What is the evidence for using microdosing mushrooms (psilocybin) to treat cluster headaches?

Evidence for Microdosing Mushrooms (Psilocybin) in Cluster Headaches

There is insufficient evidence from high-quality clinical trials to recommend microdosing psilocybin mushrooms for the treatment of cluster headaches, despite some promising preliminary research and patient reports. 1

Current Guideline-Recommended Treatments for Cluster Headaches

The 2024 VA/DoD Clinical Practice Guideline for headache management provides clear recommendations for cluster headache treatment:

First-line Abortive Treatments:

• Subcutaneous sumatriptan (6 mg) or intranasal zolmitriptan (10 mg) (weak recommendation) 1
• Normobaric oxygen therapy (weak recommendation) 1

Preventive Treatments:

• Galcanezumab for episodic cluster headache (weak recommendation) 1
• Noninvasive vagus nerve stimulation for episodic cluster headache (weak recommendation) 1
• Against galcanezumab for chronic cluster headache (weak against) 1
• Against implantable sphenopalatine ganglion stimulator (weak against) 1

Emerging Evidence on Psilocybin for Cluster Headaches

Despite not being included in current guidelines, there is emerging research on psilocybin for cluster headaches:

1. Recent Clinical Trial (2024): A small open-label trial with 10 chronic cluster headache patients showed a 31% reduction in attack frequency after three doses of psilocybin (0.14 mg/kg). One patient experienced 21 weeks of complete remission. Changes in hypothalamic-diencephalic functional connectivity correlated with treatment response. 2

2. Survey Data: The Clusterbusters Medication Use Survey found that indoleamine hallucinogens (including psilocybin) were reported by patients to be comparable to or more efficacious than conventional medications for cluster headache. Importantly, non-hallucinogenic (sub-psychoactive) doses were reported as effective. 3

3. Qualitative Analysis: Analysis of online forums revealed that cluster headache patients often turn to psychedelic substances like psilocybin as a last resort when conventional treatments fail. These patients typically use sub-psychoactive doses, focusing on headache relief rather than psychoactive effects. 4

Microdosing Considerations

The emerging science of microdosing (using sub-psychoactive doses) shows:

1. Dose-Response Effects: Laboratory studies show clear dose-dependent changes across various measures, indicating psychopharmacological effects even at microdoses. 1

2. Individual Variability: Substantial individual variability in response to microdosing has been observed, with some studies noting greater sensitivity to psychedelics in headache sufferers. 1

3. Potential Adverse Effects: Psilocybin can paradoxically cause headaches in healthy individuals, with incidence, duration, and severity increasing in a dose-dependent manner. These headaches are typically delayed, transient, and not severe. 5

Clinical Application Considerations

If considering psilocybin for treatment-resistant cluster headache patients:

• Legal Status: Psilocybin remains a Schedule I controlled substance in most jurisdictions
• Dosing: Sub-psychoactive doses may be effective for cluster headache prevention 3
• Treatment Pattern: Evidence suggests potential for both prophylactic use and aborting cluster periods 3
• Monitoring: Close follow-up for both efficacy and adverse effects is essential

Important Caveats

1. Insufficient Evidence: Current guidelines do not recommend for or against several treatments for cluster headache, and psilocybin is not mentioned due to limited high-quality evidence 1

2. Self-Treatment Risks: Patients self-treating with psilocybin may engage in risky behavior when obtaining and testing treatment alternatives 4

3. Need for Controlled Studies: While preliminary evidence is promising, well-designed randomized controlled trials are needed before psilocybin can be recommended as a standard treatment

4. Potential Mechanisms: Psilocybin's effects on cluster headaches may involve modulation of hypothalamic function, as suggested by neuroimaging studies 2

While patient reports and preliminary research suggest potential benefits of microdosing psilocybin for cluster headaches, clinicians should prioritize guideline-recommended treatments until more definitive evidence emerges.