The prevention protocol

This page covers the actual protocol patients have used for nearly 30 years to prevent or break cluster cycles using small, spaced doses of a tryptamine-class substance. The protocol is the same for psilocybin, LSD, and 5-MeO-DALT. Only the doses and timing details differ slightly. We summarize those differences in a quick reference table at the end.

Before you start

Two things to handle before your first dose: clearing potentially interfering medications from your system (read the safety chapter), and choosing a calm day with the right setup.

Clear interfering medications

A number of common cluster medications can blunt or completely block the effect of the protocol. The single biggest reason the treatment fails is interference from other medications. The conservative rule of thumb is to wait five days after your last dose of any of the following before taking your first preventive dose:^[1]

• Triptans (sumatriptan, zolmitriptan, rizatriptan, naratriptan, frovatriptan, almotriptan, eletriptan).
• Ergotamines (dihydroergotamine, methysergide, Cafergot, ergotamine tartrate).
• Corticosteroids (prednisone, prednisolone, dexamethasone). Stop only if safe to do so, under your doctor's guidance.
• Calcium channel blockers (verapamil and similar).
• SSRIs and SNRIs (fluoxetine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, duloxetine and similar). Note: SSRIs need much longer than 5 days to fully clear; some have half-lives of weeks. Talk to your doctor before stopping.
• Tricyclic antidepressants (amitriptyline, nortriptyline, imipramine).
• Anti-convulsants (topiramate, sodium valproate, carbamazepine).
• Opiates (hydrocodone, oxycodone, oxymorphone, hydromorphone, fentanyl).

Lithium and MAOI antidepressants are different: instead of blocking the treatment, they may dangerously intensify it. Do not combine these substances with lithium or MAOIs at all. The safety chapter covers this in more detail.

Choose your day and setup

You can begin the protocol at any time during a cluster period or outside of one. However, if you are an episodic patient (meaning your attacks come in cycles that last weeks or months, separated by pain-free periods), the ideal time to start is a couple of weeks before your next cycle is expected to begin. Many patients find that dosing in this window can prevent the cycle from ever getting started, rather than just shortening it. If you can, plan ahead so you can dose in that lead-up window.

• Pick a day with no work, no driving, no childcare obligations. Allow about 4 to 8 hours from start to finish, depending on the substance.
• Eat a light meal a couple of hours before, then dose on a near-empty stomach.
• Have a quiet, comfortable space ready: a chair or sofa, water, a blanket, music, your phone within reach.
• Have a trusted person aware of your schedule, especially for your first dose. They do not need to be in the room, but should be reachable.

The protocol, step by step

1. Day 0. Take your first dose. Take the dose described in the Preparing your dose chapter for whichever substance you are using. Sit somewhere quiet and let it work. Effects come on within 10 to 90 minutes (depending on the substance) and last from 2 to 8 hours.

2. Days 1 to 4. Wait and track. Do not take another dose. The "rule of five" comes from the fact that tolerance from one dose lasts about five days; dosing sooner does not work and may even slow things down. Use this time to track your attacks: how many per day, how intense (kip scale), how long they last, and any patterns.

3. Day 5. Take your second dose. Same dose, same setup. By now you may already be noticing changes: fewer attacks, shorter attacks, longer pain-free windows, or sometimes a temporary worsening (see "slap-back" below).

4. Day 10. Take your third dose. Many patients break the cycle within these first three doses. If you have, you can stop here.

5. Days 15 and 20 (if needed). Doses 4 and 5. If the cycle is reduced but not gone, continue dosing every five days. Most patients who respond do so within five doses.

6. After: maintenance. Once attacks are gone, you can stop. Some patients take a single "booster" dose every one to three months to keep the cycle from returning. Episodic patients often dose just once or twice a few weeks before their expected cycle and find the cycle never starts.

Example calendar

Here is what a 3-dose round looks like in practice:

• Aug 7. Begin detox. Stop triptans, ergots, etc.
• Aug 12 (Day 0). First dose.
• Aug 17 (Day 5). Second dose.
• Aug 22 (Day 10). Third dose (if needed).
• Aug 23 onwards. Observe. Many patients enter a remission period at this point.

Signs the protocol is working

• Fewer cluster attacks per day.
• Shorter attacks.
• Lower peak intensity (lower kip scores).
• Longer pain-free windows between attacks.
• Reduction or disappearance of "shadow" headaches (the dull background pressure between attacks).
• Better sleep.

Most patients who respond start noticing changes within the first one to three doses. If you reach dose five and there is no change, the protocol may not be working for you. Possible reasons: an interfering medication is still in your system, the dose is too low, the substance is degraded, or you are simply one of the patients these substances do not help. (Not everyone responds.)

A note on "rebound" attacks

Some patients experience an unusual phenomenon in the first day or two after a dose: their attacks get briefly worse, sometimes more frequent or more intense than before. Patients call these "rebound" or "slap-back" attacks. They are temporary, usually resolving within a few days. Many experienced patients view them as a sign the treatment is doing something. They typically lead into a period of better days.

During a slap-back, do not reach for triptans or other interfering medications. That can undo the protocol. Use oxygen if you have it, or DMT if you have access to that. Otherwise, check out these alternative methods.

Quick reference

Dose and timing reference for the three substances. Always start at the lower end and adjust upward if needed.

Psilocybin (dried mushrooms)

• Typical preventive dose: 0.5 g to 1.0 g.
• Spacing: every 5 days.
• Effects last: 4 to 6 hours.

LSD

• Typical preventive dose: 25 to 50 micrograms.
• Spacing: every 5 to 7 days.
• Effects last: 4 to 8 hours.

5-MeO-DALT

• Typical preventive dose: 10 to 15 mg.
• Spacing: every 5 days.
• Effects last: about 2 hours.