|
Cannabis for migraine
Many may be unaware that Cannabis sativa (L.,
Cannabaceae) was once a widely accepted medical treatment for
the prevention and relief of migraine headache, listed in the
United States Pharmacopeia from 1860 to 1941. In this review article,
the author presents an overview of historical use, modern research,
and safety data that supports the potential utility of Cannabis
in migraine, which affects an estimated 23 million Americans [Russo,
1998]. Currently available migraine medications are not always
reliable and may cause significant side effects.
Historical information shows that Cannabis was held
in high regard for the treatment of migraine by American and British
physicians for at least eight decades, from the latter half of
the nineteenth century until the early 1940s. According to Russo,
in 1915 "...Sir William Osler, the acknowledged father of
modern medicine, stated of migraine treatment, 'Cannabis indica
is probably the most satisfactory remedy.'" Despite vigorous
protest by the American Medical Association, Cannabis was
made illegal in the United States in 1937, and the plant was dropped
from the United States Pharmacopeia in 1941. Nonetheless, the
following year, the editor of the Journal of the American Medical
Association (JAMA) continued to recommend Cannabis
for the treatment of menstrual migraine.
Although no modern clinical studies have specifically investigated
the use of Cannabis in migraine, a number of small pain
relief studies have reported positive results in chronic headache
pain and improvement of pain tolerance. A study investigating
the effects of oral doses of the Cannabis compound delta-9-tetrahydrocannabinol
(THC) in patients with cancer demonstrated a trend toward pain
relief with escalating doses. The analgesic properties of Cannabis
are believed to be unrelated to opioid mechanisms. Recent studies
have pointed out some possible mechanisms of action for cannabinoids
in migraine, including antinociceptive effects (interference with
pain transmission) in an area of the brain that is considered
a likely area for migraine generation.
In 1988, after an extensive review of testimony, US Drug
Enforcement Agency administrative law judge Francis Young concluded
that "By any measure of rational analysis marijuana can be
safely used within a supervised routine of medical care."
In a 1995 editorial, the editor of the British Medical Journal
called for "moderation in the drug war," and a supportive
commentary was published by JAMA during the same year.
Based on the history of medical use of Cannabis and the
positive evidence demonstrated in preliminary modern studies,
the author of this review paper argues that "medical marijuana
and its possible role in migraine treatment deserves proper scientific
examination, both biochemically and clinically."
Evelyn Leigh, HRF
[Russo E. Cannabis for migraine treatment: the once and future
prescription? An historical and scientific review. Pain
1998; 76: 3-8.]
|
