Psilocybin and LSD in the treatment of Cluster Headaches
- Neurology. 2006 Jun 27;66(12):1920-2
Response of cluster headache to psilocybin and LSD.
Sewell RA, Halpern JH, Pope HG Jr.Clinical Research Laboratory, Alcohol and Drug Abuse Research Center, McLean Hospital/Harvard Medical School, Belmont, MA 02478, USA. asewell@mclean.harvard.edu
The authors interviewed 53 cluster headache patients who had used psilocybin or lysergic acid diethylamide (LSD) to treat their condition. Twenty-two of 26 psilocybin users reported that psilocybin aborted attacks; 25 of 48 psilocybin users and 7 of 8 LSD users reported cluster period termination; 18 of 19 psilocybin users and 4 of 5 LSD users reported remission period extension. Research on the effects of psilocybin and LSD on cluster headache may be warranted.
PMID: 16801660
Rev Neurol. 2006 Nov 1-15;43(9):571-2. [Article in Spanish - Translated below]
Chronic cluster headache: response to psilocybin.
Sempere AP, Berenguer-Ruiz L, Almazan F.Hospital Vega Baja, 03314 Orihuela, Espana.
PMID: 17072817
Chronic cluster headaches responding to psilocibin.
Cluster headaches are considered the most painful of all primary
headaches(1) .
They represent 1.5% of all outpatient headache patients(2) and it is a
frequent
cause of emergency room visits(3). It affects more men than women and
the age of
onset is generally between age 20 and 40. Cluster headaches
can be
classified into two categories: Episodic: With periods of remission of
over a
month. Chronic: The headaches last through the year and the periods of
remission
are less than a month.
Abortive treatments of choice include oxygen at 100% and subcutaneous
sumatriptan( 5). Inhaled oxygen has the inconvenience of difficult
access.
Sumatriptan subcutanous has a 74% efficacy in 15 minutes(6).
Sumatriptan
is contraindicated in patients with uncontrolled hypertension or
cardiac
ischemia, frequently found in male smokers. The preventive treatment
consists of
prednisione to suppress attacks, while starting maintanence treatment.
The
preventive treatment of choice is verapamil, with a 69% response (7).
If
verapamil fails, there are other possibilities such as topiramate and
lithium.
However, none of the mentioned 3 medications are FDA indicated for this
therapeutic reason. When the pharmacological treatments fail
there is the
option of surgery. The most commonly performed is the thermo
coagulation of the
trigeminal nucleus by radio waves.
We present a patient with chronic cluster headaches, resistant to
medical
treatment, with an excellent response to psicocybin treatment, an
alkaloid from
the tryptamine family. A review of the literature in PubMed did not
find any
articles in Spanish regarding the use of psicobilin in the treatment of
cluster
headaches.
A 47 year old male, with an unremarkable medical history except for
being a
smoker with cluster headaches, episodic type, since age 40 have
transformed into
chronic cluster headaches. His neurological exam was normal. He
required
Sumatriptan, subcutaneously almost on a daily basis and in home oxygen.
Occasionally he would use oral ergotamine before going to bed to
prevent
nocturnal attacks. Zolmitriptan oral was not effective in abortive use.
A
trial of preventive treatment was attempted including oral prednisone
with
verapamil (240mg a day) and topirimate (100mg a day), that were
ineffective.
Through an internet forum on patients with cluster headaches, this
patient
informed himself on other posible treatments, specifically the
treatment of
Psilocybe cubensis. Initially psilocybin was used in the acute attack
of cluster
headache and it accomplished disappearance of the pain within 20
minutes. After
three doses in two weeks the cluster headache attacks were
gone. The
patient has continued asymptomatic for the last 6 months taking an
infusion of
P. cubensis consisting of 30mg of fresh mushroom and 3gm of dehydrated
mushroom
once a month. The patient did not experience the hallucinogenic effect
with
psilocybin. Psilocybin is an alkaloid of the tryptamine
family. It is
found in many species of mushrooms, specially the of the genre
Psilocybe, like
P. cubensis and P. semilanceata ( 8 ). Psilocybin transforms to
psilocin in the
organism, that represents the active form and acts as a serotonergic
agonist at
5-Ht2a(9). Psilocybin is considered a drug with legal implications,
that is why
it's cultivation and sale is considered a crime. Recently an
observational study
has been published that gathered the use of psilocybin and LSD in the
treatment
of cluster headaches(10) . In the mentioned study, psilocybin was able
to abort
attacks in 22 of 26 patients (85%) and a preventative effect in 90% of
patients
(totally effective in in 52 % and partially effective in
37%). In
addition, psilocybin was able to prolong the period of remission in 20
of 22
patients that used it (91%). This study has evident limitations, like
the
authors pointed out the bias of selection, the patients were
contacted
through a patient support group. And a possible placebo effect.
Psilocybin would
count on the advantage of having both an abortive action as well as
preventative
of cluster headache attacks. The therapeutic effect of psilocybin
occurs in
subhallucinogenic doses, which indicates a different mechanism of
action to it
psychoactive effects. The only interests of these clinical
observations, far
from supporting the use of psilocybin in the treatment of cluster
headaches,
would be to set the need for controlled clinical studies to evaluate
the
efficacy and safety of psilocybin, as well as the need for more
research.
References:
A.P. Sempere a, L. Berenguer-Ruiz a, F. Almazán b Aceptado
tras revisión
externa: 12.09.06.
a Servicio de Neurología. b Servicio de Medicina Interna.
Hospital General
Universitario de Alicante. Alicante, España.
Correspondencia: Dr. Ángel Pérez Sempere.
Servicio de Neurología. Hospital
General Universitario de Alicante. Pintor Baeza, s/n. E-03010 Alicante.
E-mail:
aperezs@mac.com
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Fecha última consulta: 15.07.2006.
10. Sewell RA, Halpern JH, Pope HG Jr. Response of cluster headache to
psilocybin and LSD. Neurology 2006; 66: 1920-2.
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