CANNABIS AND MARINOL IN THE TREATMENT OF MIGRAINE HEADACHE

Tod H. Mikuriya, M.D.

Edie L., a thirty eight year old pert, intense, intelligent, articulate stock broker and former law student suffers from severe one-sided headaches that started when she was eleven years old. Aggravated by bacon, wines, monosodium glutamate, soy sauce, and complicated by severe menstrual cramping, she had been virtually house bound for weeks at a time. If the immobilizing pain, nausea, and depression from the attacks weren't bad enough, the side effects from conventional pharmacotherapy wrought further dysfunction.

Sedatives like phenobarbital and minor tranquilizers like Valium and Ativan left her sleepy and oversedated. Trips to the emergency room were frequent where Demerol (meperidine) and ergotamine (up to 3 injections in 24 hours) would bring the attack under control.

She had been to numerous specialists and underwent extensive workups including spinal taps, brain wave studies, xrays, allergy tests, and psychiatric interviews.

She made the observation that if she smoked marijuana just as the symptoms of an attack were starting that the attack could be kept at bay or stopped. She told this to several specialists who were treating her but this was either ignored or dismissed.

Because I could not prescribe marijuana Marinol was prescribed. Starting dropwise from puncturing a 10 milligram capsule using a method described by Dr. J. Russell Reynolds in 1890:"The dose should be given in minimum quantity, repeated in not less than four or six hours, and gradually increased by one drop every third or fourth day, until either relief is obtained, or the drug is proved, in such case, to be useless."

Actually, the adjustment of the dose came more easily. She found that her response to Marinol was not exquisitely sensitive and within several days she found that 10 milligrams two or three times a day was sufficient. The migraine attacks ceased. Subjectively, the Marinol did not cause sedation or immobility as with the other drugs but produced a feeling of well-being and relieved feelings of depression. The other medications worsened feelings of depression and immobility.

The expense of Marinol was, unfortunately prohibitive, causing her to have to resort to illicit cannabis of varying potency. Because of her continuing intermittantly severe recurrent depression and premigraine anxiety, she has been unable to return to work. On follow-up four years later she has had "..only one meperidine trip to the emergency room in the past two years." She makes oral preparations using inexpensive Mexican marijuana. She complains of not being able to optimize the potency of her confections because of the varying potencies and small quantities she must prepare. She also must resort to smoking marijuana which is her route of least preference. Notwithstanding, the use of cannabis for the treatment of migraine headache and depression has proven to be better than any of the previous conventional drug treatments she has been prescribed.

Edie's case is not without precedent. A physician of a century ago would have prescribed cannabis in one of the many purified preparations that were available. Today, most physicians, including headache specialists, are unaware of this and or that Marinol is one of the active principles of cannabis.

Migraine Headache is a specific type of pain for which cannabis was first described to be useful by J. Russell Reynolds . After some thirty years clinical experience after this initial observation, he described "Migraine: very many victims have for years kept their sufferings in abeyance by taking hemp at the moment of threatening, or onset of the attack." In Osler's medical text it was the treatment of choice for migraine headache. The most recent (and last) mention of cannabis for the treatment of migraine was from Morris Fishbein, M.D., Editor of the Journal of the American Medical Association in 1942.

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