Self-administration of Psilocybin for the Acute Treatment of Migraine: A Case Report

Abstract

Background: Migraine is a common neurovascular disorder with a pathophysiology related to the serotonin (5-hydroxytryptamine; 5-HT) system. Pharmacologic modulation of 5-HT receptors has demonstrated efficacy in the acute treatment of migraines. Psilocybin, a classic psychedelic with 5-HT receptor activity, has demonstrated therapeutic potential in the management of neuropsychiatric conditions. To date, no reports have investigated the effect of psilocybin administered acutely during a migraine episode.

Case presentation: The case of a 33-year-old male patient with a history of migraines with aura, who had acute administration of oral psilocybin (in the form of the dried fruiting body of Psilocybe cubensis mushrooms) at migraine onset is presented. Headache intensity was rated hourly using the Numerical Rating Scale (NRS) and compared to three previous migraines. Profound reductions in headache intensity and emetic episodes were reported during the migraine treated acutely with oral psilocybin administration, compared to three previous migraines.

Discussion: The severe, disabling, and treatment-resistant nature of migraines warrants continued surveillance for novel pharmacologic interventions. The established congruous pathophysiology of migraine and pharmacology of psilocybin, via the 5-HT receptor system, positions psilocybin as a potential therapeutic target.

Conclusion: While this report highlights the potential role of psilocybin in the acute management of migraines, it is essential to note that it should not be considered a basis for guiding clinical practice at this point. Further research is necessary to establish the safety and efficacy of psilocybin as a treatment option for migraines.

Keywords: Psilocybin; headache; migraine; pharmacology; psychedelics; treatment.

FIGURE 1.

Numerical Rating Scale (NRS) scores for the hourly headache intensity of four migraines treated at time zero (0) with psilocybin (dried Psilocybe cubensis 1.2g)+ibuprofen 400mg+acetaminophen 1,000mg (migraine 1 [M1]); ibuprofen 400mg+acetaminophen 1,000mg (M2); naproxen 444mg+acetaminophen 1,000mg (M3); and no treatment (M4).