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November 6, 2006
Chronic cluster headaches responding to psilocybin
By: A.P. Sempere, L. Berenguer-Ruiz, F. Almazán
REVISTA DE NEUROLOGIA
The Spanish-language journal Revista de Neurologia published a case report of a man with chronic cluster headaches treating the condition with monthly sub-psychedelic doses of psilocybin-containing mushrooms.
REVISTA DE NEUROLOGIA 2006; 43 (9), 571-572
Chronic cluster headaches responding to psilocybin.
A.P. Sempere, L. Berenguer-Ruiz, F. Almazán
Translated from Spanish by Jorge Zapatel MD
Cluster headaches are considered the most painful of all primary
headaches(1). They represent 1.5% of all outpatient headache
patients(2) and it is a frequent cause of emergency room visits(3). It
affects more men than women and the age of onset is generally between
age 20 and 40. Cluster headaches can be classified into two
categories: Episodic: With periods of remission of over a month.
Chronic: The headaches last through the year and the periods of remission
are less than a month.
Abortive treatments of choice include oxygen at 100% and subcutaneous
sumatriptan(5). Inhaled oxygen has the inconvenience of difficult
access. Sumatriptan subcutanous has a 74% efficacy in 15 minutes(6).
Sumatriptan is contraindicated in patients with uncontrolled
hypertension or cardiac ischemia, frequently found in male smokers.
The preventive treatment consists of prednisione to suppress attacks,
while starting maintanence treatment. The preventive treatment of
choice is verapamil, with a 69% response (7). If verapamil fails,
there are other possibilities such as topiramate and lithium.
However, none of the mentioned 3 medications are FDA indicated for
this therapeutic reason. When the pharmacological treatments fail
there is the option of surgery. The most commonly performed is the
thermocoagulation of the trigeminal nucleus by radio waves.
We present a patient with chronic cluster headaches, resistant to medical
treatment, with an excellent response to psilocybin treatment, an
alkaloid from the tryptamine family. A review of the literature in
PubMed did not find any articles in Spanish regarding the use of
psilocybin in the treatment of cluster headaches.
A 47 year old male, with an unremarkable medical history except for
being a smoker with cluster headaches, episodic type, since age 40
have transformed into chronic cluster headaches. His neurological
exam was normal. He required Sumatriptan, subcutaneously almost
on a daily basis and in home oxygen. Occasionally he would use oral
ergotamine before going to bed to prevent nocturnal attacks.
Zolmitriptan oral was not effective in abortive use. A trial of
preventive treatment was attempted including oral prednisone with
verapamil (240mg a day) and topirimate (100mg a day), that were
ineffective. Through an internet forum on patients with cluster
headaches, this patient informed himself on other possible treatments,
specifically the treatment of Psilocybe cubensis. Initially
psilocybin was used in the acute attack of cluster headache and it
accomplished disappearance of the pain within 20 minutes. After three
doses in two weeks the cluster headache attacks were gone. The
patient has continued asymptomatic for the last 6 months taking an
infusion of P. cubensis consisting of 30mg of fresh mushroom and 3gm of
dehydrated mushroom once a month. The patient did not experience the
hallucinogenic effect with psilocybin. Psilocybin is an alkaloid of
the tryptamine family. It is found in many species of mushrooms,
specially the of the genre Psilocybe, like P. cubensis and P.
semilanceata(8). Psilocybin transforms to psilocin in the organism,
that represents the active form and acts as a serotonergic agonist at
5-HT2A(9). Psilocybin is considered a drug with legal implications,
that is why it's cultivation and sale is considered a crime. Recently
an observational study has been published that gathered [information on] the use of
psilocybin and LSD in the treatment of cluster headaches(10). In the
mentioned study, psilocybin was able to abort attacks in 22 of 26
patients (85%) and a preventative effect in 90% of patients (totally
effective in in 52 % and partially effective in 37%). In addition,
psilocybin was able to prolong the period of remission in 20 of 22
patients that used it (91%). This study has evident limitations, like
the authors pointed out the bias of selection, the patients were
contacted through a patient support group. And a possible placebo
effect. Psilocybin would count on the advantage of having both an
abortive action as well as preventative of cluster headache attacks.
The therapeutic effect of psilocybin occurs in subhallucinogenic
dosis, which indicates a different mechanism of action to it
psychoactive effects. The only interests of these clinical
observations, far from supporting the use of psilocybin in the
treatment of cluster headaches, would be to set the need for
controlled clinical studies to evaluate the efficacy and safety of
psilocybin, as well as the need for more research.
A.P. Sempere a, L. Berenguer-Ruiz ,
Aceptado tras revisin externa: 12.09.06.
a Servicio de Neurologa. b Servicio de Medicina Interna.
Hospital General Universitario de Alicante.
Correspondencia: Dr. ngel Prez Sempere. Servicio de Neurologa.
Hospital General Universitario
de Alicante. Pintor Baeza, s/n. E-03010 Alicante.
E-mail: AP Sempere
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