Increased use of illicit drugs in a Dutch cluster headache population

This survey study (n=756) of those with cluster headaches found that they used more illicit drugs (including psychedelics) than the general population. For those who used them, about 50% said that psilocybin and LSD reduced both the attack frequency and duration of cluster headaches.

Abstract

“Introduction: Many patients with cluster headache report use of illicit drugs. We systematically assessed the use of illicit drugs and their effects in a well-defined Dutch cluster headache population.

Methods: In this cross-sectional explorative study, 756 people with cluster headache received a questionnaire on lifetime use and perceived effects of illicit drugs. Results were compared with age and sex-matched official data from the Dutch general population.

Results: Compared to the data from the general population, there were more illicit drug users in the cluster headache group (31.7% vs. 23.8%; p < 0.01). Reduction in attack frequency was reported by 56% (n = 22) of psilocybin mushroom, 60% (n = 3) of lysergic acid diethylamide and 50% (n = 2) of heroin users, and a decreased attack duration was reported by 46% (n = 18) of PSI, 50% (n = 2) of heroin and 36% (n = 8) of amphetamine users.

Conclusion: In the Netherlands, people with cluster headache use illicit drugs more often than the general population. The question remains whether this is due to an actual alleviatory effect, placebo response, conviction, or common pathophysiological background between cluster headache and addictive behaviours such as drug use.“

Authors: Willemijn C. Naber, Leopoldine A. Wilbrink, Joost Haan, Michel D. Ferrari & Rolf Fronczek

Summary

Some patients report an acute effect of cannabis, cocaine, psilocybin mushrooms (PSI) and heroin on their cluster headache attacks. In Italy, they filled out a questionnaire concerning illicit drug use, and the effect of these drugs on attack duration and attack frequency.

Statistics Netherlands provided data about the Dutch general population from their annual health survey. The data was divided into three categories: All, people classified as having headache, and people classified as having chronic pain.

The LUCA study was approved by the local medical ethics committee, and all participants provided written informed consent.

We performed Chi-square tests and independent t-tests to determine differences in drug use between the cluster headache population and the control population.

Cluster headache compared to people with headache and the chronic pain in the general population

Cluster headache patients used illicit drugs more often than people without cluster headache or chronic pain in the general population.

Gender differences

Males with cluster headache used illicit drugs more often than females, and males from the general population used illicit drugs more often than females. Females with and age cohorts used illicit drugs more often than males.

Episodic versus chronic cluster headache

There were no differences between episodic and chronic cluster headache patients in terms of general illicit drug use, or specific illicit drug use, frequency and duration of an individual cluster headache attack.

In a small study, the use of PSI was found to be more common in females than males with cluster headache. Its efficacy is limited, however.

The study found that people with cluster headache used more illicit drugs than the Dutch general population, except for the 18-24 and 25-30 age cohorts, which were too small to reach significance. This finding suggests that increased use is specific for cluster headache and not linked to headache or chronic pain per se.

The headache subgroup of the general population could have included cluster headache patients, but this small number of potential cluster headache patients would not have influenced the outcome of the headache subgroup.

Our questionnaire did not ask about motives for drug use, and the placebo effect could have overestimated the effects.

In conclusion, the Dutch cluster headache population has a higher prevalence of illicit drug use compared to the general Dutch population. This might be due to a common pathophysiology.

Cluster headache sufferers report no effect of illicit drug use on attack duration and frequency, but some report a positive effect.