#69: 🍄 Unlocking Relief: How Psychedelics are Reshaping Headache Treatments
#69: 🍄 Unlocking Relief: How Psychedelics are Reshaping Headache Treatments
A dose could stop and prevent migraine or cluster headaches
💬 In this note:
🍄 Unlocking Relief: How Psychedelics are Reshaping Headache Treatments
📚 Starling House
⚡️ Enhanced Games
🗣️ Looking for the read-aloud version of Nina’s Notes?
🍄 Unlocking Relief: How Psychedelics Are Reshaping Headache Treatments
Most of the research on psychedelics in the 20th century has largely focused on psychiatric disorders.
The positive effects in mental health are impressive and those positive effects have also been found in headache disorders, although the research is limited compared to mental health disorders.
Classic psychedelics, like psilocybin, LSD and mescaline, are metabolized in the body. They enter the brain and activate the serotonin (5-HT) receptors and cause alterations in perception, consciousness and sensation.
Some headache disorders, such as migraine, have a known biological process related to the 5-HT system.
Currently hypotheses suggest that migraines and other headache disorders may be directly impacted by psychedelics which target and bind the 5-HT receptor.
Psilocybin for Acute Treatment of Migraine
Migraines affect approximately 10% to 15% of the general population.
It is known that migraine is a common neurovascular disorder related to the serotonin (5-HT) system.
In humans, we have seven 5-HT receptor families and four are strongly associated with migraine syndrome.
Pharmacological modulation of 5-HT receptors has demonstrated efficacy in the acute treatment of migraines.
Two noteworthy therapeutic interventions are:
Sumartriptan, a drug which was among the first to selectively target specific 5-HT receptors, and activate the 5-HT1B and 5-HT1D receptors, is a common treatment for migraine and cluster headaches.
However, Sumartiptan has its limitations. It’s fast-acting and has a short halflife, which means that recurrence of headaches is common. Additionally, anecdotal evidence suggests that it must be taken at the onset of a migraine for maximum effectiveness, and is not effective when a migraine is in full swing.
Additionally, derivatives of Ergot, a fungus which contains a number of psychoactive alkaloids, including lysergic acid (LSD), have been used for decades to stop migraine.
These Ergot derivatives work by selectively targeting the 5-HT1B and 5-HT1D receptors
However, these medications are not first-line treatments due to concerns over the side effects and the safety profile.
The reported successes of psilocybin in the treatment of mental health disorders has renewed interest in its therapeutic potential in the management of migraines.
Previously, psilocybin was excluded as a possible treatment for migraine because it is primarily known to bind the 5-HT2A receptor, which accounts for its psychedelic properties, and the 5-HT2A receptor is known to not be primarily involved in migraine.
However, recent research has revealed that psilocybin, and more specifically the active metabolite, psilocin, interacts with a multitude of 5-HT receptors, including the 5-HT1B and 5-HT1D receptors which are known to be associated with migraine.
Current research trends are also emphasizing the importance of understanding the effects of psychedelics from a whole-brain perspective, rather than focusing solely on individual brain regions, which could potentially reveal even more alternative therapeutic avenues.
A few studies show conflicting results that psilocybin could help prevent migraines and also stop them once they start.
For instance, a small double-blind study of 10 people tested a single dose of preventative psilocybin, and the single dose significantly reduced weekly migraine days, with no adverse effects.
A second double blind-study looked at how five doses of psilocybin affected headaches in 18 healthy volunteers.
They found that psilocybin often led to headaches, and the frequency, length and intensity increased with larger doses.
All headaches had delayed onset, were temporary, and lasted no more than a day after taking psilocybin.
In 2023, a third study focused on using psilocybin to quickly treat migraines.
The study involved one person, a 33-year-old male who had been getting migraines with auras since he was a child.
He described the pain level of four migraines that he treated with (1) psilocybin + ibuprofen + acetaminophen, (2) ibuprofen alone, (3) naproxen + acetaminophen and (4) no treatment at all.
Taking psilocybin + ibuprofen + acetaminophen resulted in a notable reduction in headache intensity.
These results are encouraging, yet highlight the need for further research to explore how psilocybin can be used to treat migraines and other types of headaches.
Psilocybin for Cluster Headache Relief
Cluster headaches, are a severe headache condition also known as “suicide headache.”
In addition to migraine, cluster headaches are a headache disorder where most modern research has focused.
A research group led by Emmanuelle Schindler, MD, PhD, Assistant Professor, Neurologist and Medical Director of the Headache Center of Excellence at Yale is currently the only researcher in the United States studying the effect of psychedelics in headache disorders.
Schindler is currently investigating in collaboration with Deepak Cyril Dsouza, MBBS, MD from Yale Psychiatry and Chris Gottschalk, MD from Yale Neurology.
The team is investigating whether there is a therapeutic effect of psilocybin and other psychedelics on headache disorder, how to optimize this effect and to understand where the effect is coming from.
Headache disorders are decades long disorders, and management of the disorder doesn’t take place during a short research study, which presents obstacles for studying these disorders.
Psilocybin and other psychedelics, such as LSD, are chemically and pharmacologically similar to existing headache medications, leading the researchers to hypothesize that they can have effects in headache disorders.
The added benefit of psychedelics for headache disorders is that they may have the unique ability to produce lasting effects after a single dose.
The Yale research team works together with a group called Clusterbusters, Inc., made up of people suffering from cluster headaches.
This partnership has pushed forward research and also helped educate the medical world about cluster headaches.
Bringing Psychedelics to the Patients
The next challenge for psychedelic treatments for headache disorders will be to prove safety and efficacy through research, preclinical data and clinical trials.
Bringing psychedelic therapy to the market is a road filled with obstacles both medically and legally.
Although in the U.S. we may be close to seeing the first psychedelic assisted-therapy approved (MDMA-AT from MAPS PBC), it is still true that in most countries worldwide psychedelics are not approved for legal use.
Psychedelics do have the potential risk to cause side effects such as seizure and manic or psychotic episodes, which need to be carefully considered.
The final challenge will be finding a consistent model for insurance coverage, and fair pricing for those in need of these potentially life-changing therapeutics.
📚 Book of the Week
Starling House by Alix Harrow
Rating: ★★★★☆
I picked up this book because I loved two other books by Alix Harrow, The Once and Future Witches and Ten Thousand Doors of January.
It’s a story of a haunted house with a creepy tenant and buried secrets.
It was a quick read, dark and enchanting.
If you can wait, I’d save it for spooky season in October.
⚡️ Check This Out
In the news last week, the Enhanced Games were announced.
…and it will basically be the Performance Enhancing Drug fueled version of the Olympic Games.
It has been described as a “modern reinvention of the Olympic Games that does not have drug testing” and reminded of this tweet.
The idea is to explore the limits of human performance through performance enhancing drugs, nutritional supplements and biohacks.
The games have already been backed by several high-profile venture capitalists, including Peter Theil, Christian Angermayer and Balaji Srinivasan.
The event seeks to challenge traditional sports norms and contribute to research in human enhancement.
The Enhanced Games website boldly claims that 44% of athletes are already using performance enhancements, and that the Games will be a way to safely celebrate science and that sports can be safer without drug testing.
The competition will feature five events — swimming, gymnastics, weightlifting, track and field, and combat — and will be held once a year at already-existing venues.
The founder, Dr. Aron D’Souza, plans to provide more details on April 17 and promote the controversial concept in Paris during the 2024 Summer Olympics starting in July.
Edited by Wright Time Publishing