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Cannabis use may increase risk of Medication Overuse Headache (MOH)

New research has found that patients with chronic migraine who use cannabis to help manage their pain are six times more likely to develop medication overuse headache (MOH).


  • Chronic migraine is a term used to describe when a migraine patient is affected by headache at least 15 days per month, 8 of which are migraine days. 
  • Medication Overuse Headache (MOH) is a secondary diagnosis where either new headache or a worsening of existing heading results from the regular use of acute medications, such as triptans or pain relief. 
  • A large study conducted in Norway in 2004 found that 54% of people with chronic migraine also have MOH.
  • There is currently limited clinical evidence that cannabis is helpful for the treatment of migraine or migraine symptoms. 
  • Many migraine patients are either self-medicating or trying medicinal cannabis products to manage their pain.

What was studied:

  • The researchers studied the clinical records of 368 patients who are over 18 and have lived with chronic migraine for more than a year. 
  • The data collected included age, sex, diagnosis of chronic migraine, average number of headache days per month during the last 3 months, duration of chronic migraine in years, cannabis use at the time of encounter, duration of last cannabis use in months, type of cannabis used, diagnosis of medication overuse headache, and abortive medications causing the medication overuse headache.

What they found:

  • 212 patients had MOH, and 156 patients did not have MOH. The average length of time a patient has been experiencing MOH was 2 years. 
  • 150 patients were using cannabis, and 218 were not using cannabis. 
  • Patients currently using cannabis were six times more likely than those not using cannabis to have MOH. 
  • Those patients using cannabis that did have MOH consumed significantly more cannabis than those who did not have MOH.
  • The combination of cannabis and opioid use significantly contributed to MOH prevalence in chronic migraine patients.
  • The researchers speculate that cannabis consumption leads to increased sensitisation that can exacerbate the progression of medication overuse headache.

Important to note:

  • This is the first study looking for evidence of a link between MOH and cannabis use in migraine patients. 
  • This a study of correlation: two things occurring together. It is not evidence that using cannabis causes MOH. More research is required. 

What does this mean for me?

  • You need to discuss with your doctors whether a medicinal cannabis product may be useful for you, including the risk of MOH. 
  • If you are using cannabis products to manage your pain, consider being cautious and restricting your usage to less than 10 days per month to avoid MOH, in line with the current advice for triptans, opiates and combination medications. 

Researchers: Niushen Zhang, MD and Yohannes W. Woldeamanuel, MD of Stanford University School of Medicine
Paper title: Medication Overuse Headache in Chronic Migraine Patients Using Cannabis: a Case-Referent Study
Type: Preliminary paper to be presented at the American Academy of Neurology’s 73rd Annual Meeting being held virtually April 17 to 22, 2021 
Date: 1 March, 2021
Link to paper 

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