First, the good news, something the migraine/cluster headache medical marijuana patient for whom I am a caregiver could’ve told you without any scientific studies:
Pharmacological preparations of cannabinoid compounds have a variety of therapeutic uses in medicine, including different pain syndromes, but have not been previously reported as beneficial for cluster headache. We present a patient with cluster headache who was refractory to multiple acute and preventive medications but successfully aborted his attacks with recreational marijuana use; subsequent use of dronabinol provided equally effective pain relief.
In other words, some people can kill their severe headaches by smoking pot or taking Marinol pills.
But once you dig past the abstract and into the full text of the paper, you step through Alice’s looking glass into the world where 100% potent synthetic THC is a Schedule III prescribable drug and 5%-20% potent natural THC + other medical cannabinoids is a Schedule I illegal drug.
A 19-year-old right-handed university student presented to the Montefiore Headache Center for evaluation and management of his cluster headaches. Over the past 2 years, he had a cyclical pattern of stereotyped attacks occurring predictably every 1 to 2 months, lasting approximately 2 weeks. During these 2-week cluster periods, he experienced 1 attack every other day. Each cluster period was typically followed by a remission phase lasting 1 to 2 months. However, over the past 3 months, the frequency gradually increased to 1 to 2 attacks daily.
The majority of attacks would abruptly awaken him from sleep at 12:30 am or 4:30 am with excruciating right temporal and peri-orbital pain. Each episode lasted 3 to 4 h untreated, with the pain reaching maximal intensity within 10 min and declining within 10 min at its conclusion.
He did not drink alcohol, but noted that marijuana use at the onset of his headaches consistently brought complete relief within 5 min of inhalation for each attack.
OK, so smoking pot relieved the headaches, that should be it, right? No! The researchers take him off the marijuana and subject him to traditional (legal) treatments for chronic headaches, including prednisone, methylprednisolone acetate, bupivacaine, verapamil, lithium, sodium valproate, melatonin, topirimate, nifedipine, indomethacin, zonisamide, venlafaxine, ergotamine tartrate, clonazepam, sumatriptan tablets, zolmitriptan nasal spray, ergotamine/caffeine, oxycodone, aspirin/butalbital/caffeine, acetominophen/dichlorphenazone/isometheptene, and indomethacin are all tried, “without benefit” and with “intolerable adverse effects” (click any drug for its fun list of adverse effects, like nausea, vomiting, constipation, loss of appetite, extreme thirst, urinating more or less than usual, weakness, fever, feeling restless or confused, eye pain and vision problems, restless muscle movements in your eyes, tongue, jaw, or neck, pain, cold feeling, or discoloration in your fingers or toes, feeling light-headed, fainting, slow heart rate, hallucinations, seizure (blackout or convulsions), depressed mood, thoughts of suicide or hurting yourself, chest tightness, fast or pounding heartbeats, and the worst adverse reaction, death.)
So, as the last resort…
Given the lack of responsiveness to multiple agents, dronabinol [Marinol pill] 5 mg was substituted for marijuana for acute treatment of his cluster headaches; dronabinol consistently provided dramatic relief within 5 to 15 min of ingestion.
OK, so smoking pot or using Marinol helps and pharmaceuticals don’t. I can understand giving the guy Marinol instead of marijuana if both are equally effective, if only to keep him out of jail. What I can’t understand is this conclusion by the researchers:
It may be of future interest to ascertain if pain relief can be achieved when recreational marijuana or dronabinol are used in a cluster attack. We would not recommend routine use of recreational or pharmacological preparations of cannabis for treatment of cluster headaches because of the risk of long-term dependence and other potential adverse effects.
You were more than willing to run this guy through 21 different phamaceutical therapies, including steroids, oxycodone and lithium, and you’re worried about the dependence and adverse effects of cannabis? What kind of insanity is it where the herb that is safer and more effective than 21 dangerous ineffective drugs is rejected by doctors who as a last resort turn to the synthetic preparation of one part of the exact same herb they’re rejecting because it is too dangerous?