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mr peabody

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Cannabis found to reduce headache and migraine pain by nearly half

by Washington State University | Medical Xpress | Nov 25 2019

Inhaled cannabis reduces self-reported headache severity by 47% and migraine severity by 50%, according to a recent study led by Carrie Cuttler, a Washington State University assistant professor of psychology.

The study, published online recently in the Journal of Pain, is the first to use big data from headache and migraine patients using cannabis in real time. Previous studies have asked patients to recall the effect of cannabis use in the past. There has been one clinical trial indicating that cannabis was better than ibuprofen in alleviating headache, but it used nabilone, a synthetic cannabinoid drug.

"We were motivated to do this study because a substantial number of people say they use cannabis for headache and migraine, but surprisingly few studies had addressed the topic," said Cuttler, the lead author on the paper.

In the WSU study, researchers analyzed archival data from the Strainprint app, which allows patients to track symptoms before and after using medical cannabis purchased from Canadian producers and distributors. The information was submitted by more than 1,300 patients who used the app over 12,200 times to track changes in headache from before to after cannabis use, and another 653 who used the app more than 7,400 times to track changes in migraine severity.

"We wanted to approach this in an ecologically valid way, which is to look at actual patients using whole plant cannabis to medicate in their own homes and environments," Cuttler said. "These are also very big data, so we can more appropriately and accurately generalize to the greater population of patients using cannabis to manage these conditions."

Cuttler and her colleagues saw no evidence that cannabis caused "overuse headache," a pitfall of more conventional treatments which can make patients' headaches worse over time. However, they did see patients using larger doses of cannabis over time, indicting they may be developing tolerance to the drug.

The study found a small gender difference with significantly more sessions involving headache reduction reported by men. The researchers also noted that cannabis concentrates, such as cannabis oil, produced a larger reduction in headache severity ratings than cannabis flower.

There was, however, no significant difference in pain reduction among cannabis strains that were higher or lower in levels of tetrahydrocannabinol (THC) and cannabidiol (CBD), two of the most commonly studied chemical constituents in cannabis, also known as cannabinoids. Since cannabis is made up of over 100 cannabinoids, this finding suggests that different cannabinoids or other constituents like terpenes may play the central role in headache and migraine relief.

More research is needed, and Cuttler acknowledges the limitations of the Strainprint study since it relies on a self-selected group of people who may already anticipate that cannabis will work to alleviate their symptoms, and it was not possible to employ a placebo control group.

"I suspect there are some slight overestimates of effectiveness," said Cuttler. "My hope is that this research will motivate researchers to take on the difficult work of conducting placebo-controlled trials. In the meantime, this at least gives medical cannabis patients and their doctors a little more information about what they might expect from using cannabis to manage these conditions."

 
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mr peabody

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Ketamine may help treat migraine pain unresponsive to other therapies

American Society of Anesthesiologists | Oct 21, 2017

Ketamine, a medication commonly used for pain relief and increasingly used for depression, may alleviate migraine pain in patients who have not been helped by other treatments, suggests a study being presented at the ANESTHESIOLOGY 2017 annual meeting.

The study of 61 patients found that almost 75 percent experienced an improvement in their migraine intensity after a 3 to 7 day course of inpatient treatment with ketamine. The drug is used to induce general anesthesia but also provides powerful pain control for patients with many painful conditions in lower doses than its anesthetic use.

"Ketamine may hold promise as a treatment for migraine headaches in patients for whom other treatments have failed," said study co-author Eric Schwenk, M.D., director of orthopedic anesthesia at Thomas Jefferson University Hospital in Philadelphia. "Our study focused only on short-term relief, but it is encouraging that this treatment might have the potential to help patients long-term. Our work provides the basis for future, prospective studies that involve larger numbers of patients."

An estimated 12 percent of the U.S. population suffers from migraines, recurring attacks of throbbing or pulsing moderate to severe pain. A subset of these patients, along with those who suffer from other types of headaches, do not respond to treatment. People with migraines are often very sensitive to light, sound and may become nauseated or vomit. Migraines are three times more common in women than in men.

Researchers reviewed data for patients who received ketamine infusions for intractable migraine headaches, migraines that have failed all other therapies. On a scale of 0-10, the average migraine headache pain rating at admission was 7.5, compared with 3.4 on discharge. The average length of infusion was 5.1 days, and the day of lowest pain ratings was day 4. Adverse effects were generally mild.

Dr. Schwenk said while his hospital uses ketamine to treat migraines, the treatment is not widely available. Thomas Jefferson University Hospital will open a new infusion center this fall that will treat more patients with headaches using ketamine. "We hope to expand its use to both more patients and more conditions in the future," he said.

"Due to the retrospective nature of the study, we cannot definitively say that ketamine is entirely responsible for the pain relief, but we have provided a basis for additional larger studies to be undertaken," Dr. Schwenk added.

https://www.asahq.org/about-asa/news...ther-therapies
 
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mr peabody

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Okay..., the expensive pharmaceutical..., or the cheap, effective option?

by Dennis Powell | The Athens NEWS | 12 Feb 2020

Here’s some good news, really good news, and this is no joke.

If you have never suffered from migraine or cluster headaches, drop to your knees each day in thanks. Lots of people have suffered and continue to suffer from these debilitating, agonizing conditions. For a long time there was no effective treatment.

Migraine and cluster headaches are related, but they’re not the same. A migraine is a powerful headache generally preceded by some kind of visual disturbance, often a blind spot filled with garish, flashes like the spiky lights atop a carnival ride at night. It can last for days. Cluster headaches come in clusters, as the name implies. They typically arrive at the same time each day and last for several hours. Often their arrival is a couple of hours after the sufferer has gone to sleep.

Both can be unspeakably painful, with cluster headaches much more severe. Think of the headache you would get from chugging a frozen margarita. Now think of that lasting for hours. The pain is so severe that it has driven some people to suicide.

When you have a cluster headache or migraine, it owns you.

Both kinds of headaches involve pressure on the trigeminal nerve, though the mechanism is not well understood. And until fairly recently there was no effective treatment. A few decades ago a pharmaceutical compound, Sumatriptan, was approved for treatment of migraine and cluster headaches, and in my experience it is very effective. It comes in injectable form as well as pills and nasal spray. I chose the spray, which works in about 15 minutes. The other methods take longer.

I keep some around for emergencies – and believe me, when you get whacked by a migraine or worse, a cluster headache, it’s a personal emergency. But the stuff is expensive: last time I filled a prescription it was $54 per squirt. Worth every penny, but still.

Sumatriptan, sold under the brand name Imitrex, is not a worry-free solution, though. No one is sure why it works. And the side effects can be severe – as in: they can kill you. (This is rare; it has never, for instance, killed me, and I’ve used it from time to time for two decades.)

Now. What I’m about to describe involves a research sample size of - just me. But other research confirms what I found in my own little experiment 10 days ago.

The evening of Groundhog Day I experienced a visual disturbance which told me that soon I’d be owned by a full-blown migraine. My Sumatriptan supply, though plentiful, had expired. I didn’t think that this would be a problem. I went online to confirm this, reading with my peripheral vision. (I should note that there are some additional, more subtle symptoms, among them worry: What if this time the medicine doesn’t work? What if the visual display never goes away? What if this time it’s a stroke or something?)

While I was looking sideways at web pages, I happened on a study that surprised the hell out of me. In a double-blind experiment, migraine sufferers reported that plain old ginger – yes, the stuff you get to make gingerbread – was just as effective as Sumatriptan.

As it happens, I had some ginger, in the form of “gold kili Instant Honey Ginger Drink,” which I get in a bag of 20 individual packets for $3.99 at the Oriental Market on East State Street. My friend Marjorie introduced me to it years ago; she found it tasty and soothing as a hot drink on cold nights, especially when one has a cold.

So, with migraine pain en route, I decided it was time for a little experiment. I made a nice, warm cup of the stuff and eagerly consumed it. The pain arrived, but then… went away! It was all gone, as with Imitrex, in about 15 minutes. Which is to say the 20-cent packet of ginger drink was in my case as effective as a $54 dose of Sumatriptan. Your results, as the television ad lawyers tell us, may vary.

(I have not tried it on cluster headaches, and I hope you’ll forgive my not wishing for the opportunity to do so, but the mechanisms are believed to be much the same, so there’s some likelihood that it will stop, or at least mitigate, those, too.)

There’s more. Sumatriptan, as I mentioned, has serious potential side effects. With few exceptions – those who may not consume ginger for one medical reason or another, even as some people may not safely consume grapefruit – ginger has no side effects much beyond some people not liking it.

I have to say that I was skeptical, until the ginger worked. Over the years I’ve gotten exposed to a lot of flaky treatments and cures to a lot of real and imagined conditions, offered by the attractive but flaky sorts of persons who used to appear in old “Herbal Essence” shampoo commercials. I’ve spoken with many people who offered remedies one sentence ahead of talking in strange hypnotic tones about their spiritual communication with Martians.

I’ve tried some of those remedies, and while I don’t think they did any harm, they did no discernible good, either.

Likewise, I’ve seen various claims that beet extract does something wonderful but vaguely described, that cranberries are good to treat serious ailments (beyond bladder infections), that mistletoe extract can help cure cancer, and so on. A willow extract was the precursor to aspirin, which is a bona fide wonder drug. So it’s not as if there’s no good stuff out there.

But there have also been snake-oil peddlers throughout history. And it is not true that that which does not kill you makes you stronger. That which does not kill you might leave you horribly crippled, or it might do nothing at all.

Far be it from me to know which claims have merit and which ones do nothing, and which ones make things worse. In this case, though, the danger was slight; I had another remedy on hand which definitely worked, as a fall-back, so why not give it a try?

I did. It worked. And if you suffer from migraine or cluster headaches, and there’s no medical reason why you mustn’t consume ginger, it might well work for you, too.

Which you’ll agree is very good news indeed.

 
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mr peabody

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New drug Ubrogepant works quickly to relieve acute migraine pain*

by Rita Aghjayan | Clinical Advisor | 31 Jan 2020

Ubrogepant has been shown to relieve migraine pain and symptoms within 2 hours of treatment compared with placebo, according to the results published in the New England Journal of Medicine.

In December 2019, the FDA-approved Ubrogepant for the acute treatment of migraine in adults with or without aura, making it the first-in-class oral medicine for this indication.

Investigators conducted a randomized trial to assess the efficacy, safety, and side effects associated with oral Ubrogepant. Participants of the study were randomly assigned to receive an initial dose of placebo, 50 mg of Ubrogepant, or 100 mg of Ubrogepant for a single migraine attack. Patients were given the option to take a second dose if needed.

Primary outcomes included complete absence of pain and “most bothersome migraine-associated symptom” at 2 hours after the initial dose. Secondary outcomes measured at 2 hours after the initial dose included pain relief and lack of symptoms linked to migraine such as photophobia, phonophobia, and nausea. Secondary outcomes between 2 and 24 hours after initial treatment included sustained pain relief and freedom from pain.

Two hours after treatment, 21 percent of the 100-mg Ubrogepant group were free from migraine pain after an initial dose.

*From the article here:

 
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mr peabody

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Chronic sufferers choosing psilocybin for migraines

I remember the day I got my first migraine pretty vividly. I was a freshman in high school sitting in math class, when all of a sudden, my vision became blurry. I soon felt shaky, nauseous, incredibly confused, and frightened by what was happening to me. But in the hour or two it took to see a doctor, my symptoms had disappeared.

Eventually, I realized I had experienced my first migraine, and since then I suffer through a few every year. While they're pretty debilitating and can ruin an entire day, I'm lucky I don't suffer from chronic migraines like some do.

In the U.S. it's estimated that roughly 3.2 million Americans live with chronic migraines and of that percentage, some experience 15 to 20 a month. These headaches last four hours or more on average, and often force sufferers to take days off work. This adds up to not only lost hours of their lives, but lost productivity and money. In fact, it's estimated up to $31 billion in productivity is lost annually from headache disabilities in the U.S. alone.

I can tell when a migraine is coming on because of a chain of predictable symptoms. First, I begin to see auras and my vision is blurred, then all symptoms subside like the calm before a storm, and finally the piercing headache, nausea, vomiting, and shakiness.

Hallucinations and bizarre visuals often accompany or signal to migraine sufferers they're about to endure a headache. The most common visual oddities are blurriness and auras, but some experience zigzags, swirling vortices, and Picasso-esque patterns. Physical hallucinations arent unusual either.

During his first migraine, author, Anthony Peake, says, "I felt that the top of my head was lifting off and moving upwards toward the ceiling. Then I noticed the office seemed to be getting smaller, as if I was looking at it from the wrong end of a telescope."

Only about 15 to 20 percent of migraine sufferers experience migraines with auras. These migraines can be so disorienting and confusing, sometimes rendering sufferers unable to communicate properly, almost like a stroke. But despite the well-documented symptoms and prevalence of these painful experiences, doctors still don't know what causes them exactly.

Headache disorders are ranked 7th in all disabilities globally, though only 36 percent of sufferers are diagnosed. And migraines aren't even the worst type of debilitating headache - that title is reserved for cluster headaches.

Cluster headaches have been described as one of the worst pains a human being can feel, worse than childbirth, or as one sufferer put it, worse than having a limb amputated without anesthesia. Cluster headaches have been nicknamed the suicide headache for reasons that can probably be inferred.

These two types of headaches tend to occur in one gender more than the other, with migraines choosing women, and cluster headaches more often reserved for men. Some attribute this to hormonal functions, but no one really knows for certain.

Specific things activate migraines, including caffeine, lack of sleep, alcohol, weather fluctuations, and stress. Cluster headaches, on the other hand, seem to fall into episodic cycles, and contrary to migraines, sleeping can actually trigger them. Sufferers often get cluster headaches as they're entering REM sleep, leading them to fear bedtime.

LSD and psilocybin for migraines

Sometime in 2015, well over a decade after my headaches began, I was at a friend's house when I felt the early signs of an oncoming migraine. I alerted my buddies to what would happen and the protocol I typically followed to deal with the next few hours of pain.

My friend Sean said he wanted to make me something that might help my symptoms. So he whipped out his mortar and pestle and began making me a chunky paste, while I laid on the couch, preparing for the impending agony. After a few minutes, he came back with the paste and a glass of water, telling me to consume the strange concoction.

I asked what was in it and he replied, "Some honey, various herbs, and some (magic) mushrooms. Not enough to make you trip, just a micro-dose, but there's a chance you might feel a body high. It will definitely help your symptoms, though."

Now, full disclosure, I had taken psilocybin before, so I was familiar with its effects, but the idea of a potential psychedelic trip while suffering from a mind-numbing headache sounded like a horrible idea. But I trusted Sean and took the mushroom mixture.

For chronic headache sufferers, there are a number of pharmaceuticals prescribed to mitigate their symptoms and lead a semi-normal life. Triptans are one of the most commonly prescribed, often paired with an NSAID, i.e. aspirin or ibuprofen. But these drugs are not a panacea and only provide temporary relief.

Triptans are referred to as selective serotonin receptor agonists, stimulating serotonin production in the brain. This serotonin increase reduces inflammation and constricts blood vessels to alleviate the headache. Triptans belong to the tryptamine family of monoamine alkaloids. Coincidentally, the psychoactive compounds found in many psychedelics are also tryptamines.

Psilocybin converts to psilocin in the body, becoming a partial agonist for serotonin receptors known as 5-HT receptors, particularly the 5-HT(2b) and 5-HT(2a) receptors. Psilocybin and other tryptamines, including DMT and LSD, are referred to as serotonergic psychedelics because they activate these serotonin receptors. Triptans work as agonists on serotonin receptors in the same way, but instead stimulate 5-HT(1b) and 5-HT(1d) receptors.

For reasons not fully understood, the receptors that psilocybin and LSD target produce a psychedelic experience, while the receptors the triptans target do not. However, when both receptors are targeted, the psychedelic experience can be amplified immensely, but not in a pleasant way.

Unsurprisingly, another pharmaceutical used in the past to treat migraines, due to its affinity for those 5-HT receptors, is ergotamine, a peptide derived from ergot fungus, first isolated by Arthur Stoll at Sandoz Pharmaceuticals in 1918. Stoll worked alongside Albert Hoffman, the famous chemist who first synthesized LSD at Sandoz from, you guessed it, ergotamine.

When Hoffman accidentally synthesized LSD he had also worked to isolate psilocybin from the mushroom Psilocybe mexicana. Sandoz sold psilocybin to clinicians using it for psychotherapy, before the drug was criminalized in 1968. It's believed that Hoffman was actually working on synthesizing new medicines to treat headaches, which he may have apparently found, though the hype from his discovery's psychedelic properties completely overshadowed any other use for it.

After Sean gave me the micro-dose of magic mushrooms, my headache began to play out as expected. My liver had to first process the psilocybin, convert it to psilocin, and release a number of metabolites into my bloodstream; a process that usually takes 30 to 45 minutes. But after that time had passed, it felt like I had skipped the worst part of my headache and was coasting through the dull afterglow that marks the latter stage of my migraines. I also felt a little woozy, the feeling I knew the mushrooms were responsible for.

It seemed Sean's magic mushroom remedy worked. It didn't stop the headache dead in its tracks, but it did mitigate the pain significantly and shorten the span of it. Now, had I been working at the time, the subtle psychoactive effects of the psilocybin may have been distracting, but with a full-blown migraine, no work would have been accomplished anyway.

Cluster Busters - Using psychedelics for headaches

Triptans, steroids, and other pharmaceuticals prescribed to treat chronic bouts can have long-term side effects ranging from organ fibrosis, cardiac disturbances, and even osteoporosis. And while triptans are good for alleviating individual headaches, chronic sufferers have found that psychedelic serotonergics can break or even prevent the episodic cycles of headaches that recur on a predictable basis.

Those unfortunate enough to suffer from cluster headaches experience as many as eight to 10 a day during cycles. Though they don't suffer year-round, cycles typically last anywhere from two to three-months, with each headache lasting anywhere from 45 minutes to three hours.

Bob Wold is the founder and president of Cluster Busters, a group that has, for the past 15 years, advocated for the study and legal use of psilocybin and LSD for treatment of cluster headaches. Wold began suffering from them biannually for a period of 20 years after being misdiagnosed many times. He was ineffectually prescribed 75 different medications, including the highly addictive fentanyl and even cocaine drops.

Wold was so desperate to ease the pain that he almost underwent an invasive, unproven surgery that would have severed his trigeminal nerves and destroyed all sensation in his face. That was, until he found an online forum touting the benefits of serotonergic psychedelics for treating his condition.

Wold said he asked his two kids, who happened to be in college, to procure him the necessary psilocybin-containing mushrooms to see if they could ameliorate his agonizing pain. While he doesn't condone buying psilocybin mushrooms off the street, as acquiring them is illegal and hard to determine exact dosage, Wold was in a desperate state and willing to take risks.

Shortly after using the drug to treat his headaches, Wold noticed an immediate difference, saying his head hadn't felt that good in the 20 years since his condition began. From then on, he used the drug as both an analgesic and a preventative measure, spreading the word to fellow sufferers as often as possible.

Cluster Busters says it believes the key difference between triptans and serotonergic psychedelics is that the receptor targeted by the latter acts as a vasoconstrictor, preventing attacks by keeping the carotid artery from expanding and pressing on the trigeminal nerves.

Unfortunately, taboos and legal constrictions have made it hard to gauge doses and procure these drugs safely for chronic headache sufferers, but recent persistence and overwhelming anecdotal evidence from Cluster Busters has led to legally approved trials of the drugs for treatment of severe chronic headaches.

Researchers like Harvard psychiatrist, Dr. John Halpern, decided to look more closely into the stories being reported from Cluster Busters and conduct a study of his own. After interviewing 53 subjects who used a serotonergic psychedelic to treat cluster headaches, he found that 95 percent successfully delayed or completely avoided headaches. This led Halpern to set up future double-blind studies with control groups to properly test results.

Much like the dose I received from Sean to treat my migraine, the doses used by most cluster headache sufferers are micro-doses, or non-psychedelic doses. Even the slightly larger, preventative doses Wold takes a few times a year , he says, are roughly tantamount to a buzz from a few glasses of wine - enough to make lights look slightly more vivid.

Another strong proponent who deserves mention for use of psychedelics to treat chronic headaches is Graham Hancock. Hancock says at one point he was suffering from up to 20 severe migraines a month, before he took Ayahuasca and Iboga in shamanic ceremonies.

Ayauhasca is an Amazonian brew containing DMT, another serotonergic psychedelic found in many plants. Today, after suffering from chronic headaches his entire life, Hancock no longer suffers from them at all, and has vowed to take Ayahuasca two to three times a year to prevent them, and for the spiritual experience it provides.

Of course, one should tread with caution when considering these drugs for treatment. Wold says it's important to consult a doctor to ensure these psychoactive substances won't react adversely with any other medications one might be on, and to assure that one is healthy enough to take them.

With any luck, further research into serotonergic psychedelics can help relieve the pain for victims of chronic headaches and eliminate the unwarranted stigma placed on a natural substance with medicinal value. For more information visit the Cluster Busters website or MAPS, another group that continues to achieve funding and legal permission to advance clinical trials studying the healing potential of psychotropic drugs.

https://www.gaia.com/lp/content/psyc...for-migraines/
 
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