The journal of headache and pain
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Medicinal cannabis registries typically report pain as the most common reason for use. It would be clinically useful to identify patterns of cannabis treatment in migraine and headache, as compared to arthritis and chronic pain, and to analyze preferred cannabis strains, biochemical profiles, and prescription medication substitutions with cannabis. ⋯ Chronic pain was the most common reason for cannabis use, consistent with most registries. The majority of headache patients treating with cannabis were positive for migraine. Hybrid strains were preferred in ID Migraine™, headache, and most pain groups, with "OG Shark", a high THC (Δ9-tetrahydrocannabinol)/THCA (tetrahydrocannabinolic acid), low CBD (cannabidiol)/CBDA (cannabidiolic acid), strain with predominant terpenes β-caryophyllene and β-myrcene, most preferred in the headache and ID Migraine™ groups. This could reflect the potent analgesic, anti-inflammatory, and anti-emetic properties of THC, with anti-inflammatory and analgesic properties of β-caryophyllene and β-myrcene. Opiates/opioids were most commonly substituted with cannabis. Prospective studies are needed, but results may provide early insight into optimizing crossbred cannabis strains, synergistic biochemical profiles, dosing, and patterns of use in the treatment of headache, migraine, and chronic pain syndromes.
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Comparative Study
Evaluation of gray matter perfusion in episodic migraine using voxel-wise comparison of 3D pseudo-continuous arterial spin labeling.
Although previous studies have demonstrated that structural and functional abnormalities in episodic migraine (EM), less is known about altered brain perfusion in the EM. The aim of this study is to investigate altered gray matter perfusion in EM using a 3D volumetric perfusion imaging. ⋯ The current study indicated that the pattern of cerebral hyperperfusion may elucidate the neurogenic mechanism in the EM genesis, and 3D pc-ASL technique would non-invasively provide valuable cerebral perfusion information for the further pathophysiological and neuropsychological study in EM.
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Pituitary adenylate cyclase-activating polypeptide (PACAP) is widely distributed in the nervous system and is involved in migraine pathophysiology. Understanding the function of the blood-brain barrier (BBB) in relation to PACAP is important to the understand the mechanisms behind PACAP-induced migraine attacks, but also to develop antimigraine drugs targeting the PACAP receptors Here, we aim to review the transport ability of PACAP across the BBB. ⋯ PACAP38 is transported over the BBB actively, while PACAP27 cross the BBB by diffusion over the membrane, but after crossing the endothelial membrane both isoforms are either rapidly degraded or efflux back from brain to blood. Thus, a direct central action of the PACAPs is unlikely. This is supported by studies showing selective PACAP effect on extra-cerebral arteries.
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To evaluate triptan use and overuse as well as prescription patterns in Austria based on a nationwide healthcare database because data on triptan use and overuse in Austria is missing. ⋯ The rate of triptan use is low in Austria but triptan users are at risk for triptan overuse. In triptan users more days of sick-leave and the same proportion of hospital admissions as in the older non-users suggest poorer health.