Increased use of illicit drugs in a Dutch cluster headache population

Introduction

Cluster headache is an uncommon primary headache disorder marked by very severe unilateral attacks lasting 15–180 minutes, often accompanied by ipsilateral cranial autonomic symptoms. Most people experience an episodic form with remission periods, while about 14% have a chronic form without remissions longer than one month. Although standard treatments are effective for many patients, 10–20% remain refractory and often try alternative approaches, including illicit drugs. Prior small and uncontrolled studies have reported that substances such as cannabis, psilocybin mushrooms (PSI), lysergic acid diethylamide (LSD), gamma-hydroxybutyrate (GHB) and others have been used acutely or as prophylaxis, with mixed and inconclusive self-reported effects; however, systematic investigation in a Dutch population had not been performed. De Coo and colleagues set out to systematically assess lifetime use of illicit drugs and self-reported effects on attack frequency and attack duration in a representative Dutch cluster headache population. The study compared prevalence and patterns of drug use in people screened for cluster headache within the nationwide LUCA programme to age- and sex-matched data from the Dutch general population, and explored differences by gender, age cohort, and episodic versus chronic disease.