Psychoactive substances as a last resort—a qualitative study of self-treatment of migraine and cluster headaches

People with treatment-resistant cluster headache and migraine often turn to online forums to discuss alternative pharmacological treatments, including illicit psychoactive substances. A qualitative thematic analysis of discussions on three forums found that patients are in a desperate and vulnerable situation, viewing such substances as a last resort. Psilocybin, lysergic acid diethylamide, and related psychedelic tryptamines were reportedly effective for both preventing and treating attacks, while cannabis results were more unpredictable. Users showed little interest in psychoactive effects, often using sub-psychoactive doses to avoid them. No severe adverse events were reported, but desperation sometimes led to risky behavior in obtaining and testing treatments.

Study at a glance

Abstract

BACKGROUND: Treatment resistant cluster headache and migraine patients are exploring alternative treatments online. The aim of this study was to improve comprehension regarding the use of non-established or alternative pharmacological treatments used by sufferers of cluster headaches and migraines. METHODS: A qualitative thematic analysis of the users' own accounts presented in online forum discussions were conducted. The forum boards https://shroomery.org/ , http://bluelight.org , and https://clusterbusters.org/ met the inclusion criteria and were used for the study. RESULTS: The analysis resulted in six themes: a desperate need for effective treatments; the role of the forum-finding alternative treatments and community support; alternative treatment substances; dosage and regimens; effects and treatment results; and adverse effects. The results provide an insight into why, how, and by which substances and methods sufferers seek relief from cluster headache and migraines. CONCLUSIONS: These patients are in a desperate and vulnerable situation, and illicit psychoactive substances are often considered a last resort. There appeared to be little or no interest in psychoactive effects per se as these were rather tolerated or avoided by using sub-psychoactive doses. Primarily, psilocybin, lysergic acid diethylamide, and related psychedelic tryptamines were reportedly effective for both prophylactic and acute treatment of cluster headache and migraines. Treatment results with cannabis were more unpredictable. No severe adverse events were reported, but it was observed how desperation sometimes spurred risky behavior when obtaining and testing various treatment alternatives. The forum discourse mainly revolved around maximizing treatment results and minimizing potential harms.