April 21, 2011
Headache Treatment: Alternative or Illicit?
By: Jennifer Gibson, PharmD
LSD and psilocybin, both of which are psychedelic drugs that operate primarily on the serotonin system, are beginning to enter the public consciousness as possible treatments for certain kinds of chronic, debilitating headaches. Clinical pharmacist Jennifer Gibson points to increasing frustration with traditional medical treatments for cluster headaches and similar conditions, the high number of side effects associate with traditional treatments, and patients’ desire to choose their own treatments as the primary reason that psychedelics are gaining acceptance as medicines. Gibson concludes the article by calling for more and larger studies of the clinical benefits of psychedelics.
Originally appearing at http://brainblogger.com/2011/04/21/headache-treatment-alternative-or-illicit/.
Headache disorders can be painful and debilitating conditions. Ranging from infrequent tension-type headaches to cluster headaches to migraines, headaches affect nearly every individual at one time or another. Pain – particularly of the neck and back – accompany many headaches. Traditional pharmacological treatment begins with acetaminophen (Tylenol), but this is not effective for all headache sufferers. More potent pain-killers are used in a step-wise manner to treat pain associated with headache, and preventive and abortive treatments are available and effective for certain types of headache. The most alarming headache treatment option to emerge is the use of lysergic acid diethylamide (LSD) and psilocybin (a hallucinogen derived from mushrooms).
The acknowledgment that hallucinogenic drugs might have a benefit in headache treatment first appeared in the medical literature in the 1960’s and 1970’s. Of course, the stigma associated with drug use at that time was not what it is today, and the dangers associated with drug use were not as well-defined. Now, more than 50 years after Timothy Leary was expelled from Harvard, arguably for supporting the use of illegal drugs, LSD is returning to the school. A Harvard professor is now self-funding research to prove that hallucinogenic drugs are effective headache treatment.
In 2006, an analysis of people who took LSD and/or psilocybin to treat cluster headaches was published by Harvard researchers. The report included results from interviews with 53 patients who had used the psychedelic agents to self-treat cluster headaches. Remarkably, a majority of patients reported benefits of the drugs, including an end to headaches and an extended remission period. The data is limited owing to a small sample size and recall bias; the study was not controlled or randomized.
The use of treatments other than traditional pharmacological management is increasing, owing to general dissatisfaction with traditional medicine, the risk of side effects of traditional headache treatments, and a desire for patient autonomy in healthcare. However, herbal supplements or massage techniques to treat headaches are a far cry from hallucinogenic drugs. The scientist leading the research into hallucinogens claims that his work has produced a non-hallucinogenic derivative of LSD. He is investigating the effectiveness of the compound and is interested in seeking FDA approval for the agent. So far, no major pharmaceutical companies are interested in joining forces with him.
Throughout the history of pharmacy and medicine, there are examples of treatments being discovered in unlikely places, but LSD as a therapeutic agent seems quite extreme. Current treatments are far from perfect, and, admittedly, are not effective for every person or every type of headache. But, LSD and psilocybin are illicit drugs, classified as Schedule I drugs by the FDA, having no recognized medical use and a high potential for abuse. Though therapeutic doses might be at sub-hallucinogen levels, there is no evidence regarding the safety or abuse related to these experimental compounds.
Headaches are not altogether understood. Therefore, treatment options are not well-defined. Headaches can be caused by a variety of conditions – medical, physical, or emotional — and treatment options vary more than the causes of headaches. Research concerning the best possible headache treatment is far from definitive, as is the role of hallucinogenic drugs in traditional medicine. Physicians and patients should make advised and cautious decisions about all treatment modalities. Larger-scale randomized, controlled trials are needed before patients should be advised to take a trip to treat a headache.
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