Most migraine patients using medical cannabis chose high-THC hybrid strains and many replaced opioids | Research

The takeaway

Among 2,032 medical cannabis patients, 88% of those treating headaches likely had migraines, with hybrid strains preferred and 41-60% reporting they substituted cannabis for prescription medications, most commonly opioids.

Read this if you have migraines or chronic pain and are considering medical cannabis, especially as an alternative to opioids.

41-60% of pain patients replaced prescriptions with cannabis, most commonly opioids

What the researchers found

Researchers surveyed 2,032 medical cannabis patients and found that pain syndromes accounted for 42% of cannabis use, with chronic pain being the most common reason. Among the 505 patients using cannabis for headaches, 88% screened positive for probable migraine using a validated questionnaire.

Hybrid cannabis strains were preferred across all pain subtypes. The most popular strain among headache and migraine patients was "OG Shark," which is high in THC/THCA, low in CBD/CBDA, and contains the terpenes beta-caryophyllene and beta-myrcene, both known for anti-inflammatory and analgesic properties.

Perhaps the most striking finding was the high rate of prescription medication substitution. Between 41% and 60% of pain patients reported replacing prescription drugs with cannabis. Opioids were the most commonly substituted medication across all groups, ranging from 40.5% to 72.8%. Among headache patients specifically, opioids (43.4%), antidepressants/anti-anxiety medications (39%), and NSAIDs (21%) were the most commonly replaced.

Why it matters

This is one of the largest studies to characterize how medical cannabis patients with specific pain conditions actually use cannabis, what strains they prefer, and what medications they replace. The high rate of opioid substitution is particularly relevant to the opioid crisis, suggesting that medical cannabis access may provide an alternative for some chronic pain patients.

The numbers in context

2,032 patients surveyed. Pain syndromes: 42.4% of all use. Chronic pain: 29.4%. Arthritis: 9.3%. Headache: 3.7%. 88% of headache patients screened positive for probable migraine. 41.2-59.5% substituted prescriptions with cannabis. Opioid substitution: 40.5-72.8% across pain groups. Preferred headache strain: OG Shark (high THC, low CBD, beta-caryophyllene, beta-myrcene).

How the study worked

This was a cross-sectional electronic survey of patients registered with a medical cannabis provider in Canada. The 2,032 respondents provided data on cannabis use patterns, preferred strains, consumption methods, and prescription medication substitution. Headache patients were screened for migraine probability using the validated ID Migraine questionnaire. Strain biochemical profiles were analyzed.

What this study cannot tell us

Self-reported data from registered medical cannabis patients may not represent all cannabis users with pain. There was no verification of diagnoses beyond the ID Migraine screen. The substitution data reflects patient perception, not medically confirmed tapering. The study cannot determine whether cannabis was equally effective as the medications it replaced.

How to read the evidence

This is a large cross-sectional survey providing moderate evidence of use patterns, but self-reported data and lack of clinical verification limit conclusions about efficacy.

When this study was published

Published in 2018. Medical cannabis strain options and patient practices have continued to evolve.

The bigger picture

This study provides real-world data on how patients are using medical cannabis for pain, filling a gap between clinical trials (which test standardized preparations) and actual patient behavior. The strain preferences and substitution patterns can guide future research and clinical recommendations.

Questions still open

Is the preference for high-THC strains in migraine patients supported by the pharmacology, or is it driven by availability and marketing? Can cannabis safely replace opioids for chronic pain long-term? Do the terpene profiles of preferred strains contribute meaningfully to pain relief?

Common questions

What cannabis strains work best for migraine?

In this survey, migraine patients preferred the hybrid strain "OG Shark," which is high in THC, low in CBD, and contains the terpenes beta-caryophyllene and beta-myrcene. However, this reflects patient preference, not clinical trial evidence of superiority.

Can cannabis replace opioids for pain?

Between 41% and 73% of patients in this survey reported substituting opioids with cannabis. While this is encouraging, the study cannot confirm that cannabis was equally effective, and patients should work with healthcare providers when considering any medication change.

Read the original research

Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort.

The journal of headache and pain, 19(1), 37

View on PubMed ↗Publisher’s paper ↗

Citation

Baron, Eric P; Lucas, Philippe; Eades, Joshua; Hogue, Olivia. (2018). Patterns of medicinal cannabis use, strain analysis, and substitution effect among patients with migraine, headache, arthritis, and chronic pain in a medicinal cannabis cohort.. The journal of headache and pain, 19(1), 37. https://doi.org/10.1186/s10194-018-0862-2