research support from Harry Dent Family Foundation.
Paul B. Hart	Mr. Hart has nothing to disclose.
Jennifer W. McVige, MD, FAAN (Dent Neurological Institute)	Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AbbVie. Dr. McVige has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for UCB. Dr. McVige has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Neurelis. The institution of Dr. McVige has received research support from Amgen. The institution of Dr. McVige has received research support from Eli Lily. The institution of Dr. McVige has received research support from Biohaven/Pfizer. The institution of Dr. McVige has received research support from Lundbeck. The institution of Dr. McVige has received research support from Dent Family Foundation. The institution of Dr. McVige has received research support from Abbvie. The institution of Dr. McVige has received research support from Teva. The institution of Dr. McVige has received research support from Theranica. Dr. McVige has a non-compensated relationship as a Neurology Board with UCNS that is relevant to AAN interests or activities. Dr. McVige has a non-compensated relationship as a Board Exam Board Member with ABPN that is relevant to AAN interests or activities.
Nicolas Saikali, MD	Dr. Saikali has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for AbbVie. Dr. Saikali has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Lilly. Dr. Saikali has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Saikali has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Upsher-Smith. Dr. Saikali has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Axsome. The institution of Dr. Saikali has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Lundbeck.

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