LSD to Improve Cluster Headache Impact Trial (LICIT)

Efficacy and Safety of Minidosing Lysergic Acid Diethylamide (LSD) for Chronic Cluster Headache: a Randomized Placebo-controlled Study

This study aims to investigate the efficacy and safety of LSD 25μg every 3 days for 3 weeks versus placebo in the treatment of chronic cluster headache (cCH).

It is a 3-week double-blind placebo-controlled intervention study, preceded by a 4-week baseline observation period and followed by a 5-week post-treatment observation period.

Primary objective: to evaluate the efficacy of LSD 25μg every 3 days for 3 weeks in cCH.

Additional objectives:

• To evaluate the safety of LSD 25μg every 3 days for 3 weeks in cCH.
• To explore the exposure-response relationship of 25μg LSD in cCH.
• To explore cost-effectiveness of treatment with LSD in cCH.
• To evaluate the efficacy of LSD on health-related quality of life.

Study Overview

• Status: Recruiting
• Conditions: Chronic Cluster Headache
• Intervention / Treatment: Drug: LSD tartrate; Drug: Placebo

Detailed Description

Treatment of cluster headache consists of acute remedies for attacks (mainly 100% O2, sumatriptan), transitional treatment for temporary frequency reduction (subcutaneous steroid injection at the greater occipital nerve (GON block), oral steroids or frovatriptan) and prolonged prophylaxis (e.g. verapamil, lithium, topiramate). Although the latter compounds have shown some efficacy in reducing the attack frequency, the evidence for their effect is weak. All current prophylactics are prescribed off-label and are limited in their utility due to associated side effects. Despite treatment, many (notably chronic) cluster headache patients continue suffering headache attacks.

Invasive, expensive treatments like hypothalamic deep brain stimulation, occipital nerve stimulation and sphenopalatine ganglion stimulation are last resort options. Recently, a monoclonal antibody targeting calcitonin gene related peptide (CGRP) received FDA approval for episodic cluster headache, but was shown to be ineffective in cCH. Thus, there is a considerable unmet need for effective treatments that are better tolerated, safe and affordable.

In this study, the investigators will assess the efficacy of prophylactic treatment with LSD in cCH. The evidence for the efficacy of LSD is limited, with the majority of data originating from case reports or uncontrolled and retrospective (internet) surveys. Nevertheless, these studies do provide indications that LSD may hold potential as a cluster headache prophylaxis.

The primary objective of this randomized double-blind placebo-controlled trial is to compare the efficacy of LSD 25μg every 3 days for 3 weeks versus placebo in cCH. The investigators aim to show that, at the end of treatment, verum is more efficacious than placebo with comparable tolerability in an ambulatory setting. To explore the sustainability of benefit the investigators will also assess the (sustained) response at 5 weeks post-treatment (8 weeks postrandomization).

If the study findings are positive, LSD should be further studied before use in routine clinical practice. Non-hallucinogenic low-dosed LSD may provide an alternative or adjunctive option for patients who do not respond to or cannot tolerate currently available treatments.

• Study Type: Interventional
• Enrollment (Estimated): 65
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Julia Jansen, MD; Phone Number: +31 24 3658765; Email: julia.jansen@cwz.nl

Study Locations

• Netherlands
  • Leiden, Netherlands
    • Recruiting
    • Leiden University Medical Center (LUMC)
    • Contact: Martien van Liefland; Phone Number: 071 526 21 11; Email: LICIT@LUMC.nl
    • Contact: Rolf Fronczek, MD, PhD
    • Contact: Martien van Liefland, MD
  • Nijmegen, Netherlands
    • Recruiting
    • Canisius-Wilhelmina Ziekenhuis (CWZ)
    • Contact: Julia Jansen; Phone Number: 024 365 82 10; Email: LICIT@cwz.nl
    • Contact: Willemijn Leen, MD, PhD
    • Contact: Julia Jansen, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 75 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• CCH according to the International Classification of Headache Disorders version 3 (ICHD-3)
• At screening: stable weekly attack frequency in the 4 weeks prior to screening (assessed retrospectively), averaging at least 8 per week and each week within a 40% window around the average
• At randomization: average of at least 8 attacks per week and no absence of attacks on more than two consecutive days during baseline

Exclusion Criteria:

• Use of excluded concomitant treatment at screening (lithium; other prophylactics if not on a stable dose for less than one month; steroids/GON block within 2 months before screening; sphenopalatinum block, neurostimulation (changed setting within 3 months before screening) or botulinum toxin within 3 months before screening) and during the double-blind phase
• Use of LSD(-derivatives) (other than investigational drug), psilocybin, ketamine or cannabis within 3 months prior to screening and throughout the study
• Lifetime and/or family history (first degree relatives) of psychotic or bipolar disorder, suicidal intention or attempt
• A score of 6 or more on the 'Ervaringenlijst' (PQ-16) to exclude subclinical susceptibility to psychosis
• Actual abuse of alcohol and/or recreational drugs
• Lifetime history of cardiac valvular disease
• History or evidence of cognitive disorder at screening
• Positive urine drug screen at screening
• Females: Pregnancy, lactation, no acceptable contraceptive use

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Verum; Lysergic diethylamide tartrate (equivalent to 25 microgram LSD base), one dose every 3 days for 3 weeks (totalling 7 vials)	Drug: LSD tartrate; LSD tartrate equivalent to 25 microgram LSD base; Other Names: Lysergic acid diethylamide
Placebo Comparator: Placebo; Placebo vial looking like verum vial, one vial every 3 days for 3 weeks (totalling 7 vials)	Drug: Placebo; Placebo with equal appearance

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean change in weekly attack frequency, across treatments groups.	In week 3 post-randomization, compared to the 4-week baseline average per week	week 3 of treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Global Impression of Change (PGIC)	Patient Global Impression of Change at week 3 post-randomization; scale 0-7, higher scores representing better improvement	Day 21 post-randomization
Pharmacokinetic (PK)-pharmacodynamic (PD) modelling	Plasma LSD concentrations on day 18 post-randomization frequency	Day 18 post-randomization
Mean change in weekly attack frequency across weeks 4-8 compared to the 4-week baseline and for each week separately.		week 8 post-randomization
100% reduction (remission rate) in number of weekly attacks in the third treatment week, compared to the 4-week baseline, across treatment groups.	Rate of subjects with 100% reduction in weekly attack frequency compared to baseline	week 3 post-randomization
≥50% reduction (50% responder rate) in number of weekly attacks in the third treatment week, compared to the 4-week baseline, across treatment groups.	Rate of subjects with more than 50% reduction in weekly attack frequency compared to baseline	week 3 post-randomization
≥30% reduction (30% responder rate) in number of weekly attacks in the third treatment week, compared to the 4-week baseline, across treatment groups.	Rate of subjects with more than 30% reduction in weekly attack frequency compared to baseline	week 3 post-randomization
100% reduction (remission rate) in number of weekly attacks across weeks 4-8 compared to the 4-week baseline and for each week separately.	Rate of subjects with 100% reduction in weekly attack frequency compared to baseline	week 8 post-randomization
≥50% reduction (50% responder rate) in number of weekly attacks across weeks 4-8 compared to the 4-week baseline and for each week separately.	Rate of subjects with 50% reduction in weekly attack frequency compared to baseline	week 8 post-randomization
≥30% reduction (30% responder rate) in number of weekly attacks across weeks 4-8 compared to the 4-week baseline and for each week separately.	Rate of subjects with 30% reduction in weekly attack frequency compared to baseline	week 8 post-randomization
Mean change in weekly attack frequency in the entire 3 week treatment period compared to the 4-week baseline.		week 3 post-randomization
Mean change in mean headache attack duration (minutes) per week, across treatment groups	In week 3 compared to the weekly average during 4-week baseline	week 3 post-randomization
Mean change in mean headache attack duration (minutes) per week, across treatment groups	Across weeks 4-8 compared to the 4-week baseline and for each week separately.	week 8 post-randomization
Mean change in mean headache attack severity (VAS 1-10), across treatment groups	In week 3 compared to the weekly average during 4-week baseline	week 3 post-randomization
Mean change in mean headache attack severity (VAS 1-10), across treatment groups	Across weeks 4-8 compared to the 4-week baseline and for each week separately.	week 8 post-randomization
Mean change in number of abortive medication use, across treatment groups	In week 3 compared to the weekly average during 4-week baseline	week 3 post-randomization
Mean change in number of abortive medication use, across treatment groups	Across weeks 4-8 compared to the 4-week baseline	week 8 post-randomization
Failure of sustained response'	Time to initiation of additional prophylactic treatment and/or GON-block during weeks 4-8, across treatment groups	Weeks 4-8 post-randomization
Patient Global Impression of Change (PGIC)	Patient Global Impression of Change at week 8 post-randomization; scale 0-7, higher scores representing better improvement	weeks 3 and 8
Health-related quality of life	Change from baseline in EQ-5D-5L Visual Analogue Scale (VAS) at weeks 3 and 8.	weeks 3 and 8
Hospital Anxiety and Depression Score (HADS)	Change from baseline in Hospital Anxiety and Depression Scale (HADS) at weeks 3 and 8.	weeks 3 and 8.
Cost-effectiveness analysis (CEA) from a societal perspective comparing the LSD intervention with usual care.	Healthcare use and productivity losses will be measured by patient questionnaires (iMCQ, and iPCQ)	Week 1, 3 and 8
Efficacy of treatment masking	measured as perceived treatment assignment on a 5-point scale (likely verum/possibly verum/don't know/possibly placebo/likely placebo).	Week 1 and 3 post-randomization

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Alcohol consumption	Units of alcohol consumed during baseline, treatment and follow-up	during the entire 12-week duration of the study
PK-PD modelling	Correlation between individual pharmacokinetics of LSD and relative change of weekly attack frequency	Week 1 and 3

Collaborators and Investigators

• Sponsor: Radboud University Medical Center
• Collaborators: Leiden University Medical Center; ZonMw: The Netherlands Organisation for Health Research and Development; Canisius-Wilhelmina Hospital
• Investigators: Principal Investigator: Kees Kramers, Prof., Radboud University Medical Center

Publications and helpful links

General Publications

• Hoffmann J, May A. Diagnosis, pathophysiology, and management of cluster headache. Lancet Neurol. 2018 Jan;17(1):75-83. doi: 10.1016/S1474-4422(17)30405-2. Epub 2017 Nov 23.
• Rozen TD, Fishman RS. Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache. 2012 Jan;52(1):99-113. doi: 10.1111/j.1526-4610.2011.02028.x. Epub 2011 Nov 11.
• Tepper SJ, Stillman MJ. Cluster headache: potential options for medically refractory patients (when all else fails). Headache. 2013 Jul-Aug;53(7):1183-90. doi: 10.1111/head.12148. Epub 2013 Jun 28.
• McGeeney BE. Cannabinoids and hallucinogens for headache. Headache. 2013 Mar;53(3):447-58. doi: 10.1111/head.12025. Epub 2012 Dec 20.
• Andersson M, Persson M, Kjellgren A. Psychoactive substances as a last resort-a qualitative study of self-treatment of migraine and cluster headaches. Harm Reduct J. 2017 Sep 5;14(1):60. doi: 10.1186/s12954-017-0186-6.
• Sewell RA, Halpern JH, Pope HG Jr. Response of cluster headache to psilocybin and LSD. Neurology. 2006 Jun 27;66(12):1920-2. doi: 10.1212/01.wnl.0000219761.05466.43.
• Schindler EA, Gottschalk CH, Weil MJ, Shapiro RE, Wright DA, Sewell RA. Indoleamine Hallucinogens in Cluster Headache: Results of the Clusterbusters Medication Use Survey. J Psychoactive Drugs. 2015 Nov-Dec;47(5):372-81. doi: 10.1080/02791072.2015.1107664. Epub 2015 Nov 23.
• de Coo IF, Naber WC, Wilbrink LA, Haan J, Ferrari MD, Fronczek R. Increased use of illicit drugs in a Dutch cluster headache population. Cephalalgia. 2019 Apr;39(5):626-634. doi: 10.1177/0333102418804160. Epub 2018 Oct 5.

Study record dates

Study Major Dates

• Study Start (Estimated): April 16, 2025
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): April 1, 2027

Study Registration Dates

• First Submitted: July 5, 2022
• First Submitted That Met QC Criteria: July 25, 2022
• First Posted (Actual): July 28, 2022

Study Record Updates

• Last Update Posted (Actual): April 15, 2025
• Last Update Submitted That Met QC Criteria: April 10, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Chronic cluster headache; Lysergic acid diethylamide
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Headache Disorders, Primary; Headache Disorders; Trigeminal Autonomic Cephalalgias; Headache; Cluster Headache; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Neurotransmitter Agents; Psychotropic Drugs; Serotonin Antagonists; Serotonin Agents; Hallucinogens; Serotonin Receptor Agonists; Lysergic Acid Diethylamide
• Other Study ID Numbers: 131-2022

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Individual patient data underlying publication, after deidentification, will be shared upon request to the corresponding author
• IPD Sharing Time Frame: 9-36 months after article publication
• IPD Sharing Access Criteria: For purpose of meta-analysis and approved by an independent review board
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No