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Schindler EAD, Sewell RA, Gottschalk CH, Flynn LT, Zhu Y, Pittman BP, Cozzi NV, D'Souza DC. Psilocybin pulse regimen reduces cluster headache attack frequency in the blinded extension phase of a randomized controlled trial. J Neurol Sci 2024; 460:122993. [PMID: 38581739 DOI: 10.1016/j.jns.2024.122993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/21/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND In a recent randomized, double-blind, placebo-controlled study, we observed a nonsignificant reduction of attack frequency in cluster headache after pulse administration of psilocybin (10 mg/70 kg, 3 doses, 5 days apart each). We carried out a blinded extension phase to consider the safety and efficacy of repeating the pulse regimen. METHODS Eligible participants returned to receive a psilocybin pulse at least 6 months after their first round of study participation. Participants kept headache diaries starting two weeks before and continuing through eight weeks after the first drug session. Ten participants completed the extension phase and all ten were included in the final analysis. RESULTS In the three weeks after the start of the pulse, cluster attack frequency was significantly reduced from baseline (18.4 [95% confidence interval 8.4 to 28.4] to 9.8 [4.3 to 15.2] attacks/week; p = 0.013, d' = 0.97). A reduction of approximately 50% was seen regardless of individual response to psilocybin in the first round. Psilocybin was well-tolerated without any unexpected or serious adverse events. DISCUSSION This study shows a significant reduction in cluster attack frequency in a repeat round of pulse psilocybin administration and suggests that prior response may not predict the effect of repeated treatment. To gauge the full potential of psilocybin as a viable medicine in cluster headache, future work should investigate the safety and therapeutic efficacy in larger, more representative samples over a longer time period, including repeating the treatment. CLINICAL TRIALS REGISTRATION NCT02981173.
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Affiliation(s)
- Emmanuelle A D Schindler
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America; Neurology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America; Headache Center of Excellence, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America.
| | - R Andrew Sewell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | | | - L Taylor Flynn
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | - Yutong Zhu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Nicholas V Cozzi
- Neuropharmacology Laboratory, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America; Alexander Shulgin Research Institute, Lafayette, CA, United States of America
| | - Deepak C D'Souza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America; Psychiatry Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
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