Transcript:

Using DMT to Abort Cluster Headaches

May all beings be free from suffering, especially those who are trapped in hell.

Welcome everybody. Today we’re going to talk about a pretty gnarly topic, but it’s a very important one. I think if we focus as a community and make direct, persistent action towards these goals, we will be improving the world in an unprecedented way—maybe more significant than the introduction of anesthesia to medicine. And I don’t say this lightly. I actually think it is up there as a possible gift to the world.

On Discussing Extreme Suffering

Now, I am going to be talking about extreme suffering. I don’t only talk about extreme suffering—I talk about a lot of interesting things. I talk about the geometry of DMT levels, the joy of jhanas, the phenomenology of MDMA and unconditional love, and lots of things. I think it’s important to talk about the full spectrum: to understand the positives, the extreme positives, the things that get us going in the morning, the reasons to be alive. But we cannot neglect the other side—the things that actually make us not want to exist.

There are big things we can do to push the global hedonic range away from touching the extremes of suffering. At the very least, we can deliver access to safe, sustainable, wonderful technologies that produce MDMA-like states of love and empathy and bodily wellness. But the complete package is not complete without really emphasizing that intense suffering is a very big deal and it is morally urgent that we actually tackle it.

I’m going to give you some basics, what I have seen works and doesn’t work, information about what we’re planning to do in the future, and some requests—especially for anybody who has used this technique to abort cluster headaches. Please contact us. We would love to get your testimonial. There’s a link in the description where we’re gathering video testimonials, which I think are the most powerful, especially from a PR perspective for spreading the word. Written testimonials are also welcome—we’re happy to just have an interview with you and turn that into text, whatever works.

There are also some more experimental experiments that I think are extremely high value and probably fairly safe. I don’t want to come across as saying “please do this,” but if you have a high risk tolerance and you suffer from this condition and you’re willing to experiment a little bit, you may provide enormously useful information for the world.

Introduction: DMT for Cluster Headaches

So let’s get started. We’re going to talk about using DMT to abort cluster headaches. This surprises people, right? I mention this and people think I’m joking. It’s the DMT guy, the guy who talks about the hyperbolic geometry of DMT experiences, now saying that DMT cures cluster headaches and migraines. It really sounds crackpot-y, like the kind of hippie who will say that royal honey mixed with pollen cures pancreatic cancer or something.

Yes, I mean, I do think about DMT all the time, so yeah, he who has a hammer will see everything as a nail. But in this case, I swear that’s not what’s happening. This took me by surprise and I would not be promoting this if I didn’t actually think this was a really serious possible intervention for reducing drastic amounts of suffering in the world.

Background: Heavy Tails of Valence

The first time I found out about this was around 2019 when I was conducting some research on the logarithmic scales of pleasure and pain. This is written up in EA Forum posts, as well as in peer-reviewed papers with Chris Percy and other collaborators. We rebranded it as the heavy tails of valence hypothesis, which roughly says that the intense experiences—the intense range of both pleasure and pain—is not just one or twice as intense as the mid-ranges but potentially one or two orders of magnitude.

We provided compelling reasons to believe that 10 out of 10 pain—such as what you may experience with kidney stones or severe benzo withdrawal (people don’t believe me but it really does seem to be the case) or cluster headaches (cluster headaches may actually go higher than 10 out of 10, although that’s a topic I’m not going to talk very much about today)—in all of those cases, if you talk to people who have undergone those extreme experiences, generally speaking they will say that the actual intensity of the suffering and discomfort was 10, 100, maybe even a thousand times brighter, worse, more repugnant than something they might describe as five out of 10 pain.

I’m not going to repeat the reasons—there are articles online and presentations I’ve given specifically about this topic. But this is something I feel quite confident on.

The Priority of Addressing Extreme Suffering

Starting from that basis, I recognized: just as in effective altruism people realize that if you apply this 80/20 logic for where to donate your money to improve the lives of people in the world, if you understand that suffering follows this extreme distribution—where the top 1% of suffering is just orders of magnitude worse than the top 2%, and so on—it really ought to reprioritize how you see the world when it comes to making it better. Cutting off the extremes, the negative extremes, becomes a tacit priority.

I would argue you don’t need to be a classic utilitarian to actually believe this. From deontological perspectives, from virtue ethics, and of course from negative utilitarianism, classic utilitarianism, prioritarianism—pretty much any popular, sensible ethical framework that I can think of would essentially agree that if there is a ridiculously cheap intervention that is very effective against some of the worst types of suffering, that bubbles up as a priority.

Now, a utilitarian may want to know more. They may actually want to know: how many patients? How much do they actually suffer? How much are you actually going to relieve their suffering? And how much is it going to cost? If you are of that ilk, we have a pretty thorough analysis largely done by my collaborator Alfredo Parra in EA forums, titled “Quantifying the Global Burden of Cluster Headaches and Migraines.”

Essentially, we use empirical data as well as explicit assumptions which you can tweak—you can put your own numbers on the various assumptions. With that, it is a fairly robust finding that cluster headaches bubble up as one of the major causes of suffering in the world. Meaning that even though they’re not that common, if you actually prevent them, you’re going to be getting rid of a significant percent of world suffering—maybe double digits. Imagine that. Imagine something simple like distributing DMT cartridges to people who suffer from cluster headaches. You can manufacture them for like $3 to $5, and if you’re mass-producing them and cutting down 15% of the world’s suffering—imagine that.

That is the sort of thing that keeps me very motivated and hopeful on this topic because it really does seem very doable. But there are of course a lot of caveats and important considerations.

My Confidence Level

I’m going to give you an info dump. Pretty much everything that I’m going to be telling you, my level of confidence on it is between moderate and very high. Nothing that I will tell you is something that I feel like I’m not sure about or iffy about. Now, it’s very likely that I will make mistakes—this is an ongoing area of research. It’s quite likely that we will find counterexamples to some of the things that I will tell you, or we may find better protocols. But I do think that sharing what I know with the world as soon as possible in a consumable format is actually really beneficial.

Without further ado, I’m just going to go through the content. I’m trying to speak more slowly—David Pearce recommended I do that. Otherwise I just power through. But yeah, speaking more slowly, carrying a calm vibe. Let’s not get too agitated just because we’re talking about a very gnarly topic. Actually, as an aside, that might be one of the things that people value about some of my videos and content: I do talk about very gnarly topics, but hopefully with a good vibe and compassion, as opposed to helplessness or suffering. It does make me extremely sad that these things exist, but I think that the best way forward is actually carrying a good vibe and just focusing on the effort. That is what’s going to work.

Basic Facts About Cluster Headaches

First of all, some of the basics: one in a thousand people suffer from cluster headaches. Typically they present themselves as episodes that last between one hour to up to three hours. For some people it’s as short as 40 minutes, but usually that is the range. They tend to happen at the same time every day. They tend to divide into two types: episodic and chronic.

People who have episodic cluster headaches only experience them for a fraction of the year—maybe two months or three months. It’s typically seasonally triggered. People may actually have knowledge that their cluster headaches get activated around, say, February 20th, and it’s very reliable. And at the same time of the day.

Researchers suggest that this indicates cluster headaches are related to the circadian rhythm, at the very least, or hormonal releases through circadian rhythm adjustments. Another interesting reason to believe this is that cluster headaches actually adjust to daylight savings time. Somebody might be having cluster headaches at 11 p.m. every day, and then daylight savings time starts, and then over the next several days it goes from 11 p.m. to 11:20, 11:40, and then adjusts to midnight, which is the same point in the day relative to when they usually go to sleep. So it really seems to be implicated with the circadian rhythm.

The Pain of Cluster Headaches

The pain of cluster headaches is extraordinary. I have not experienced it thankfully. I really hope I never experience it. It seems to be one of those pains that is inherently traumatizing. I am very skeptical, for example, that even advanced Zen monks would be able to not transform that pain into suffering. I’m very skeptical because it’s worse than being burned alive. It’s worse than amputation without anesthesia. It’s worse than a lot of things that you would imagine pain going as far as. And the very horrible thing is that not only does it go further than that, but it actually may do so by an order of magnitude or more.

You often hear people saying, “From a scale from 0 to 10, a cluster headache is a 15.” And I don’t think they’re kidding. They are using something like a logarithmic scale implicitly here.

Pain and Suffering Are Interconnected

Here’s something that I get often: people often prioritize psychedelics for depression and anxiety, and so on, which of course is good. It’s good that we are doing that research and advancing those causes. However, it is very common for people—this is naive, not that they’re bad people or that they lack compassion, this is just naivety—you just don’t know that really intense pain essentially tends to just transmute into extreme suffering, and also extreme psychological pain.

So cluster headache patients experience not only 10 out of 10 pain physically—they might describe it feeling like there’s a red-hot ice pick entering your eye and being wiggled around as a torture device of sorts, like “Why am I still alive? How is this pain not killing me?” That is the typical response. But if that wasn’t enough, it also comes with a profound sense of doom, a sense of abandonment, a sense that God betrayed you, a sense that reality hates you.

Again, I haven’t experienced these. I’ve experienced very unpleasant psychedelic states, bad trip-like states of consciousness back in the day—not in a long while. But I am familiar with what a pretty unpleasant psychedelic state might be. They tell me this is worse. That the doom you feel on a cluster headache is itself next level. If you could isolate the doom independent of the pain, that also would be an outlier in and of itself.

So I really want to emphasize that this concern that “Well, I can deal with pain, the thing I can’t deal with is depression” is misguided. You just don’t know the reality of things. I don’t want to be condescending, but it really does seem to be the case. This is very significant from the point of view of effective altruism.

A Sociological Observation

This is a bit of a sociological observation, but high systematizers tend to actually on average have high pain thresholds. This may have to do with prenatal testosterone and the empathizing-systematizing spectrum. I think it’s actually very common for high systematizers to not suffer very much because of physical pain, especially not in their youth, especially if they don’t have a chronic condition or aren’t suffering from migraines or something like that.

So it is not that uncommon, I think, for the people who call the shots about what we should prioritize to themselves just be ignorant about this matter. They just don’t know that pain of this sort exists and that it is also suffering. There isn’t a clean distinction. In fact, I would argue that pain and suffering are two sides of the same coin. They’re really dissonance in the field at the end of the day, except that pain is really high-frequency dissonance, highly localized, whereas suffering is low-frequency holographic dissonance. This is a very speculative thing, but I suspect that mathematically they’re tapping into the same thing. They’re not fundamentally different things, and they’re both bad.

So let’s stop this idea that suffering is independent from pain or that pain is not as bad as depression or anxiety or something like that, which is just not the case.

Also, talking to Bob Wold and people who have these conditions, they will effectively assert that for most cluster headache patients, they have comorbid depression and anxiety, but it’s not independent of the cluster headache. In fact, it’s usually caused by the cluster headache. A single cluster headache will typically give you lifelong PTSD, from what I’ve heard.

Long-Tail Distributions

I must emphasize, because these are long tails: a person’s cluster headache may be itself 10 times less bad than another person’s cluster headache, which makes this a little bit murky. I’m a little bit cautious generalizing too much because for some people they may say their cluster headache was not as bad as their kidney stone. And lo and behold, kidney stones also follow a long-tail distribution.

These long-tail distributions will keep coming up whenever we do a hedonic analysis, is my claim. There’s a very simple reason why, and it has to do with the multiplicative properties of these factors and how they come together to really create avalanches of activity.

The most straightforward analogy is: if you look at the distribution of avalanches in the world, some countries have a lot of avalanches and some countries have very few, and there’s a few countries that have one or two. The reason it’s so skewed is because the factors multiply each other. You need the right temperature, the right humidity, the right landscape, and the frequency of those factors itself also tends to follow these long-tail distributions. As a consequence, when you actually multiply the amplitude of all of these factors to get the amplitude of the results—such as how big the avalanches are, how much snow they carry—that distribution itself will be extremely skewed.

The factors that feed into a cluster headache, I think, are essentially something like that. So for some people, they may have a bunch of these factors, but maybe one of those factors is very low in its contribution, and therefore it all gets multiplied downwards, and they may get the impression that it’s not as bad.

We really need a science here. We’re developing it at QRI, but we really need to change to a paradigm where we acknowledge the logarithmic scales of pleasure and pain and make that a scientifically valid understanding.

Predictors of Cluster Headaches

Enough about the actual phenomenon. I do know a lot more about the specific feelings of it. I don’t think it’s very helpful to mention it here. But what I want to emphasize is that it really is that bad. People very often kill themselves to avoid any further experience of this sort.

So what are some predictors of cluster headaches? Going through the literature:

Genetics is a very big factor. If one of your close family members has cluster headaches, I believe you have a multiplier of about 18 times higher probability that you will develop cluster headaches compared to people in the general population.

Smoking—how much you smoke, how often. I’m talking about cigarettes here. I’m not aware of marijuana smoke itself being a problem, but I would actually be surprised if there wasn’t some correlation there. But it really does seem that tobacco smoke in particular is pretty bad. This is both in terms of lifetime consumption of tobacco and your probability of developing cluster headaches. If I was campaigning against tobacco use, which I think is a good thing to do all things considered, is actually a very powerful intervention potentially. I might emphasize: this is doubling, tripling, quadrupling your chances of getting cluster headaches. People don’t think about that when they start smoking. It doesn’t occur to you to consult the internet and see if the habit you’re developing has a small probability of extraordinarily bad outcomes. People don’t tend to do that. But yeah, that is a very strong factor.

Alcohol is interesting because it’s typically a trigger, but it doesn’t seem to be predictive in the sense that if you drink alcohol, that doesn’t seem to raise your chances that you will develop cluster headaches. But if you have cluster headaches, it is highly advisable that you do not drink. I cannot count how many times I’ve seen Reddit posts in r/clusterheads of people saying, “Oh, I really shouldn’t have had that one beer.” It really was not worth it. They have one beer in a bar thinking, “Yeah, it’s been a while. I don’t get clusters,” and then going back home, they just have to stop in the middle of the highway and wait it out while screaming in agony for three hours. So alcohol is a very well-known trigger. Very, very worth avoiding.

Head trauma is another predictor of cluster headaches.

Sleep apnea—obstructive sleep apnea—which is surprising and interesting. If you’re at risk or you suffer from clusters, I would definitely recommend checking out and treating your obstructive apnea.

Age: Essentially, onset of cluster headaches at later ages, or when you’re older, predicts that they’re much more likely to be chronic, meaning that it’s something that you would experience every day.

Why I’m So Confident

Let’s move on to why I’m so confident—actually, we as a community at this point, the core team of collaborators at QRI and people who are trying to move this cause forward. Why are we so convinced? Because there’s no peer-reviewed published article in a credible journal that says DMT aborts and prevents cluster headaches, right? So why am I so confident? Why am I willing to stake my reputation and put a flag in here and say, “God damn it, this is very important”?

Because the evidence is actually really strong. It’s just unconventional. There are a lot of situations where this happens.

Just one example: When COVID was starting, you would see in the media people talk about how “there’s no evidence that this is going to become a pandemic, there’s no peer-reviewed study that indicates that COVID is going to become a pandemic.” But the rationalists were saying, “Okay, this is growing exponentially,” and were seeing where the trend goes and were saying, “Yep, this is going to become a pandemic. It’s unstoppable now.” They were raising those alarms a month before there was some kind of mainstream consensus that, “Oh dang, yes, this is inevitably a pandemic.”

When you have a high concentration of smart, dedicated people who are checking each other’s work and have a tradition of having good epistemology and actually really care about the outcomes, often times you’ve got to trust that as opposed to the official line. Because the official line—there are often structural reasons why the truth just doesn’t come out until it’s too late.

The other very good example I think is anesthesia—the development of anesthesia for surgery. This was discovered by Humphry Davy and then Michael Faraday: that nitrous oxide and ether, chloroform, taken at sufficient concentrations would actually make you unconscious and also just completely numb to intense physical sensations. This is something that they knew with high confidence because they had personally tried it. They had tried it with friends. Things such as: “Well, okay, I’m having this extreme pain in my teeth. I need a teeth procedure,” and then they would use chloroform and it’s like, “Wow, okay, I don’t feel it at all.”

But somehow that information just didn’t really convince doctors. It really didn’t convince the mainstream. And it really wasn’t until 45 years later—almost 50 years later—where there were public demonstrations of using anesthesia for surgery where it actually worked. I think that this could have been accelerated. I don’t want to be so cynical to say it’s just human nature to ignore these huge blessings and forget about them and have hundreds of millions of people suffering in the meantime. No, I mean, I think we can get better at it. But we’re not very good at it yet, it seems.

The Inside View: Bob Wold’s Experience

Very concretely though, why am I super, super confident? The inside view is as follows:

Bob Wold, founder of Clusterbusters—he was looking for medicines that could help his own cluster headaches for years, like I believe 20 to 30 years. He tried up to 70 different compounds in all kinds of dosages and combinations and protocols—while the cluster headache is happening, before, after—and pretty much nothing worked until he explored psychedelics. Then he had near-miraculous relief.

Now, the psychedelics are tricky. The standard protocol that was started to be developed by this community—essentially a “busting protocol,” as they describe it—involves taking psilocybin or LSD, say, once every three weeks. It doesn’t talk about DMT originally. But down the line, when Bob actually encountered DMT, he said, “Oh my gosh, actually this works way better. This actually aborted right away. I don’t have to wait 30 minutes for the LSD to kick in to start to feel some kind of relief. I can just take a very small dose of DMT and within 10 seconds the pain goes from 10 out of 10 to 1 out of 10.”

So we’re talking about stratospheric effect sizes being reported by somebody who thoroughly knows all of the alternatives, is at the center of this community of people who are highly motivated to find cures, and who reports that it works just better than everything else that they have tried.

And it’s not just him. You will see in the QRI YouTube channel I have an interview with people from Clusterbusters—Joe McKay, for example, who is a 9/11 survivor. He dealt with a lot of PTSD from that and developed cluster headaches. Yes, psychedelics helped him enormously, and he was so thankful for mushrooms. They gave him hope. They really reduced his suffering. But then DMT—DMT is breakthrough, man. And I don’t mean breakthrough in the sense that it can take you to a breakthrough level experience, although it can also do that, but breakthrough from a medical perspective, from an ethical, moral urgency, triage perspective. It is a breakthrough that DMT just seems to be in a league of its own when it comes to how good it is at solving this.

In fact, Bob Wold, as he describes in that interview, actually suspects that cluster headaches are literally caused by not having enough endogenous DMT. I don’t know about that, but it is telling that such a person would actually say, “Yeah, maybe this is the cause. It’s not only a really good treatment; it’s actually the reason why we’re getting cluster headaches—that maybe you’re having some circadian rhythm-dependent, hormonal imbalance-dependent lack of endogenous DMT.” What is the DMT doing there to begin with? Who knows. But it is there. We do have DMT in us.

Additional Evidence

But it’s not just that. In 2019, before talking to them directly, just randomly interviewing people who have gone through cluster headaches, I was aware that psilocybin seems to help. But I just randomly encountered a guy from South Africa who said, “Yeah, after I found DMT, that’s all I need, and I don’t understand why this is not more well-known.” And I thought, “Huh, hold on a second.”

Since then there have been significant developments. I mean, on a more proximal, semi-personal note: I’ve been spreading this information around, and I cannot tell you the joy that I get when I get a message—let’s say from the dad of a friend who suffers from cluster headaches—saying, “Thank you for sharing this. Now my cluster headaches are pretty much taken care of.”

There is enormous value in spreading this information. Essentially, when people I have encountered are in a condition to try this and are in the depths of a cluster headache, it works. Actually, I have a friend who witnessed this firsthand. He was hanging out with a friend—he didn’t know he had cluster headaches. His friend had had cluster headaches before, but my friend didn’t know. Then all of a sudden, hanging out, his friend starts having this enormous pain and just gets to the ground in fetal position and is screaming and making all these horrible noises.

My friend remembered, “Huh, I remember that DMT actually helps.” And it just so happened that his roommate had a DMT vape pen because they’re in the psychedelic sphere, roughly, or adjacently at the very least. He found the DMT vape pen and gave it to him. He just took a tiny bit, and within 30 seconds it went from being on the floor, weeping and screaming, to being able to have just a normal conversation.

So, god damn. It’s one thing to hear a few scattered anecdotes. Another thing is to say: when people are suffering from cluster headaches and if you suggest this and they try it, it typically works. That is so much more encouraging and powerful.

Ongoing Research

But there are many other reasons to believe this. In fact, currently there is a legitimate Yale study being conducted specifically about this—about DMT for cluster headaches. It’s led by Dr. Emmanuelle Schindler, arguably the leading researcher on the topic of psychedelics for cluster headaches. So I have no doubt that in the near to medium-term future, there’s going to be scientific consensus that this works. It is just very tragic that we didn’t act on it first.

The Qualia Research Institute has published pieces on cluster headaches, notably:

• “Treating Cluster Headaches Using N,N-DMT and Other Tryptamines” by Quentin Frerichs
• “Cluster Headache Frequency Follows a Long-Tail Distribution” by Andrés Gómez Emilsson
• “Quantifying the Global Burden of Extreme Pain from Cluster Headaches” by Alfredo Parra
• “The Heavy Tail of Extreme Pain Exacerbates Health Inequality: Evidence from Cluster Headache Underinvestment” by Alfredo Parra Hinojosa, Chris Percy, and Andrés Gómez Emilsson
• “‘Most Painful Condition Known to Mankind’: A Retrospective of the First-Ever International Research Symposium on Cluster Headache” by Alfredo Parra
• “DMT for Cluster Headaches: Aborting and Preventing Extreme Pain with Tryptamines and Other Methods” (video interview of Andrés Gómez Emilsson with Clusterbusters)
• “Emerging evidence on treating cluster headaches with DMT” by Alfredo Parra, Curran Janssens, and Andrés Gómez Emilsson

Also of note, the Eleusinia Retreat center in Mexico is offering DMT to patients who seek to treat their cluster headaches (see Andrés’ interview with the retreat founder, Jessica Khurana)

Medication Interactions – CRITICAL INFORMATION

Moving on—very important information: medication interactions. This is actually very hands-on, very important.

Do not combine psychedelics with lithium. That is one of the most dangerous interactions that you can have. If you’re taking high-dose lithium for, for example, bipolar disorder, and you accidentally take one hit of LSD, you are likely going to have horrible seizures and be completely out of it with convulsions. You might need to be hospitalized. So lithium and psychedelics is no joke.

I think very small amounts of lithium and psychedelics don’t have that much of a problem. I’ve actually heard anecdotes of people who have combined them and it hasn’t been a disaster. But I would not mess with that. I would just not mess with combining lithium and psychedelics. Very important caveat.

Some of the substances that are prescribed for cluster headaches do interact with psychedelics. DMT in particular is so physiologically safe and also so short-acting—if you’re just vaporizing it—that interactions are unlikely to be fatal. But you really should avoid them, to the extent that it is possible.

Very relevant: Ergotamines, triptans, MAOIs (as we know, in ayahuasca it’s combined to extend effects). SSRIs. But the really, really important ones to avoid are those that might cause serotonin syndrome if you’re combined with them, or extreme vasoconstriction.

So before you mess with psychedelics, if you’re taking any medication—even any random supplement, magnesium, whatever it may be—always, always, always check that you’re not going to have a horrible interaction. Chances are it’s going to be fine, but there are some things that you really have to avoid.

As a first pass, absolutely consult with a doctor or ChatGPT—or Claude, or whoever plays ball. Whichever of these large language models will play ball, they actually will have a lot of really good information. But double-check, double-check.

An important piece of advice: In places where they do use psychedelics to treat cluster headaches or migraines, they will ask you to essentially wean yourself off of other medications so that ideally you can take, let’s say, the DMT in a body that doesn’t have anything that might interact with it. It might not be necessary actually for a lot of medications, but that is the protocol they often recommend.

A few things are probably actually totally fine. For example, beta blockers. I wouldn’t worry about those. You can even find Alexander Shulgin having taken beta blockers and combining them with LSD. I think that’s one of the trip reports in PiHKAL—might not have been LSD, but another lysergamide.

Technique Matters

Next point: A lot of ways to treat these conditions are quite sensitive to the technique.

I’ll give you an example. Oxygen—whatever the case, if you have cluster headaches, you should get oxygen. That actually should be: no matter what, you should get oxygen, because that may actually just be enough. For a lot of people it isn’t, but for a lot of people it is. But for a lot of people oxygen doesn’t really work. But then if you dig deep into it, the reason it doesn’t work is that they’re not using it properly.

Let me give you a hint: You need a lot of oxygen. There is avideo on YouTube where a member of Clusterbusters is educating a group of people on how to use oxygen. He’s showing, “Well, the cannulas that they give you maybe in the ER or something—a little bit of air through the nose—no, that’s not going to do it.” Even a specific valve that you use to breathe oxygen through your mouth has to have the right shape and width to allow enough volume fast enough.

The suggested protocol when you’re starting to feel a cluster headache and you have oxygen nearby is to go and take the high-flow oxygen and breathe really hard. That is what has a decent chance of aborting a cluster headache.

So for any of these things, make sure that you’re actually investigating the right technique. Chances are, if it’s not working, maybe the technique has to be tweaked. It might not be that the intervention doesn’t work; it’s that you’re just not doing it quite right. That’s an important piece of advice, and this is absolutely the case with DMT.

As I will describe in a second, there is an art to it, and it works differently for different people. Again, maybe because of the multifactorial contribution to the probability of a cluster headache—different people have different factors that are contributing to it. So you might need slightly different techniques in a very personalized fashion.

5-MeO-DMT Does Not Work (For Most)

The next point I want to make is that 5-MeO-DMT doesn’t seem to work very well in this case. It works for some people—there are actually some reports of people trying 5-MeO-DMT for cluster headaches and they get instant relief. However, there are also reports, more numerous, of people trying 5-MeO-DMT on a cluster headache and it not working, which is a pretty bad idea.

Especially, for example, if you confused it with N,N-DMT. Because 5-MeO is so much more potent, it’s easy to overdo, and it causes this time dilation effect. So that’s actually a hazard. If you take 5-MeO-DMT while you’re having a cluster headache, you’re increasing the subjective duration of that cluster headache, arguably the overall suffering. So yeah, don’t do it. It’s not recommended.

Whereas there are other things that are not as powerful as DMT—ketamine, for example. Ketamine doesn’t seem to hurt though. So if you suffer from cluster headaches, give ketamine a shot. I mean, it may be enough. Typically it isn’t, but it is reported as something that both lessens the pain and also extends the duration of remission.

Protocols

Okay, so protocols. Let’s say that yes, you have weaned off of some of the key medicines. You’re not at risk of serotonin syndrome or anything of the sort. How do you approach this?

Well, here’s the very encouraging piece of information: It seems that for most sufferers, you need very little. We’re talking about like 3 milligrams. I don’t know how familiar you are with the intensity scale for DMT, but let me give you a little bit of a sense of it.

The Dose-Response Curve for DMT

The dose-response curve for DMT is highly nonlinear.

If you take 1 milligram, you might as well not have taken anything. It’s… I mean, you really have to be an advanced meditator, an advanced psychonaut with a lot of sensitivity and have slept well, etc., to notice, “Ah, maybe there’s a little bit of a change at 1 milligram.” Well, I bet deep in a meditation retreat you probably could notice, but…

2 milligrams: Maybe things feel a little bit moist and liquidy, and you feel a little bit wet. It’s hard to describe. That’s approximately the direction of the effect.

At 3 milligrams, you start seeing colors a little bit brighter. Maybe a sense that things are not melting, but things are liquefying a little bit. You may not even notice it. Interestingly, at that dosage, it is actually very clear-headed. It is not psychologically challenging. I mean, if you are really anxious and you take 3 milligrams of DMT, you may make the anxiety a little bit worse. It also may make it better. For a lot of people, small-dose DMT is actually really calming and relaxing.

Recently at a psychedelic retreat, I was hanging out with somebody who for the first time was trying DMT. He was very afraid of it. I said, “Yeah, I’m very happy to sit for you. If you want to take the DMT right next to me, I’ll be here for you. You’ll be safe.” He was being very cautious and taking very small amounts. And he was like, “Whoa, I did not expect it to feel so mellow. I didn’t know it was so mellow.”

Well, he wasn’t taking 10 milligrams. But yeah, at that range for a lot of people it’s very relaxing. It’s not depersonalizing typically. I would say it’s psychologically maybe comparable in how challenging it might be to like 2 milligrams of an edible THC where you can barely feel it.

By the time we get to 5 milligrams, well, that’s where the interesting qualia starts to emerge. That’s where you start getting some sense of things strobing. There’s some kind of liquid or viscous, vibrating membrane that starts to deposit on top of your sensory fields.

By the time you get to 10 milligrams, then we’re in the territory of this being as intense as two hits of LSD or something like that. Still though, typically not as psychologically challenging. I think there’s a very deep reason why, and it has to do with the frequency of the effects—by which I mean the frequency of the vibrations. It tends to be very high frequency. LSD is not as high frequency. So interestingly, DMT affects your world simulation very deeply, but it affects first and foremost the high frequencies.

Your sense of self is actually a mid-frequency type of representation. And so it’s not affected until you take a lot of DMT. So even 10 milligrams of DMT is surprising: “Wow, actually I can think clearly. I know who I am. I know what I did. But oh my gosh, everything is so trippy.”

When you get to like 15 milligrams, that is when it starts to become seriously psychedelic and is where DMT is unmistakably its own thing. No other drug—maybe other very similar drugs like DPT for example have similar characteristics—but none of the mainstream psychedelics. It has its own unique flavor at that dosage, and nothing is going to replicate it.

If you actually want to have the blast of a breakthrough experience where you completely dissociate from your body and you don’t know where you are—interestingly, you still probably remember who you are and the fact that you’re on DMT—that’s like the 30 milligram range. And if you want to also forget who you are or maybe become one with the universe, so to speak, but still full of checkerboard patterns and intense tactile-visual synesthetic sensations, 50 milligrams.

So there’s a wide range. I would say if you’re staying between 0 and 5 milligrams, it for most people really is not a very challenging experience at all. Again, people react to substances quite differently. So always start with a very small amount and familiarize yourself with it.

But what I want to say is that in the case of aborting cluster headaches, most of the reports emphasize that they only needed a little bit. They only needed enough for the colors to be a little bit bright and you feel safe, grounded. You’re not traveling to other dimensions or being invaded by UFOs or the Nordics or whatever it would be. No, no, no. That’s not what’s going to happen. So I’ve got to reassure you of that.

Titration

The other thing too is that if it doesn’t work right away, you can keep taking it. So you take 3 milligrams, you hold it in for 30 seconds—well, some people say hold it in, some people say experiment with also not holding it in and see if that works a little bit better. There are some discrepancies depending on who you ask who uses this technique. But generally speaking, yes: take 3 milligrams, wait 30 seconds, see if it’s lessening the pain. If it’s not really, then take another 3 milligrams, wait another 30 seconds up to a minute, see how you’re feeling, then take another. And you can keep doing it.

I mean, for some people it may take four or five. For some people it just doesn’t work, and that’s important to mention. Unfortunately, no therapy works for everybody. In this case, I am estimating, based on anecdotes and a lot of people I’ve talked to—DMT probably will work for more than 80% of people is my current guess when done optimally. But there are some people for whom it just doesn’t seem to work, which is of course extremely tragic.

But in general, the typical use case is where you only need one or two very low doses. We’re talking about 10 out of 10 pain going all the way to 1 out of 10 pain, 0 out of 10 pain. For some people, it may be only up to 3 out of 10 pain, but that’s still a massive, massive difference. I would argue even if this only took you from 10 out of 10 pain to 9 out of 10 pain, that still would be a huge ethical improvement. It would still be massive from an ethics point of view.

Experimentation and Prophylactic Use

I will say: Experiment quite a bit. Highly recommended to experiment with DMT outside of the cluster headache episode. I mean, DMT itself is prophylactic when it comes to preventing future cluster headaches. So actually, some of the people I’ve talked to who for years were taking high-dose psilocybin every three weeks—now they actually just get by by having one breakthrough DMT experience as a prophylactic once every three weeks. With that, they just don’t get cluster headaches anymore. That is in the huge success category.

Interestingly, these people actually learned eventually to actually enjoy the DMT experience and not be afraid of it, which tells you that a lot of the discomfort you may experience on DMT is actually psychological and is resistance to the weirdness of the state.

What I can tell you from by now over a thousand DMT experiences at all dosages is—I generally don’t say I’m experienced at things. I’m not an experienced piano player. I’m not an experienced painter. But I am an experienced DMT user. I really am.

What I can tell you is that there are some gnarly, unpleasant DMT states, especially if you’re in a bad mood to begin with (which I have experimented with, again in safe, legal contexts—thankfully I’m very grateful). But on the whole, if you just focus on: “Okay, how actually unpleasant is this? Am I making it a bigger deal than it has to be?” It is—it can be unpleasant, but it is at the level of a cold plunge, let’s say. You can endure a cold plunge. Going into fairly cold water is an unpleasant experience, but can you do it? Can you be there for one minute and survive it and not freak out and not be screaming around and trying to resist and just going to try to ease into it? You absolutely can with training and determination and some mindfulness and maybe some exercise before and breathwork and preparation. You absolutely can do it.

So I would say it’s sort of similar. DMT can be quite unpleasant, but physically it’s not going to kill you. And if you just mindfully understand: “Okay, these are a bunch of really fast dissonant sensations,” it’s not that bad.

When I talk to people who suffer from cluster headaches, it’s like: “Well, okay, relative to a cluster headache, how bad was the worst you felt on just DMT?” And they will say, “Yeah, it’s a joke. It’s just incomparable.” Different planets. Different universes. We’re not talking about the same thing.

Cost-Benefit Analysis

Which is why—this is one of the key reasons why I think: oh my gosh, there is a legitimate concern that promoting psychedelics to reduce extreme pain will give people bad trips. Yes. Absolutely. That’s an important thing to prevent. But from an ethical standpoint, from a moral standpoint, I think the cost-benefit analysis is so skewed that the chances of a bad trip have to be pretty high for it to not be worth it.

In these cases, usually—yes, I mean, the typical pattern is that if somebody’s been suffering from cluster headaches for years and they were saying, “Well, I wanted to exhaust the medical interventions before I went into actually trying psychedelics in Mexico or Canada or something like that”—typically they will say, “I wish I had done that earlier. I wish I had done that 10 years earlier. I wouldn’t have had to endure hundreds, thousands of PTSD-producing events.” Yeah. No, that is a typical response. Even taking into account the uncomfortable, unpleasant high-dose psilocybin experiences that may have come with it.

Other Concerns

There are other concerns, of course. DMT, especially high doses consumed frequently, can produce delusional disorder and also sensory disturbances, HPPD. This is, I think, really, really unlikely if you’re just doing 3 milligrams every now and then to avoid a cluster headache. That’s not, I don’t think, really that much of a concern. But it is important to put out there that maybe you become too comfortable with DMT and you start doing it a lot. You really have to check in with others to see if your epistemology is going haywire.

A Note on Epistemology

By the way, maybe I should mention this: I’m friends with a bunch of people who care a lot about epistemology, including OG rationalists. A good friend of mine, Justin Shovelain, for example—we’ve been meeting a bunch about all sorts of things for many years, mostly having to do with psychometrics, consciousness, intelligence, AI safety, things of that nature. He, broadly speaking, has been always telling me, “Well, your sanity half-life might not be that long just given the sort of experiments that you run on yourself.” So every couple of years I have a conversation with him where he tests my epistemology, to make sure that: am I actually doing appropriate Bayesian inference given the sensory input that I have and the information that I’ve consumed and integrated? And how good am I actually at evaluating the quality of evidence and information?

Mostly because some of the conclusions I have arrived at are pretty weird. But I’ve got to reassure you: after having gone through several pretty pointed epistemic evaluations, I’m fine. I’m fine, guys. My capacity to do Bayesian inference is just fine. It’s just the information on which I’m applying that Bayesian inference is generally speaking not available to most people. That’s what I would argue.

Of course, I can make mistakes. I can be confident in things that I’m wrong about, etc. But essentially, if your self-image is, let’s say, that of a philosopher-scientist, curious explorer, as opposed to, let’s say, if your self-image is that of a grandiose shaman—well, if you think you have a grandiose shaman personality and you take a lot of DMT, the DMT space will likely confirm your suspicion that you’re here as the next Maitreya and you’re going to enlighten the world and all sorts of crazy things. You may start believing that there are UFOs in the back of the moon and they’re colluding with the Russians.

Even if it’s true though, the evidential base is probably pretty corrupted, and the inference process is often compromised. But what I want to emphasize is that this is a niche problem. It tends to also occur with personality issues. DMT itself as a compound is not typically the problem. The problem tends to be the memeplex and the pattern of views and the way it reinforces people’s personalities. Whereas direct organic damage from low-dose DMT that will mess up your epistemology? I wouldn’t worry too much about it.

The Body Buzz

Okay, other things about the protocol: What I have heard, not from everybody but from a good number of people who use DMT to avoid cluster headaches and migraines as well (although migraines is a little bit of a different conversation), is that you want to hit the level that causes this feeling of a body buzz—[makes buzzing sound]—which happens, starts to happen at around 3 milligrams. At higher doses it becomes really strong and overwhelming, and eventually your body explodes and you go to the astral realm and all of this stuff. But yeah, no—in small doses it’s typically a neutral to pleasant feeling of high-frequency vibrations in your body. It can be a little bit unpleasant and jarring, but typically it’s neutral to pleasant.

That body buzz unique to DMT seems to be the thing that somehow melts the cluster headache away. So that as a target, right? So I wouldn’t recommend that: “Hey, if you’re going to be experimenting with this treatment be