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Schindler EAD, Sewell RA, Gottschalk CH, Luddy C, Flynn LT, Lindsey H, Pittman BP, Cozzi NV, D'Souza DC. Exploratory Controlled Study of the Migraine-Suppressing Effects of Psilocybin. Neurotherapeutics 2021; 18:534-543. [PMID: 33184743 PMCID: PMC8116458 DOI: 10.1007/s13311-020-00962-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/26/2023] Open
Abstract
While anecdotal evidence suggests that select 5-hydroxytryptamine 2A (5-HT2A) receptor ligands, including psilocybin, may have long-lasting therapeutic effects after limited dosing in headache disorders, controlled investigations are lacking. In an exploratory double-blind, placebo-controlled, cross-over study, adults with migraine received oral placebo and psilocybin (0.143 mg/kg) in 2 test sessions spaced 2 weeks apart. Subjects maintained headache diaries starting 2 weeks before the first session until 2 weeks after the second session. Physiological and psychological drug effects were monitored during sessions and several follow-up contacts with subjects were carried out to assure safety of study procedures. Ten subjects were included in the final analysis. Over the 2-week period measured after single administration, the reduction in weekly migraine days from baseline was significantly greater after psilocybin (mean, - 1.65 (95% CI: - 2.53 to - 0.77) days/week) than after placebo (- 0.15 (- 1.13 to 0.83) days/week; p = 0.003, t(9) = 4.11). Changes in migraine frequency in the 2 weeks after psilocybin were not correlated with the intensity of acute psychotropic effects during drug administration. Psilocybin was well-tolerated; there were no unexpected or serious adverse events or withdrawals due to adverse events. This exploratory study suggests there is an enduring therapeutic effect in migraine headache after a single administration of psilocybin. The separation of acute psychotropic effects and lasting therapeutic effects is an important finding, urging further investigation into the mechanism underlying the clinical effects of select 5-HT2A receptor compounds in migraine, as well as other neuropsychiatric conditions. Clinicaltrials.gov : NCT03341689.
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Affiliation(s)
- Emmanuelle A D Schindler
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
- Neurology Service, Veterans Affairs Connecticut Healthcare System, MS 127, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Veterans Affairs Headache Center of Excellence, West Haven, CT, USA.
| | - R Andrew Sewell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | | | - Christina Luddy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - L Taylor Flynn
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Hayley Lindsey
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Neurology Service, Veterans Affairs Connecticut Healthcare System, MS 127, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Veterans Affairs Headache Center of Excellence, West Haven, CT, USA
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Nicholas V Cozzi
- Neuropharmacology Laboratory, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Alexander Shulgin Research Institute, Lafayette, CA, USA
| | - Deepak C D'Souza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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