In the first double-blind, placebo-controlled trial, vaporised cannabis was found to be more effective for treating acute migraine symptoms than a placebo.
While preclinical and retrospective studies have suggested cannabinoids may be effective in migraine treatment, according to the researchers, until now, there have been no randomised clinical trials examining these effects in adults with acute migraine symptoms.
The randomised, double-blind, placebo-controlled crossover trial – widely considered the gold standard in clinical research – involved 92 participants, of which 83% were female.
Individuals were treated for up to four separate migraine attacks – 247 migraine attacks in total – with vaporised THC-dominant, CBD-dominant, and a balanced CBD/THC cannabis flower, alongside a placebo.
Researchers specifically examined the effects of each type of cannabis on pain relief, as well as complete freedom from pain, and the participants’ ‘most bothersome symptoms’.
The results, published in the journal Headache: The Journal of Head and Face Pain, found that participants who used a combination of THC and CBD reported significant pain reduction and improvement in their ‘most bothersome symptom’ within 2 hours of treatment.
Around 67% of people reported meaningful pain relief with cannabis containing a balance of THC and CBD, compared to 47% with a placebo, with around 60% reporting complete pain freedom, compared to 35%.
Freedom from the most bothersome symptoms, such as nausea and light sensitivity, was also achieved more often with the balanced cannabis (60%) than with the placebo (35%).
No serious adverse events were reported, and benefits were sustained at 24 and 48 hours.
The THC-dominant cannabis was also superior to placebo for pain relief, with 68.9% of participants, compared to 46.6%, but not pain freedom or most bothersome symptom freedom at the two-hour mark.
Meanwhile, CBD-dominant cannabis was not superior to the placebo for pain relief, pain freedom, or most bothersome symptom freedom.
READ MORE: Could cannabis inhalation help with migraine management?
“First compelling evidence” for cannabis in migraine treatment
The researchers say the findings suggest that a vaporised, balanced cannabis flower may be a viable treatment for acute migraine in patients who do not respond to standard therapies.
Speaking to Medscape, the study’s senior author, Dr Nathaniel M. Schuster, a pain/headache neurologist, said: “This is the first placebo-controlled study in this space. It’s the first real — to—me—compelling evidence for the antimigraine effects of cannabis in humans.
The authors also argue that the fact that the study was conducted independently from the industry strengthens its findings, although more large-scale, long-term studies on benefit and risk are still needed.
“In this first randomized, double-blind, placebo-controlled trial testing the efficacy of cannabinoids for the acute treatment of migraine, vaporized 6% THC + 11% CBD cannabis flower was superior to placebo for pain relief, pain freedom, and MBS freedom at 2 h as well as 24-h sustained pain freedom and sustained MBS freedom and 48-h sustained MBS freedom,” the authors wrote.
“Strengths of the study include that it was a randomized, double-blind, placebo-controlled study conducted with foundation funding and cannabis from the NIDA DSP and without industry involvement. However, this also limits the generalizability of the study’s findings to commercial products used by patients in real-world settings.”
They add: “Future research should include multicenter RCTs and long-term studies of benefits and risks with repeated use.”
