Ask the Experts: Cluster Headaches and Hallucinogenic Drugs

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Dr. John H. Halpern, M.D. sheds some light on the rumor regarding the link between hallucinogenic drug use and relief from cluster headaches.

Q: “I suffer from extremely painful cluster headaches. I’ve read that some people have turned to hallucinogenic drugs to find relief. Do these drugs work and what are the risks?”

A:Cluster headaches may be the most painful we know of in medicine. Typically appearing as a series of attacks on one side of the head, the sharp, stabbing pain can last from 15 minutes to three hours or longer and will keep returning over a period of weeks to months, usually behind or near the eye.

As the pain increases the person will start pacing and/or do anything to distract themselves, such as hitting their head or pulling their hair; this desperate condition is much more serious than having a migraine disorder. Standard treatments like high-flow oxygen and triptan-type medicines are quite effective for most but not all, and triptans can bring on more attacks later. Prednisone, lithium and verapamil can reduce the severity and frequency of symptoms, but no medication does it all, which is to end a single attack, break a cluster series early and extend the pain-free remission period.

So it’s easy to see why those who experience cluster headaches are looking for better options. Patients have noticed that hallucinogenic drugs such as LSD and psilocybin-containing mushrooms, though illegal, can quickly shut down attacks and lengthen the time between attack periods. ClusterBusters, a nonprofit organization for people who experience cluster headaches, sponsored my laboratory’s research on the effects of hallucinogens on this type of headache. Our first publication of this work, in the journal Neurology, found very promising effects, but unfortunately it’s not enough to recommend these drugs as a treatment for cluster headaches just yet. Clinical research must first be completed to satisfy the U.S. Food & Drug Administration. But on an encouraging note, that first survey in my lab has led to more research, including a very small trial of a version of LSD, 2-bromo-LSD, that does not cause intoxication but may still offer relief. Should these results continue as the research expands, we may yet have a powerful new medication without the hallucinogenic side effects.

John H. Halpern, M.D., assistant professor of psychiatry, Harvard Medical School and director of the Laboratory for Integrative Psychiatry at McLean Hospital, Belmont, Massachusetts

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