This is a linkpost for https://www.project-syndicate.org/commentary/psychedelic-drugs-should-be-legal-for-cluster-headache-by-peter-singer-2025-12
Peter Singer's latest column on Project Syndicate is about cluster headaches.
Sufferers of cluster headaches, also known as "suicide headaches," will do anything to stop what is possibly the most painful condition known to medicine, including using illegal drugs like psilocybin and LSD. Given strong evidence that psychedelics work, why aren't doctors allowed to prescribe them?
He also urges readers to sign our open letters on clusterfree.org. Please sign and ask others to sign.
From a medical perspective this seems a bit daft
In medicine you quickly learn that anectode is extremely unreliable and the average person is positively busting to attribute cause and effect to whatever they just experienced. Every homeopathic remedy/energy healer/prayer/crystal/snake oil has its die-hards who will give you convincing anectodes of immediate success, so doctors become rightly extremely skeptical about these stories.
The actual evidence he provides is this review of some case studies and surveys and 4 clinical trials but which have pretty low numbers. The review itself says:
Combined with the small risk of psychosis from psilocybin I understand why health systems wouldn't want to rush into mainstreaming them as treatment.
Thanks for your comment!
It is true that published studies on psychedelics are few and small. Hopefully that will change but, currently, investment into cluster headache is minute relative to its severity and prevalence.
There are no studies for DMT in particular (though one survey is being carried out at Yale). However, we've argued that the little evidence we have on DMT specifically should be taken very seriously (which is what motivates the Yale group).
I think this definitely does not apply to DMT for CH. As mentioned in the post I linked above, patients can report going from experiencing the worst possible pain to being completely pain free within seconds of inhaling DMT. The cause and effect could not be any clearer. (There are also other statistical ways to quantify the reliability of anecdotes, see e.g. here.)
(And yet it's worth pointing out that two of the three co-authors of that review, namely Christopher Gottschalk and Emmanuelle Schindler, are among the strongest supporters of psychedelic treatments for CH. Gottschalk is the Director of Headache Medicine at Yale and immediate past president at the Alliance for Headache Disorders Advocacy.)
How big is the risk of psychosis at low doses, and how does it compare to experiencing literally the worst possible pain, day in and day out?
I've been thinking about / working on cluster headaches since summer 2024, not just reading the academic literature but also following support groups online and talking to patients directly. There's no doubt in my mind that psychedelics help many patients enormously, and at low doses for most patients. I know some patients who decide not to take psychedelics, but we should give those who do want to use them the right to try them without any legal repercussions.