Migraines, cluster headaches and psychedelics


Phantom limb pain it is not the only form of chronic pain that is being rigorously investigated for treatment with psychedelic drugs. Researchers at Yale University have recently published first controlled study of a psychedelic in headache disorders, in which they described how psilocybin reduced the frequency of headache significantly better than placebo among 10 people with migraines.

The same team is about to complete two additional studies on psilocybin and chronic headache: one focused on cluster headaches, sometimes called “suicidal headaches” because of its persistent and severe nature; and the other post-traumatic or post-concussion headaches, which develop after a head injury and often assume migraine features.

Despite the many treatment options available, migraine remains the leading cause of disability worldwide, says Emmanuelle Schindler, a professor of neurology at Yale and lead author of the January 2021 paper on migraines and psilocybin. Neurotherapy. Meanwhile, there are few useful treatments for cluster headache, and none FDA-approved for post-traumatic headache.

These conditions are not considered curable. Still, what the Yale team is looking for is even closer to a cure than a treatment, a promise based on case studies and patient reports that began in the early 1990s, when desperate patients with clustered headaches began to learn and share among themselves that taking magic mushrooms offer lasting relief.

It may seem like an unprecedented use for psilocybin, but psychedelics and headaches have a long history. “The serotonin 2A receptor is well known to have therapeutic value in headache disorders,” says Schindler. “When Albert Hoffman started LSD, was looking for a compound that restricted blood vessels. And this kind of medicine was used to treat migraines.

Triptans & tryptamines

Currently, seven “triptans” are approved by the FDA to treat acute headache symptoms. These drugs are sold under different brands, including Maxalt (rizatriptan), Imitrex (sumatriptan), Relpax (eletriptan), Amerge (naratriptan) and Axert (almotriptan). But they all belong to a broader class of compounds known as tryptamines. The neurotransmitter serotonin (5-hydroxytryptamine) is also a tryptamine, as are the “classic” serotonergic psychedelics: psilocybin, LSD, DMTand mescaline.

Tryptans do their magic by shrinking the blood vessels around the brain. Unlike some of their fellow tryptamines, they are not psychoactive. Nor do they provide preventive or lasting relief. They simply serve to treat pain, nausea, sensitivity to light and other symptoms, from a headache at a time.

However, for more than 25 years, those suffering from cluster headaches have turned to their illegal counterparts in triptans for more persistent benefits. According to a 2012 survey of 496 patients, mushrooms and LSD not only does it treat the pain as it is happening, but it can also shorten or abort an accumulation period or cause the remission of chronic headache, even after infrequent and non-hallucinogenic doses.

Emmanuelle Schindler was the lead author of a 2015 article on Journal of Psychoactive Drugs describing the survey and its results. “While psychedelics are said to treat pain acutely, what is most notable is their ability to treat the underlying cause of pain,” he says.

These long-term results are now the focus of his ongoing research: “Headache, migraine, and post-traumatic headache are neurological disorders; headache attacks are symptoms of the disorder. We are studying the effects of psilocybin on the disorder by measuring the change in the number and intensity of headache attacks over time, not the acute effects on a single headache attack. “

A new mechanism

The mechanisms by which psychedelics produce these prolonged improvements are little known. Schindler suggests the neuroendocrine system it could play a role, along with neuroplastic, genetic, and psychological processes. According to her, several brain regions may be involved, including the hypothalamus, brainstem, and cerebral cortex. And the proven anti-inflammatory properties of these compounds may also be an important factor.

Schindler’s team at Yale isn’t the only one looking forward to learning more. Other recently launched or ongoing studies include:

  • a randomized, double-blind test at the University Hospital of Basel, Switzerland, investigating LSD as a treatment for cluster headache in 30 participants;
  • a potential pilot to study in Denmark, looking at psilocybin as a prophylaxis of cluster headache in 20 patients;
  • and an open-label explorer to study at King’s College London, sponsored by the psychedelic pharmaceutical company Beckley Psytech, which evaluates the effects of psilocybin on cognition in 12 patients with a chronic headache disorder known as short-term unilateral neuralgiform headache attacks (SUNHA).

Finally, Schindler says he’s about to launch it second study on migraines and psilocybin, a follow-up published earlier this year that will evaluate the relative effects of single versus double doses of psilocybin on headache burden and neuroinflammatory markers in 24 patients.

“While we still have a long way to go, it’s very exciting what we’ve demonstrated and what patients have reported,” Schindler says. “It’s about a new mechanism that nothing else in the world of headaches can do.”

First part on psychedelics & chronic pain – Amazing: psychedelic & Phantom limb pain

Nate Seltenrich, a freelance science journalist based in the San Francisco Bay Area, covers a wide range of topics such as environmental health, neuroscience and pharmacology.

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