People using cannabis for migraine relief can have rebound headaches, similar to overuse headaches experienced by people who use too much migraine pain medication.
That’s according to a study released today.
The research will be presented at the American Academy of Neurology’s 73rd annual meeting, which is being held virtually during the week of April 17.
“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,” said Dr. Niushen Zhang, a study author and director of the Headache Fellowship Program at Stanford University in California.
“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.”
What is migraine?
Migraine is a neurological condition that’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Migraine attacks can last for hours to days, the pain of which can be so severe it interferes with daily activities.
Something called an “aura” often comes as a warning sign, involving visual disturbances such as flashes of light, blind spots, tingling on one side of the face or in an arm, and difficulty with speaking.
Medication can be helpful, often in conjunction with self-help remedies and lifestyle changes.
About 39 million people in the United States have migraine. It’s estimated that 12 percent of U.S. women and 6 percent of U.S. men have this condition.
Everything from pain medication to yoga has been prescribed for relief, often with mixed results.
What the cannabis study revealed
The study published today looked at records of 368 people who experience chronic migraine for at least a year — chronic being defined as at least 15 headache days per month.
Of the subjects, 150 were already using cannabis for relief.
Of the 368 participants, 212 had medication overuse headaches.
Researchers said that people using cannabis for migraine were six times more likely to also have medication overuse.
Previous research showed opioids and cannabis both influence part of the brain called the periaqueductal gray, which is also linked to migraine.
The concept of rebound headaches isn’t new to some doctors who regularly prescribe cannabis as medicine.
“Cannabis can cause rebound headaches,” Dr. Dustin Sulak, an integrative medicine practitioner and co-founder of Healer, a medical cannabis brand, told Healthline. “The two most common reasons are dehydration and overuse, especially via the inhaled route of delivery. Cannabis can cause the mucous membranes to become more dry and increase the thickness of the mucous.”
“This, plus inadequate water intake, often results in rebound headache that comes on as the cannabis is wearing off,” he added.
How to properly use cannabis
Sulak said inhaling cannabis builds tolerance faster, which often prompts users to increase dosage.
“The effectiveness of the treatment diminishes, and rebound headaches are more common,” Sulak said. “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. Many patients can effectively take a low dose of THC before bed and a moderate dose of CBD (cannabidiol) during the day for prevention.”
Stacia Woodcock is a clinical cannabis pharmacist and dispensary manager for Massachusetts-based Curaleaf. She told Healthline when people describe rebound headaches, “usually it is a result of a patient increasing their dose too fast or using more than the recommended dose.”
“Also, if patients who have been using cannabis regularly for more than a month discontinue their use for some reason, that can also cause a rebound headache that is secondary to mild withdrawal syndrome,” she said. “Those are the most common instances in which I encounter rebound headaches with patients.”
Woodcock said every person responds differently to cannabis, which makes it difficult to prescribe a standard dose.
“This is why we always recommend starting with a low dose and titrating slowly upward to the desired effect, to avoid any adverse side effects such as rebound headaches,” she said.
“Generally speaking, healthy lifestyle choices like maintaining good sleep habits, a healthy diet free of triggering foods, and limited alcohol intake, go a long way to help prevent occurrences of migraine and rebound headaches,” Woodcock said.
Authors of the study wrote one of its limitations was that it was retrospective, and that “longitudinal” studies will be necessary to further explore causes, and the effect, of cannabis on rebound headaches.
“Stay very hydrated — a good idea for almost everyone with chronic headache,” Sulak said. “Always avoid building tolerance to cannabis, especially THC (the psychoactive compound in cannabis) and, if it seems like this happens, reset the tolerance with a 48-hour period of cannabis abstinence, followed by a 25 percent to 50 percent dose reduction.”
“Some migraineurs report that if they catch the migraine very early, inhaled cannabis helps, but if they wait too long, cannabis can actually make the migraine worse,” Sulak said. “I always encourage migraineurs to use cannabis at the earliest sign a migraine is starting.”