Headaches were common among substance abusers, with cannabis use duration linked to higher rates | Research

The takeaway

Among 1,015 psychoactive substance users, 27% reported headaches, with 94.5% saying headaches began after substance use started, and longer cannabis use associated with higher headache rates.

Read this if you use cannabis regularly and experience headaches.

78% of substance users with headaches never sought medical help

What the researchers found

Researchers surveyed 1,015 consecutively admitted substance users about headaches. Cannabis was the most commonly used substance (80.5%), followed by alcohol (74.6%) and methamphetamine (18.7%).

Overall, 27% reported headaches. Critically, 94.5% of those with headaches said they began after substance use started, suggesting a potential link. Among individual substances, benzodiazepine, methamphetamine, cocaine, heroin, and volatile solvent users had higher headache rates than cannabis users alone.

For cannabis specifically, younger age at first use and longer duration of use were associated with higher headache incidence. This correlation was not seen with other substances. Migraine was more prevalent in this population than in previously reported community samples. Notably, 78% of headache sufferers had never sought medical help.

Why it matters

Headache is an underappreciated symptom in substance users, and 78% had never sought help for it. The specific association between cannabis use duration and headache incidence, not seen with other substances, raised questions about chronic cannabinoid effects on pain pathways.

The numbers in context

1,015 patients. Cannabis use: 80.5%. Alcohol: 74.6%. Headache prevalence: 26.9%. Headache after substance use onset: 94.5%. Never sought help for headache: 78%.

How the study worked

Cross-sectional study of 1,015 consecutively admitted psychoactive substance users. All completed a detailed headache questionnaire. Headache onset timing relative to substance use was recorded. This was a single-group study without a non-user comparison group.

What this study cannot tell us

No control group of non-substance users. Self-reported headache timing is subject to recall bias. Polydrug use was the norm (most used multiple substances), making it impossible to attribute headaches to cannabis specifically. The population was from a single treatment center.

How to read the evidence

Cross-sectional study without a control group. Identifies associations but cannot determine causation. Polydrug use confounds cannabis-specific conclusions.

When this study was published

Published in 2012. Cannabis-related headache, particularly rebound or withdrawal headache, has received more attention since.

The bigger picture

This study hinted at a paradox: while acute cannabis may relieve headaches, chronic use might increase their frequency. This mirrors the medication overuse headache phenomenon seen with traditional painkillers.

Questions still open

Does chronic cannabis use cause headaches or do headache-prone individuals self-medicate with cannabis? Could cannabis withdrawal headaches account for the association? Does the paradox of acute relief versus chronic worsening apply to cannabis headache?

Common questions

Can cannabis cause headaches?

This study found longer cannabis use was associated with more headaches, but could not prove causation. The timing (94.5% of headaches started after substance use began) was suggestive. It is possible that chronic use affects pain pathways, similar to medication overuse headache with traditional painkillers.

Why would cannabis cause headaches if it is used to treat them?

This potential paradox mirrors what happens with many pain medications: acute use provides relief, but chronic daily use can lead to rebound headaches. Whether this applies to cannabis specifically needs more research.

Read the original research

Headaches related to psychoactive substance use.

Clinical neurology and neurosurgery, 114(7), 990-9

View on PubMed ↗Publisher’s paper ↗

Citation

Beckmann, Yeşim Yetimalar; Seçkin, Mustafa; Manavgat, Ali İlhan; Zorlu, Nabi. (2012). Headaches related to psychoactive substance use.. Clinical neurology and neurosurgery, 114(7), 990-9. https://doi.org/10.1016/j.clineuro.2012.02.041