Chronic Migraine Headache:

five cases successfully treated with Marinol and/or illicit cannabis.

Tod H. Mikuriya, M.D.

Case 1

A thirty eight year old white female stock broker supervisor with a twenty-six year history of unilateral vascular headaches escalating to generalized headache with tension headache overlay. The severity and frequency of episodes responded only to parenteral dihydroergotamine, meperidine, and trimethobenzamide HCl with sedation and further immobilization.

Marinol (delta 1-9 tetrahydrocannabinol dissolved in sesame oil) was begun with gradual upward titration dropwise to avoid undesirable mental side effects. She experienced a significant decrease in the frequency of attacks except when she ran out of medication.

She tolerated 40 mg daily (10 mg QID) without side effects but experienced an attack after running out of the THC capsules. Because of financial straits secondary to her disability status and the high expense of Marinol she has partially substituted illicitly obtained marijuana which she has ingested orally with similar relief.

Over the past four years she has maintained better control over the attacks with only one trip to the emergency room for a meperidine treatment in the past two years. She continues to utilize illicit cannabis because of the high cost of Marinol but has difficulty with irregular dosage with either too little or too much.

Case 2

Her mother, a 58 year old hospital ward clerk who has experienced migraine headaches with similar symptoms but less profoundly debilitating than those of her daughter.Likewise, she was treated with a gradually increasing dosageof Marinol with stabilization at a 10 mg daily dose (5 mg BID).Notwithstanding her undergoing stressful conditions on the job she experienced successful stopping of episodes in prodromal stage.

Left neck numbness, anorexia, water retention and left diplopia were reversed with normalization of gastric motility, diuresis,and peripheral vasodilation. She subjectively felt a relief of affectual pressure. She experienced no debilitating side effects as with other antimigraine agents and sedatives. Perceptually she described a "shift of vision"- slightly out of focus. This effect was transient.

Case 3

A 44 year old female teacher has a thirty year history of familial unilateral severe vascular headaches with antecedent visual scotomata. She switched to self-medication with marijuana after 9 years of

meperidine/sedative treatments with their impairing effects.

Cases 4 & 5

She taught her daughters ages 21 and 17 to self-medicate with marijuana with similar success in aborting migraine headaches in the prodromal phase with scotomata.

Discussion

While hemp drugs (cannabis) were introduced to western medicine by O'Shaughnessy in 1839 and attained wide usage until the turn of the century with the development of synthetic and semisynthetic analgesics.Their use declined though maintaining mention in medical texts until removal from the formulary in 1940. Reclassified as a schedule I drug in 1970 alleged to having no medicinal redeeming importance, the synthetic THC created by government sponsored research contractors was downscheduled to II in 1986, the same as non-combination opiates requiring triplicate prescription.

Grinspoon has recently described use of cannabinoids therapeutically for migraine.

It would appear that further clinical trial of both Marinol and cannabis for the treatment of migraine headache would be desirable.

References

Fishbein, M Queries and Minor Notes: Migraine Associated With Menstruation JAMA Vol 120:4 Sept 26, 1942 p 326

Grinspoon L and Baklar Marijuana Forbidden Medicine

Mackenzie, S. Indian hemp in persistent headache. JAMA 1887 9:732.

O'Shaughnessy, W.B.: On the preparations of the Indian Hemp or gunjah; their effects on the animal system in health and their utility in the treatment of tetanus and other convulsive diseases. Trans. Med. and Phys. Soc., Bengal, 1838-40; 71-102, 421-461.

Osler, W., and McCrae: Principles and Practice of Medicine. 8th ed., D. Appleton & Co., New York, 1916, p. 1809

Reynolds JR On Some Therapeutical Uses of Indian Hemp. Arch Med London 1859 Vol 2 154 - 160

Reynolds, JR: Therapeutical uses and toxic effects of cannabis indica. Lancet 1890 1; March 22: 637-638

Solis-Cohen, S. and Githens, T.S.: Pharmacotherapeutics, Materia Medica and Drug Action. D. Appleton and Co. New York, 1928.

Volfe, Z, Dvilansky, A, Nathan, I, Cannabinoids block release of serotonin from platelets induced by plasma from migraine patients. Int. J Clin Pharmacol. Res, 1985; 5(4): 243-6

September 12, 1991

Berkeley, CA