Published online 13 September 2006 | Nature | doi:10.1038/news060911-05

Corrected online:

News

Cluster headache sufferers say LSD can abort attacks.

Cluster headaches cause excruciating pain around the eyes.

We need to study the effect of powerful hallucinogens such as LSD (lysergic acid diethylamide) and psilocybin, the active ingredient in 'magic' mushrooms, on debilitating cluster headaches, researchers say.

Their study, which points towards the effectiveness of these drugs, is published in the journal Neurology1. It is the first formal look at reports of LSD's therapeutic benefits in nearly 40 years, says Andrew Sewell of the Alcohol and Drug Abuse Research Center at McLean Hospital in Belmont, Massachusetts. LSD was used extensively in psychiatric research in the 1960s, but as mainstream attitudes swung against 'acid', prohibitive measures made researching the beneficial effects of hallucinogens extremely difficult.

Cluster headaches are characterized by excruciating pain that lasts from fifteen minutes to up to three hours if left untreated. In the chronic form, attacks can happen up to eight times a day, with no period of remission lasting longer than a month. The condition is not fatal, but for some sufferers it is so horrific they commit suicide.

There is no cure, but sufferers are often given supplemental oxygen to ease an attack. Some are prescribed migraine drugs, but these may not work and the side effects are often extreme.

About five years ago, users of Internet message boards began swapping stories about chronic sufferers who gained two- to six-month periods of complete remission after one or two sub-hallucinogenic doses of LSD or psilocybin.

Sewell and John Halpern, both of the Alcohol and Drug Abuse Research Center, decided to investigate. They interviewed 53 cluster-headache sufferers around the world who had self-administered psychedelics in an attempt to alleviate their symptoms. Medical records were checked to verify that they did indeed suffer from cluster headaches.

Acid test

Their results are startling: the majority (85%) of psilocybin users report that it aborted attacks — better than oxygen, which stopped attacks for 52% of the patients surveyed. LSD and psilocybin were both better at preventing future attacks than conventional medicines.

The authors note there are many potential sources of bias in this type of retrospective analysis: sufferers may be more likely to recall and report good experiences than bad, for example. "Many retrospective studies have shown strong effects that evaporated when studied properly, so we are inclined to take a sceptical stance," says Sewell. Nonetheless, they say further research with controlled, randomized clinical trials is warranted.

In the meantime, many sufferers are convinced of the psychedelic drugs' utility. One patient, Bob Wold, started the Clusterbusters website to alert the community to the potential benefits — and dangers — of psychedelic drugs. For him, he says, a single dose every six months helps to stave off attacks. "I use psilocybin, and use just enough that I can feel the effects but don't really hallucinate as people would expect." The feeling, he says, is similar to what others might call a "two-beer buzz".

Head case

"I think there are better things to test," says Peter Goadsby, an expert in cluster headaches from the Institute of Neurology, University College London. But, he adds, "there seems to be a large number of people who think it's been useful to them, so it's a reasonable thing to consider."

Sufferers of the condition certainly need help, he adds. "It's the most appalling thing that can happen to you short of losing your family. That people are taking LSD and psilocybin is a reflection of the desperate straits they are in."

It is unclear how the drugs might work, though it is clear they affect the brain. LSD and psilocybin are types of amines called tryptamines, and their chemical structures are very similar to natural neurotransmitters such as serotonin. One conventional medicine for cluster headaches, Methysergide, is known to be chemically similar to LSD.

The study was partly funded by MAPS (Multidisciplinary Association for Psychedelic Studies), a non-profit alliance of scientists and campaigners that funds research into the therapeutic benefits of psychoactive drugs and lobbies for changes in US law.

The California-based MAPS is also helping to fund a study into the effects of MDMA (3,4-methylenedioxymethamphetamine, also known as ecstasy) on post-traumatic stress disorder. And a MAPS-funded study into psilocybin as a treatment for obsessive compulsive disorder has been completed at the University of Arizona, Tucson. Halpern is separately leading another study on the effects of MDMA on end-stage cancer anxiety.

Halpern and Sewell are now pushing for clinical trials of LSD and psilocybin. "We owe it to patients to determine whether this treatment works," says Sewell. "And we owe it to neurologists to provide them with accurate information so that they can effectively counsel patients."

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Corrected: This article incorrectly stated that MAPS is funding Halpern's work on MDMA and cancer anxiety. MAPS no longer provides funding to McLean Hospital.