Medical Editor: Dr. David Cox, PhD, ABPP

Cluster headaches can be so painful that those who experience them may develop suicidal ideation. They’ve been described as more painful than anesthesia-free childbirth or amputation. While there are current legal treatments available, many of them are ineffective or unavailable to most patients. Those that do work can come with side effects, such as rebound headaches, placing the patient right back in the throes of pain. There is anecdotal and scientific research suggesting that psilocybin shows promise for the treatment of cluster headaches. Continue reading to learn what cluster headaches are, their cause, the limitations of current medications, and the potential of psychedelic therapy.

What are cluster headaches?

Cluster headaches are extremely painful headaches. The pain is so severe that they earned the nickname “suicide headaches,” and have been described as more painful than amputation without anesthesia. “It can put the strongest man on his knees screaming and crying, pulling out hair, smashing his head against the wall or with his fists and during a bad attack, begging for death to just escape this pain and is why many do take their own lives at a rate of 20 times the national average,” writes John Fletcher, the president and founder of Cluster Headache Foundation Inc.

Cluster headaches occur on one side of the head and often behind and around the eye. “For me, I usually describe it as a red hot metal spike that’s been stuck in my eye socket and the asshole holding it is trying to pry my skull open. I’ve endured a lot of painful things in my life, but cluster headaches take the cake, and there’s nothing medicine can do for you,” describes one Reddit user.

Researchers are still investigating what causes cluster headaches. 2017 study suggests abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system may trigger episodes. A cluster period can last for weeks, months, or in extreme cases, even a year. During this time, attacks typically last between 15 minutes and 180 minutes. While they are often conflated with migraines, the two conditions are very different. Migraines vary in pain severity. While cluster headaches come in debilitating bursts, migraines last a day or more. Migraines also can take place all over the head, while cluster headaches stick to one side.

Cluster headaches are also rarer than migraines. While migraines occur in 15% of the population worldwide, about one in 1,000 people experience cluster headaches.

What is the current treatment for cluster headaches?

Given that cluster headaches are so painful and disruptive, finding treatment that works is essential. “The severity of the disorder has major effects on the patient’s quality of life and, in some cases, might lead to suicidal ideation,” according to a 2018 article on the diagnosis, pathophysiology, and management of cluster headaches. The article describes the use of triptans, which are drugs that quell nerve pain. However, they can cause “rebound headaches,” and do not work for everyone. “Certain things that are absolute lifesavers for others like steroids and triptans are hit-or-miss for me,” writes one Reddit user. Pain medications such as NSAIDs and narcotics are also not only ineffective for most patients but can cause rebound headaches.

Other medications, such as Lithium, can be used to prevent attacks, with varied success. A frequently-cited 1981 study suggests that oxygen therapy, wherein one inhales oxygen through a mask, may relieve pain in 7 out of 10 patients. However, many patients and practitioners are hopeful about more recent studies which indicate that psilocybin could treat cluster headaches.

How do psychedelics treat cluster headaches?

A 2017 study that analyzed anecdotal reports of using psilocybin and LSD for both cluster headaches and migraines suggests that psychedelic medicine has potential in treating these conditions. In particular, this study addresses how many treatment-resistant cluster headache patients there are (around 20% of chronic cases). “Considering that CH is one of the most intense and disabling pain conditions known, the urgency of the circumstances has led care providers and patients to try unusual or experimental remedies,” the study’s authors wrote. They noted that such patients aren’t interested in the psychoactive effects of psilocybin but just want pain relief.

A 2006 study also suggests that psilocybin and LSD may successfully stop a cluster headache attack. ClusterBusters, a non-profit advocacy and education group on cluster headaches, is part of a pilot study on the safety and efficacy of psilocybin treatment. It’s hypothesized that because cluster headaches are caused by changes in hypothalamic activity, and psilocybin slows blood flow to the area, it may prevent the onset of a cluster attack. The 2006 study found that of 19 psilocybin users interviewed, 18 reported a longer remission.

While psilocybin shows great promise for cluster headache treatment, legal limitations curtail research on the subject. Psilocybin is legal in Oregon and decriminalized in cities such as Oakland, Denver, and Washington D.C., yet is still a Schedule I drug federally. Not only does this limit research, but it prevents patients from asking about it, and practitioners from discussing it. Much of what we know is anecdotal. “I got ahold of a handful of tiny magic mushrooms last year. Never tried them before this,” writes one Reddit user with cluster headaches. “I was nervous about trying them so I only ate three. I fell asleep thinking it didn’t work. The next day I didn’t feel any pain, but it was too early to tell. So I ate another four mushrooms and didn’t get any pain that time. The results 15 months later: The headache pain never came back.  Not even a hint of pain. Not the slightest shadow.”

Conclusion and Final Thoughts

Cluster headaches can be an agonizing medical condition. No human should have to bear the physical pain and debilitating effects of cluster headaches. While there is legal treatment available, it has not adequately solved the problem. The evidence suggests that psilocybin can treat cluster headaches safely. It has been reported that of 10,000 people who took psilocybin, only 17 went to the hospital. This is drastically lower than the rates for legal drugs such as alcohol and amphetamines, and even LSD. Therefore, it’s logical that research is expanded to further study the effects of psilocybin on cluster headaches.