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Chichorro JG, Gambeta E, Baggio DF, Zamponi GW. Voltage-gated Calcium Channels as Potential Therapeutic Targets in Migraine. THE JOURNAL OF PAIN 2024; 25:104514. [PMID: 38522594 DOI: 10.1016/j.jpain.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
Migraine is a complex and highly incapacitating neurological disorder that affects around 15% of the general population with greater incidence in women, often at the most productive age of life. Migraine physiopathology is still not fully understood, but it involves multiple mediators and events in the trigeminovascular system and the central nervous system. The identification of calcitonin gene-related peptide as a key mediator in migraine physiopathology has led to the development of effective and highly selective antimigraine therapies. However, this treatment is neither accessible nor effective for all migraine sufferers. Thus, a better understanding of migraine mechanisms and the identification of potential targets are still clearly warranted. Voltage-gated calcium channels (VGCCs) are widely distributed in the trigeminovascular system, and there is accumulating evidence of their contribution to the mechanisms associated with headache pain. Several drugs used in migraine abortive or prophylactic treatment target VGCCs, which probably contributes to their analgesic effect. This review aims to summarize the current evidence of VGGC contribution to migraine physiopathology and to discuss how current pharmacological options for migraine treatment interfere with VGGC function. PERSPECTIVE: Calcitonin gene-related peptide (CGRP) represents a major migraine mediator, but few studies have investigated the relationship between CGRP and VGCCs. CGRP release is calcium channel-dependent and VGGCs are key players in familial migraine. Further studies are needed to determine whether VGCCs are suitable molecular targets for treating migraine.
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Affiliation(s)
- Juliana G Chichorro
- Biological Sciences Sector, Department of Pharmacology, Federal University of Parana, Curitiba, Parana, Brazil.
| | - Eder Gambeta
- Cumming School of Medicine, Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Darciane F Baggio
- Biological Sciences Sector, Department of Pharmacology, Federal University of Parana, Curitiba, Parana, Brazil
| | - Gerald W Zamponi
- Cumming School of Medicine, Department of Clinical Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Schindler EAD. Psychotropic Drugs Reemerging as Headache Medicines. CNS Drugs 2024:10.1007/s40263-024-01107-x. [PMID: 39037675 DOI: 10.1007/s40263-024-01107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/23/2024]
Abstract
Scientific and public attention on the therapeutic effects of psychedelics and other psychoactive compounds in headache disorders has recently grown. The use and reported therapeutic effects of such treatments have long been reported, though formal clinical trials are only recently taking place. When considering how these substances might be further studied and eventually applied, it is important to consider the specific headache disorder, the particular drug, and the mode of use. No singular protocol will be applicable across all headache disorders and drugs. In this leading article, the nuance required to consider the value of classic psychedelics, ketamine, and cannabinoids as headache medicines is presented.
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Affiliation(s)
- Emmanuelle A D Schindler
- Neurology Service, VA Connecticut Healthcare System, MS 127, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
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de Barros GAM, Pos AM, Sousa ÂM, Pereira CL, Nobre CDDA, Palmeira CCDA, Caruy CAA, Munhoz DC, Kraychete DC, Avelar ECQ, Fukushima FB, Garcia JBS, Torres JNL, Rodrigues KDA, Palladini M, Neto ODHC, Carmona MJC. Cannabinoid products for pain management: recommendations from the São Paulo State Society of Anesthesiology. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844513. [PMID: 38740135 PMCID: PMC11167254 DOI: 10.1016/j.bjane.2024.844513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/12/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
There is growing interest in using cannabinoids across various clinical scenarios, including pain medicine, leading to the disregard of regulatory protocols in some countries. Legislation has been implemented in Brazil, specifically in the state of São Paulo, permitting the distribution of cannabinoid products by health authorities for clinical purposes, free of charge for patients, upon professional prescription. Thus, it is imperative to assess the existing evidence regarding the efficacy and safety of these products in pain management. In light of this, the São Paulo State Society of Anesthesiology (SAESP) established a task force to conduct a narrative review on the topic using the Delphi method, requiring a minimum agreement of 60% among panelists. The study concluded that cannabinoid products could potentially serve as adjuncts in pain management but stressed the importance of judicious prescription. Nevertheless, this review advises against their use for acute pain and cancer-related pain. In other clinical scenarios, established treatments should take precedence, particularly when clinical protocols are available, such as in neuropathic pain. Only patients exhibiting poor therapeutic responses to established protocols or demonstrating intolerance to recommended management may be considered as potential candidates for cannabinoids, which should be prescribed by physicians experienced in handling these substances. Special attention should be given to individual patient characteristics and the likelihood of drug interactions.
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Affiliation(s)
| | | | - Ângela Maria Sousa
- Universidade de São Paulo (USP), Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | - Cecília Daniele de Azevedo Nobre
- Casa de Saúde São José (Rede Santa Catarina), Rio de Janeiro, RJ, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | | | - Derli Conceição Munhoz
- Faculdade de Medicina da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | | | | | - Fernanda Bono Fukushima
- Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
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Makarevičius G, Dapkutė A, Ryliškienė K. Complementary and alternative medicine use in migraine patients: results from a national patient e-survey. Front Neurol 2024; 15:1378532. [PMID: 38863511 PMCID: PMC11165229 DOI: 10.3389/fneur.2024.1378532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Object This cross-sectional study aims to investigate migraineurs' preferred complementary and alternative medicine (CAM) types and the factors influencing their usage. Materials and methods An anonymous e-survey was distributed to Lithuanian Migraine Association members, and social media migraine support communities. The collected data consisted of demographic, migraine-related questions, personal qualities, CAM habits. Results 470 respondents were analyzed. 95.96% were women with a median age of 37 (IQR 31, 44). The median duration of migraine was 17.5 years (IQR 10, 25) and the median headache severity was rated 8 (IQR 7, 10) out of 10. 68.90% of participants had one or more headache days per week. 71.49% of respondents were triptan users, 27.66% used medical prophylaxis, and 17.87% used monoclonal antibodies. 52.55% of respondents used CAM in the past 12 months. Physical activity (36.17%), dietary changes/fasting (27.02%), relaxation/meditation (26.60%) were the most used CAM types. Reasons for CAM use included dissatisfaction with conventional treatment effectiveness (42.51%), concerns about safety (48.18%) and adverse effects (37.25%). Factors associated with the decision to explore CAM included longer headache duration (p = 0.017, Mann-Whitney U test), frequent sick leaves (p < 0.001, Mann-Whitney U test), current preventive medication use (p = 0.016, chi-square test), positive views on CAM safety/naturality (p = 0.001/ p < 0.001, Mann-Whitney U test), belief of having a healthy diet (p < 0.001, chi-square test), food-related worries (p = 0.011, Mann-Whitney U test) and Big-five personality trait of openness to experience (p = 0.049, chi-square test). After logistic regression, the frequent need to take sick leaves, having a healthy diet, food-associated fears maintained statistical significance. CAM use was not associated with non-adherence to conventional medicine. 48.99% of CAM consumers disclosed CAM use to their doctors. Conclusion CAM is explored by a significant proportion of migraineurs, less than half communicate this to their doctors. In our sample, physical activity, dietary changes, and relaxation techniques were the most common. Many patients opted for CAM due to previously experienced side effects/ineffectiveness of conventional migraine treatment or the fear of potential harm from standard medication. Individual factors, such as openness of personality can be an important contributing factor.
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Affiliation(s)
- Gytis Makarevičius
- Center of Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Schuster NM, Wallace MS, Marcotte TD, Buse DC, Lee E, Liu L, Sexton M. Vaporized Cannabis versus Placebo for Acute Migraine: A Randomized Controlled Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.16.24302843. [PMID: 38405890 PMCID: PMC10889030 DOI: 10.1101/2024.02.16.24302843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Preclinical and retrospective studies suggest cannabinoids may be effective in migraine treatment. However, there have been no randomized clinical trials examining the efficacy of cannabinoids for acute migraine. Methods In this randomized, double-blind, placebo-controlled, crossover trial, adults with migraine treated up to 4 separate migraine attacks, 1 each with vaporized 1) 6% Δ9-tetrahydrocannabinol (THC-dominant); 2) 11% cannabidiol (CBD-dominant); 3) 6% THC+11% CBD; and 4) placebo cannabis flower in a randomized order. Washout period between treated attack was ≥1 week. The primary endpoint was pain relief and secondary endpoints were pain freedom and most bothersome symptom (MBS) freedom, all assessed at 2 hours post-vaporization. Results Ninety-two participants were enrolled and randomized, and 247 migraine attacks were treated. THC+CBD was superior to placebo at achieving pain relief (67.2% vs 46.6%, Odds Ratio [95% Confidence Interval] 2.85 [1.22, 6.65], p=0.016), pain freedom (34.5% vs. 15.5%, 3.30 [1.24, 8.80], p=0.017) and MBS freedom (60.3% vs. 34.5%, 3.32 [1.45, 7.64], p=0.005) at 2 hours, as well as sustained pain freedom at 24 hours and sustained MBS freedom at 24 and 48 hours. THC-dominant was superior to placebo for pain relief (68.9% vs. 46.6%, 3.14 [1.35, 7.30], p=0.008) but not pain freedom or MBS freedom at 2 hours. CBD-dominant was not superior to placebo for pain relief, pain freedom or MBS freedom at 2 hours. There were no serious adverse events. Conclusions Acute migraine treatment with 6% THC+11% CBD was superior to placebo at 2 hours post-treatment with sustained benefits at 24 and 48 hours.
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Affiliation(s)
- Nathaniel M. Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego Health System, San Diego, CA
- Center for Medicinal Cannabis Research, University of California, San Diego Health System, San Diego, CA
| | - Mark S. Wallace
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego Health System, San Diego, CA
- Center for Medicinal Cannabis Research, University of California, San Diego Health System, San Diego, CA
| | - Thomas D. Marcotte
- Department of Psychiatry, University of California, San Diego Health System, San Diego, CA
- Center for Medicinal Cannabis Research, University of California, San Diego Health System, San Diego, CA
| | - Dawn C. Buse
- Department of Neurology, Albert Einstein College of Medicine
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California, San Diego Health System, San Diego, CA
| | - Lin Liu
- Department of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego Health System, San Diego, CA
| | - Michelle Sexton
- Centers for Integrative Health, Department of Family Medicine, University of California, San Diego Health System, San Diego, CA
- Center for Medicinal Cannabis Research, University of California, San Diego Health System, San Diego, CA
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Vgontzas A. Examining substance use patterns in adults with migraine: A changing landscape. Headache 2024; 64:129-130. [PMID: 38235829 DOI: 10.1111/head.14660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Angeliki Vgontzas
- John R. Graham Headache Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kotz D, Kastaun S, Manthey J, Hoch E, Klosterhalfen S. Cannabis Use in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:52-57. [PMID: 37967282 PMCID: PMC10979436 DOI: 10.3238/arztebl.m2023.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND The federal government of Germany is planning to liberalize the recreational cannabis market for adults. We aimed to collect key baseline data on frequency of use, routes of administration, and co-use of cannabis and inhaled nicotine or tobacco products in the population. METHODS Based on data from a national survey of 9644 people aged >14 years, we analyzed self-reported use of cannabis in the past 12 months and preferred route of administration (single choice: smoked with tobacco; smoked without tobacco; inhaled without tobacco; consumed with food; consumed in another form). RESULTS The prevalence of past-year cannabis use was 4.6% (95% CI [4,2; 5,1%]), with higher rates among 14-24- (11.4%) and 25-39-year-olds (8.2%) as well as among co-users of inhaled nicotine or tobacco products, particularly waterpipe users (27.0%). Smoking cannabis with or without tobacco was the preferred route of administration, reported by 92.4% (95% CI [89,6; 94,6%]). It was most frequently reported by 14-24-year-olds and by co-users of inhaled nicotine or tobacco products. CONCLUSION Smoking remains the predominant form of using cannabis-especially among younger users, who are at greatest risk of cannabis-related consequences. The true prevalence of cannabis use may have been underestimated in our study, however, as not all participants answered the questions on cannabis. Nevertheless, preventive and harm reduction efforts are needed to reduce the harm from using cannabis. Continuous monitoring is required to evaluate the effects of the forthcoming law changes in Germany.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sabrina Kastaun
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
- Institute of General Practice (ifam), Patient-Physician Communication Research Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf (UKE)
- Department of Psychiatry, Medical Faculty, University of Leipzig
| | - Eva Hoch
- IFT Institut für Therapieforschung, Center for Mental Health and Addiction Research, Munich
- Department of Psychology, Division of Clinical Psychology and Psychological Treatment, Ludwig-Maximilans-Universität München, Munich
- Department of Psychiatry and Psychotherapy, Cannabinoid Research Group, University Hospital, LMU Munich, Munich
| | - Stephanie Klosterhalfen
- Institute of General Practice (ifam), Addiction Research and Clinical Epidemiology Unit, Centre for Health and Society (chs), Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf
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Cavarra M, Mason NL, Kuypers KPC, Bonnelle V, Smith WJ, Feilding A, Kryskow P, Ramaekers JG. Potential analgesic effects of psychedelics on select chronic pain conditions: A survey study. Eur J Pain 2024; 28:153-165. [PMID: 37599279 DOI: 10.1002/ejp.2171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Chronic pain is a major cause of suffering and disability and is often associated with psychiatric complications. Current treatments carry the risk of severe side effects and may lead to limited or no relief at all in a relevant portion of this patient population. Preliminary evidence suggests that classical psychedelics (e.g. LSD and psilocybin) may have analgesic effects in healthy volunteers, and in certain chronic pain conditions and observational studies reveal that they are used in naturalistic settings as a means to manage pain. METHODS In order to gain insight on the effectiveness of such compounds in chronic pain conditions, we set up a survey addressed to chronic pain patients inquiring about psychedelic use and the relief levels achieved with both conventional treatments, full psychedelic doses and microdoses. We analysed data related to five conditions selected based on diagnostic homogeneity within each of them: fibromyalgia, arthritis, migraine, tension-type headache and sciatica. RESULTS Except for sciatica, volunteers reported that psychedelics led to better pain relief compared to conventional medication in all examined conditions. More specifically, full doses performed better than conventional medication. Microdoses led to significantly better relief compared to conventional medication in migraines and achieved comparable relief in the remaining three categories. Implications for future research are discussed. CONCLUSIONS Full doses and microdoses may hold value in the treatment of some specific chronic pain conditions. SIGNIFICANCE Psychedelic substances are receiving increasing attention from the scientific literature because of evidence showing beneficial effects on several measures related to mental health in clinical samples and healthy volunteers samples. Previous evidence suggests that people suffering from chronic pain are using psychedelics to seek relief and the present paper presents the results of a survey study investigating their use and analgesic effects among individuals suffering from fibromyalgia, arthritis, migraine, tension-type headache and sciatica.
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Affiliation(s)
- Mauro Cavarra
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Natasha Leigh Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Kim P C Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | | | | | | | - Pamela Kryskow
- Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Johannes G Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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Patel P, Hussain K. Cannabis use and serum beta-human chorionic gonadotropin: a smoky illusion. Clin Exp Dermatol 2023; 48:1063-1064. [PMID: 37279527 DOI: 10.1093/ced/llad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
Systemic isotretinoin is a well-known human teratogen that remains the most effective treatment for patients > 12 years old with severe nodulocystic acne. This is, to our knowledge, the first report in the dermatology literature of a false-positive serum beta-human chorionic gonadotropin level from recreational cannabis use. It is important to raise awareness of this phenomenon given the ramifications of positive results for the patient, clinician and the potential workup required by various medical teams. We emphasize the importance of taking a recreational drug and alcohol history during the initial consultation and also highlight the importance of revisiting the topic in subsequent follow-up appointments.
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Affiliation(s)
- Priyank Patel
- Dermatology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Khawar Hussain
- Dermatology Department, Imperial College Healthcare NHS Trust, London, UK
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Muacevic A, Adler JR, Ojinna BT, Ravi N, Shantha Kumar V, Choday S, Parisapogu A, Tran HHV, KC A, Elshaikh AO. Efficacy and Safety of Medical Marijuana in Migraine Headache: A Systematic Review. Cureus 2022; 14:e32622. [PMID: 36660507 PMCID: PMC9845509 DOI: 10.7759/cureus.32622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Medical marijuana treatment for migraine is becoming more common, although the legality and societal acceptance of marijuana for medical purposes in the United States have been challenged by the stigma attached to it as a recreational drug. These substances function to reduce nociception and decrease the frequency of migraine by having an impact on the endocannabinoid system. Our study reviewed the clinical response, dosing, and side effects of marijuana in migraine management. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a literature search in PubMed, Google Scholar, and Science Direct, and nine studies were included in the systematic review. The studies demonstrated that medical marijuana has a significant clinical response by reducing the length and frequency of migraines. No severe adverse effects were noted. Due to its effectiveness and convenience, medical marijuana therapy may be helpful for patients suffering from migraines. However, additional clinical trials and observational studies with longer follow-ups are required to study the efficacy and safety of the drug.
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