Frågedatum: 2023-09-13
RELIS database 2023; id.nr. 710, ULIC
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Cannabinoider (Cannabinol, Dronabinol) och psilocybin för behandling av klusterhuvudvärk



Fråga: Läkemedelsbehandling vid klusterhuvudvärk: Finns evidens för cannabinoider (Cannabinol, Dronabinol) och för psilocybin?

Svar: Several review articles assessed the available literature on cannabinoids and hallucinogens for headache (1-4).

There are no clinical studies conducted to support the use of cannabis for cluster headache (1-4). However, supporting literature, primarily limited to case based, anecdotal, or laboratory-based scientific research suggests a role for medicinal cannabis and cannabinoids in several types of headache disorders including migraine and cluster headache (1-4).

In a case report (5), a 19-year-old male who was refractory to a multitude of preventive and abortive medications reported that smoking marijuana at the onset of a cluster headache attack would consistently give complete headache relief within 5 minutes of inhalation, and was the only thing that helped. Given the dramatic improvement with smoked cannabis, his physician decided to substitute the smoked cannabis with Dronabinol (Marinol®) 5?mg, a synthetic cannabinoid. Dronabinol taken at the onset of cluster headache consistently provided complete and rapid relief within 5-15 minutes (5). Dronabinol preparation does not contain other cannabinoids such as cannabidol which has analgesic activity; hence dronabinol overall has not been a great choice for migraineurs (4).

In a study (6) conducted in 2 French headache centers with a patient questionnaire evaluating marijuana use in cluster headache patients, 63/139 (45.3%) had a history of cannabis use, of which 27 patients (19.4% of total cohort) had used it to treat cluster headache attacks (6). Efficacy was reported in 25.9%, variable or uncertain effects in 51.8%, and negative effects in 22.3%. Thus, in almost three quarters, the cluster headache subjects did not report efficacy. Due to cannabis's variable responses, the survey concluded that cannabis should not be used as a therapeutic option for managing cluster headache attacks. The authors noted the need for controlled trials with synthetic selective cannabinoids to show a more convincing therapeutic benefit
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A survey of 113 patients with chronic cluster headaches in France found that 26% regularly consumed cannabis, although whether cannabis was used for treatment of cluster headache or only recreationally was not further evaluated (7).

Hallucinogens such as psilocybin mushroom are being increasingly used by cluster headache patients outside of physician recommendation mainly to abort a cluster period and maintain quiescence for which there is considerable anecdotal success (4). Psilocybin was reported as effective by the respondents in multiple self-reported efficacy surveys (8). In a small pilot study in patients with cluster headache (n=16), the effect of psylocybin did not differ from placebo (9).

Referenser:
  1. Poudel S, Quinonez J, Choudhari J, Au ZT, Paesani S, Thiess AK, Ruxmohan S, Hosameddin M, Ferrer GF, Michel J. Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature. Cureus. 2021 Aug 24;13(8):e17407. doi: 10.7759/cureus.17407. PMID: 34589318; PMCID: PMC8459575.
  2. Lochte BC, Beletsky A, Samuel NK, Grant I. The Use of Cannabis for Headache Disorders. Cannabis Cannabinoid Res. 2017 Apr 1;2(1):61-71. doi: 10.1089/can.2016.0033. PMID: 28861505; PMCID: PMC5436334.
  3. Baron EP. Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: what a long strange trip it's been. Headache. 2015;55:885–916
  4. McGeeney BE. Cannabinoids and hallucinogens for headache. Headache. 2013 Mar;53(3):447-58. doi: 10.1111/head.12025. Epub 2012 Dec 20. PMID: 23278122.
  5. Robbins MS, Tarshish S, Solomon S, Grosberg BM. Cluster attacks responsive to recreational cannabis and dronabinol. Headache. 2009; 49: 914-916.
  6. Leroux E, Taifas I, Valade D, et al.. Use of cannabis among 139 cluster headache sufferers. Cephalalgia. 2013;33:208–213
  7. Donnet A, Lanteri-Minet M, Guegan-Massardier E, et al. Sociêtê Française d'Etude des Migraines et Cêphalêes (SFEMC). Chronic cluster headache: A French clinical descriptive study. J Neurol Neurosurg Psychiatry. 2007; 78: 1354-1358.
  8. Rusanen SS, De S, Schindler EAD, Artto VA, Storvik M. Self-Reported Efficacy of Treatments in Cluster Headache: a Systematic Review of Survey Studies. Curr Pain Headache Rep. 2022 Aug;26(8):623-637. doi: 10.1007/s11916-022-01063-5. Epub 2022 Jun 27. PMID: 35759175; PMCID: PMC9436841.
  9. Schindler EAD, Sewell RA, Gottschalk CH, Luddy C, Flynn LT, Zhu Y, Lindsey H, Pittman BP, Cozzi NV, D'Souza DC. Exploratory investigation of a patient-informed low-dose psilocybin pulse regimen in the suppression of cluster headache: Results from a randomized, double-blind, placebo-controlled trial. Headache. 2022 Nov;62(10):1383-1394.