A systematic review to assess the use of psilocybin in the treatment of headaches

Summary & key facts

Researchers reviewed eight studies that tested psilocybin as a treatment for different kinds of headaches, including migraines and cluster headaches. They searched six databases and checked each study carefully. Most studies found that people reported fewer or less severe headaches, and some people had much longer pain-free periods. Higher, or “macro,” doses sometimes helped more than tiny, or “micro,” doses. Side effects included hallucinations for some people, short-term increases in anxiety or pain for a few, and one report of higher blood pressure. The reviewers say the results look promising but more legal, carefully controlled research is needed.

Key facts:

• The review looked at eight published studies about psilocybin for headaches found across six major databases.
• Six of the eight studies reported clinically meaningful improvements in headaches as reported by participants.
• Three studies reported results that were statistically strong, meaning the changes were unlikely to be due to chance.
• Participants in five studies said their headaches improved in how often they happened, how strong they were, how long they lasted, or how long pain-free periods lasted.
• About 90% of participants in one study had a longer remission period between headaches after taking psilocybin.
• One study found that people taking higher, or macrodoses, had about 12% more pain relief three days after dosing than people taking microdoses.
• About 18% of people with essential headaches who took psilocybin reported hallucinations.
• Some people had temporary increases in anxiety or pain: about 5% with microdosing and about 14% with macrodosing.
• One study observed an increase in average arterial (blood) pressure after psilocybin ingestion.
• Psilocybin is still illegal in many countries, and the reviewers said more regulated research is needed before conclusions can be firm.

Abstract

Introduction Psilocybin is a naturally occurring psychedelic compound whose effects have been seen in studies for treatment of depression, anxiety and pain management. Given its structural similarities to 5-hydroxytryptamine, a monoamine controlling brain modulation of pain input, preliminary studies sought to test serotonergic interactions of psilocybin with headaches. Objectives Explore efficacy of psilocybin as treatment for individuals with headaches, including migraines, essential headaches, cluster headaches and unclassified head pains. Methods Studies were found from six major databases, with inclusion criteria consisting of participants with any type of headache using psilocybin as a treatment. Each study was independently screened by two reviewers at two stages, with inconsistencies reviewed by a third, senior reviewer. Results The systematic review evaluated eight articles. Benefits of macrodosing were explored in one study which reported higher levels of pain relief in comparison to microdosing and conventional pain medications. Top benefits of microdosing as reported by participants included convenience, perceived safety and reduced side effects when compared to hallucinogenic doses of psilocybin. Participants across five studies reported improvements to their headaches as characterized by changes in frequency, intensity, duration and remission period. Reported improvements were clinically significant in the six studies and statistically significant in three papers. With psilocybin intervention, two studies reported a decrease in headache attack frequency, three studies reported a decrease in intensity, and one study indicated a decrease in duration. The greatest benefit reported was for psilocybin taken during a remission period, with the average length of that remission period between headaches extending for 91% of participants. One study focused on the dosages of psilocybin in relation to its efficacy, indicating that there was more headache pain relief amongst macrodosers, with a difference of 12.3% of participants experiencing pain reduction 3 days after dosage in comparison to microdosers. 18% of participants who experienced essential headaches also experienced hallucinations as a result of ingested psilocybin. Others showed a temporary increase in symptoms of anxiety and pain - 5.3% with microdosing and 14.1% macrodosing. One study observed an increase in average arterial pressure after ingestion. Conclusions Six of eight screened papers showed that psilocybin was clinically significant in the treatment of headaches as captured through self-reports. While the first controlled study for psilocybin use for headaches was detailed in this study, psilocybin remains illegal in many countries, presenting a need for further regulated research. Disclosure of Interest None Declared

Topics

Chemical synthesis and alkaloids Complementary and Alternative Medicine Studies Psychedelics and Drug Studies

Categories

Clinical Psychology Psychology Social Sciences

Tags

Clinical psychology Distress Hallucinogen Headaches Internal medicine Medicine Migraine Psilocybin Psychiatry Psychology Receptor Serotonergic Serotonin

Substances

Psilocybin

Conditions & symptoms

Chronic Pain Chronic pain