Medicinal Cannabis - Treatment resistant pain, neuropathic pain, cluster headaches and migraines

This course is designed to empower healthcare professionals with the skills and knowledge required to assess, prescribe, and manage medicinal cannabis for patients experiencing chronic or intractable pain and headaches. It highlights evidence-based practices, therapeutic mechanisms, and real-world clinical applications. No prerequisites are required, although a basic understanding of the endocannabinoid system, THC and CBD, and administration routes is recommended.

Unit 1: Headaches – Clinical Overview & Classification
This unit introduces the clinical landscape of treatment-resistant headaches, including:
- Cluster Headaches: Rare but extremely painful, with a prevalence of chronic cases requiring long-term management. Epidemiology, familial risk, and treatment challenges are explored.
- Migraines: Focus on episodic and chronic subtypes, with detailed diagnostic criteria. The role of cortical spreading depression, aura phenomena, and risk factors such as stroke and psychiatric comorbidities are addressed.
- Medication Overuse Headache (MOH): Differentiating MOH from chronic migraines, causes, and withdrawal strategies.
- Diagnostic Frameworks: Primary vs secondary headaches, red flags, and neuroimaging indications.
The unit sets the clinical foundation necessary to explore cannabinoid-based interventions in subsequent units.

Unit 2: The Role of Cannabinoids in Pain and Headache Management
This unit examines how cannabinoids function in the body and their potential therapeutic effects:
- Mechanisms of Action: Interaction with CB1/CB2 receptors, TRPV1 channels, serotonergic pathways, and the endocannabinoid system.
- Evidence Base: Reviews major studies, including Cochrane and Canadian guidelines, assessing the efficacy of cannabis in neuropathic and headache disorders.
- Cannabinoid Pharmacology: How CBD and THC alleviate pain, impact neurotransmission, and support neuroprotection.
- Headache-Specific Data: Focus on cannabinoid impact on migraines and cluster headaches, including limitations in current evidence and anecdotal reports.
- The Entourage Effect: Synergistic benefits of full-spectrum cannabis over isolates.
The unit contextualizes cannabis as a third-line therapy, emphasizing its adjunctive potential in complex pain syndromes.

Unit 3: Practical Considerations for Prescribing Medicinal Cannabis
This final unit provides practical, clinician-focused guidance on integrating cannabis into patient care:
- Patient Assessment: Clinical history, contraindications (e.g. psychosis, pregnancy), and shared decision-making.
- Formulations & Dosing: Oral, sublingual, and inhaled options. “Start low, go slow” titration principles, balancing THC and CBD, and personalised treatment strategies.
- Monitoring & Adjustments: Setting treatment goals, regular reviews, dose optimisation, and planning an exit strategy.
- Safety & Compliance: Addressing legal considerations (e.g. driving with THC), medication interactions, and consent procedures.
- TGA Guidance & Access Pathways: Special Access Scheme (SAS B), Authorised Prescriber route, and medical-grade vaporisers.
Case examples and graphics aid in applying these concepts practically to real-world scenarios.

This course equips general practitioners with the clinical confidence and evidence-based framework to prescribe medicinal cannabis where appropriate. It fosters safe, ethical, and personalised care for patients who have not responded to conventional treatments for chronic pain and headache conditions.