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Medicine Headache

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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