Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort

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BACKGROUND:

Medicinal cannabis registries
typically
report pain as
the
most
common
reason
for
use.
It
would
be
clinically
useful
to
identify
patterns
of cannabis treatment
in
migraine
and
headache,
as
compared
to
arthritis
and
chronic pain,
and
to
analyze
preferred cannabis strains,
biochemical
profiles,
and
prescription
medication
substitutions
with cannabis.

METHODS:

Via
electronic
survey
in
medicinal cannabis patients
with
headache,
arthritis,
and
chronic pain,
demographics
and
patterns
of cannabis use
including
methods,
frequency,
quantity,
preferred
strains,
cannabinoid
and
terpene
profiles,
and
prescription
substitutions
were
recorded. Cannabis use
for
migraine
among
headache
patients
was
assessed
via
the
ID
Migraine™
questionnaire,
a
validated
screen
used
to
predict
the
probability
of
migraine.

RESULTS:

Of
2032
patients,
21
illnesses
were
treated
with cannabisPain syndromes
accounted
for
42.4%
(n = 861)
overall;
chronic pain 29.4%
(n = 598;),
arthritis
9.3%
(n = 188),
and
headache
3.7%
(n = 75;).
Across
all
21
illnesses,
headache
was
a
symptom
treated
with cannabis in
24.9%
(n = 505).
These
patients
were
given
the
ID
Migraine™
questionnaire,
with
68%
(n = 343)
giving
3
“Yes”
responses,
20%
(n = 102)
giving
2
“Yes”
responses
(97%
and
93%
probability
of
migraine,
respectively).
Therefore,
88%
(n = 445)
of
headache
patients
were
treating
probable
migraine
with cannabis.
Hybrid
strains
were
most
preferred
across
all pain subtypes,
with
“OG
Shark”
the
most
preferred
strain
in
the
ID
Migraine™
and
headache
groups.
Many pain patients
substituted
prescription
medications
with cannabis (41.2-59.5%),
most
commonly
opiates/opioids
(40.5-72.8%).
Prescription
substitution
in
headache
patients
included
opiates/opioids
(43.4%),
anti-depressant/anti-anxiety
(39%),
NSAIDs
(21%),
triptans
(8.1%),
anti-convulsants
(7.7%),
muscle
relaxers
(7%),
ergots
(0.4%).

CONCLUSIONS:

Chronic pain was
the
most
common
reason
for cannabis use,
consistent
with
most
registries.
The
majority
of
headache
patients
treating
with cannabis were
positive
for
migraine.
Hybrid
strains
were
preferred
in
ID
Migraine™,
headache,
and
most pain groups,
with
“OG
Shark”,
a
high
THC
(Δ9-tetrahydrocannabinol)/THCA
(tetrahydrocannabinolic
acid),
low
CBD
(cannabidiol)/CBDA
(cannabidiolic
acid),
strain
with
predominant
terpenes
β-caryophyllene
and
β-myrcene,
most
preferred
in
the
headache
and
ID
Migraine™
groups.
This
could
reflect
the
potent
analgesic,
anti-inflammatory,
and
anti-emetic
properties
of
THC,
with
anti-inflammatory
and
analgesic
properties
of
β-caryophyllene
and
β-myrcene.
Opiates/opioids
were
most
commonly
substituted
with cannabis.
Prospective
studies
are
needed,
but
results
may
provide
early
insight
into
optimizing
crossbred cannabis strains,
synergistic
biochemical
profiles,
dosing,
and
patterns
of
use
in
the
treatment
of
headache,
migraine,
and
chronic pain syndromes.

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