Cluster and Cannabis: Caution?

As is the case with many cluster or migraine treatments, reviews are mixed when it comes to cannabis. This isn’t really reason to ignore it or embrace it – uncertainty is not surprising in a treatment that has been studied as little as cannabis, for a condition that has been studied as little as cluster.

Back in 2010, the results of a questionnaire were published that gave us some early insight into just how effective cannabis was at the time. More than half of the cluster headache patients who had used cannabis felt that the results were “variable or uncertain”. But 22% said it was definitely un-useful or even made their symptoms worse. 25% felt that it was beneficial, providing at least a 50% improvement.

So that leaves us with a 75% fail, or in some cases variable effectiveness.

In a more recent European study, a THC-CBD combination was administered in a study to cluster patients as a preventative, with an extra dose administered as needed during an attack. This seemed to help, but only about as much as amitriptyline, an antidepressant often used for cluster.

An interesting side note was that the abortive dose helped some patients – and which ones? The patients who had had migraine as children. For patients who had not had childhood migraine, the extra dose did nothing at all.

Studies like these leave us with a multitude of questions – what dose is the right dose? How should it be administered? How does it compare to other more established treatments? There are so many options that successful treatment can’t be ruled out, but it will be a long time before there is solid evidence for a good treatment.

The caution comes in because, as with any new treatment, the long term effects of various versions of cannabis treatment are unknown. But more immediately, cluster headache patients should be aware that for many cannabis does make symptoms worse.

Being aware of the risks doesn’t mean you shouldn’t try the treatment. It just means that you are aware of the risks, and so can make wise decisions with your doctor about which treatment to try first.

And we hope that research continues.

For more information:

• Is Cannabis Effective for Cluster Headache? (Neurology Reviews)
• Cannabinoids suitable for migraine prevention (European Pharmaceutical Review)