Studying classic psychedelics for the management of headache disorders: Considerations for Veterans

Patients with headache disorders, such as migraine or cluster headache, often have poor quality of life and can be disabled by their condition. Military members and Veterans have a high risk of developing a headache disorder, particularly because they are also at risk for brain injury through head trauma. New headache treatments are needed, because the available treatments may not work, have too many side effects, or are not affordable. Psychedelics have been discussed as a treatment in headache disorders for more than 50 years. Patients report that drugs such as lysergic acid diethylamide (a synthetic psychedelic) and psilocybin (a compound found in so-called magic mushrooms) provide long-lasting relief from headaches for weeks or months after just a single or few doses. Formal studies investigating this unique ability are starting to take place. Findings from the first studies of psilocybin in migraine and cluster headache are encouraging, although these studies are small and not conclusive, and more research is needed. Veterans have been active in the recent re-emergence of psychedelics, although they may not all be able, or willing, to take part in studies because of underlying health conditions or viewpoints gained through military experience. Headache disorders, such as migraine and cluster headache, are common conditions that are accompanied by significant disability and poor quality of life. Military members and Veterans are at increased risk of developing headache disorders, particularly in the context of traumatic brain injury. Although there are several treatment options for headache management, poor efficacy, tolerability, or access limit their success, and there is always a need to identify new treatments in headache medicine. The therapeutic effects of psychedelic drugs for headache disorders have been reported for decades. Unlike conventional treatment options, psychedelics are reported to have lasting (weeks, months) therapeutic effects after limited dosing (single or few doses). Controlled trials of psilocybin and lysergic acid diethylamide are emerging. Recently published studies of psilocybin in migraine and cluster headache are reviewed in this article. Although anecdotal evidence is generally supported, more research is required before the safety and efficacy of psychedelic drugs for headache disorders can be verified. Veterans have been active in emerging research with psychedelics, although safety and cultural concerns may preclude some in this population from participating. Les troubles cephalalgiques tels que la migraine et l'algie vasculaire de la face sont des affections courantes qui s'accompagnent d'un handicap important et d'une mauvaise qualite de vie. Les militaires et les veteran(e)s courent un risque accru de developper des troubles cephalalgiques, en particulier dans le contexte d'un traumatisme cerebral. Il existe plusieurs options de traitement pour gerer les maux de tete, mais leur portee est limitee par une efficacite ou une tolerance mediocres ou par la difficulte d'acces, et la necessite de trouver de nouveaux traitements demeure vive en medecine cephalalgique. Les effets therapeutiques des drogues psychedeliques sur les troubles cephalalgiques sont documentes depuis des dizaines d'annees. Contrairement aux traitements conventionnels, les psychotropes produiraient des effets therapeutiques durables (semaines, mois) avec un dosage limite (une dose ou quelques-unes). Les essais cliniques sur la psilocybine et le diethylamide de l'acide lysergique sont de plus en plus frequents. Cet article passe en revue des etudes publiees recemment sur l'usage de la psilocybine dans le traitement de la migraine et de l'algie vasculaire de la face. Bien que ces etudes appuient generalement les temoignages anecdotiques, des recherches supplementaires s'imposent avant de pouvoir considerer que l'innocuite et l'efficacite des drogues psychedeliques pour les troubles cephalalgiques sont demontrees. Les veteran(e)s prennent part activement aux recherches emergentes sur les psychotropes, meme si des preoccupations quant a leur caractere inoffensif ou certaines reserves culturelles peuvent empecher des membres de cette population d'y participer.