Psychedelic drugs may offer lasting therapeutic benefits for headache and chronic pain disorders after limited dosing, a feature that distinguishes them from conventional treatments. A recent controlled trial of psilocybin in migraine is reviewed, though its limitations are noted. Several neurobiological targets of psychedelics related to headache and chronic pain are highlighted, but separating acute from lasting effects is key to understanding their unique clinical actions. Considerable research is still needed to determine the effects, safety, and mechanisms of psychedelics in these conditions.
Patients with headache disorders like migraine or cluster headache often have poor quality of life, and military members and Veterans are at high risk, especially due to head trauma. Available treatments may not work, have side effects, or be unaffordable. Psychedelics have been discussed as a treatment for over 50 years; patients report that LSD and psilocybin provide long-lasting relief for weeks or months after just a single or few doses. Formal studies are beginning, and first results for psilocybin in migraine and cluster headache are encouraging but small and not conclusive. Veterans have been active in the re-emergence of psychedelics but may not all be able or willing to participate in studies due to health conditions or military viewpoints.