Frequently asked questions

Common questions and answers about using psilocybin, LSD, and 5-MeO-DALT for cluster headache prevention. If your question is not answered here, the dedicated chapters on safety, dosing, and legality go into much more depth.

Will I get addicted?

No. Psilocybin, LSD, and 5-MeO-DALT are not physically addictive. They do not create cravings or physical dependence, and you do not need to take more over time to get the same effect. A 2024 systematic review and meta-analysis in JAMA Psychiatry found that serious adverse events from classic psychedelics (including psilocybin and LSD) are extremely rare in controlled settings.^[1] The U.S. National Institute on Drug Abuse classifies psilocybin and LSD as having low potential for abuse and dependence relative to most other controlled substances. 5-MeO-DALT is less well studied, but follows a similar pattern in patient reports.

Tolerance does build up rapidly with repeated use, which is part of why the protocol uses a five-day spacing between doses. If you took these substances every day, they would simply stop working.

Will I hallucinate?

At the small doses used for prevention, the experience is much milder than what you might imagine from films or stories.

• Psilocybin (around 0.5 g of dried mushrooms): most people experience body warmth, mild relaxation, and slightly altered perception. Some sensitive people see soft colour shifts or geometric patterns with eyes closed. You will not lose touch with reality.
• LSD (around 25 to 50 mcg): most people feel subtle shifts in mood, body sensation, and energy. Visual changes at this dose are usually slight if present at all.
• 5-MeO-DALT (around 15 mg): virtually no hallucinogenic effects. Most patients describe it as barely noticeable, with mild drowsiness and possibly cold fingers and toes.

If the experience is stronger than expected, it usually means the dose was a little too high or the substance was more potent than estimated. The next dose can be smaller. None of these substances at preventive doses produce the dramatic visual or psychological effects associated with full recreational doses.

Is it legal?

It depends on which substance and where you live. The Legality chapter goes into detail. The short version:

• Psilocybin is illegal in most countries, with some exceptions (psilocybin truffles in the Netherlands, decriminalized in some US cities and states). It is a Schedule III substance in Canada despite the open storefronts, and Schedule I in the US.
• LSD is illegal in essentially every country. Switzerland has a narrow medical compassionate-use program for selected patients.
• 5-MeO-DALT is the most widely legal of the three. It is uncontrolled at the federal level in the US and Canada, and in many European countries. Some specific countries (UK, Sweden, Switzerland, Finland, Japan, Singapore, China) and the US state of Florida have explicitly scheduled it.

This guide does not encourage breaking the law. We present the medical information so you can make informed decisions about your own health. Always check the current law in your country.

Will it show up on a drug test?

Standard workplace drug tests (5-panel, 10-panel) do not test for psilocybin, LSD, or 5-MeO-DALT. Only specialised tests can detect them, and those are uncommon outside of forensic settings.

• Psilocybin and its metabolite psilocin are not detectable by standard panels. Specialised urine or blood testing can detect psilocin for about 24 hours after a dose.
• LSD clears the body within a day or two and is not detected by standard panels.
• 5-MeO-DALT is a research chemical and is not on any standard panel. There is one notable exception: in the 2015 patient survey, one respondent reported a positive saliva test for amphetamine or methamphetamine while using 5-MeO-DALT.^[2] If you are subject to drug testing, this is worth being aware of.

Will people around me notice?

Unlike vaped DMT or smoked cannabis, none of the three substances in this guide produce a smell that lingers in your home or on your clothes.

• Psilocybin mushrooms. Dried mushrooms have very little odour. The taste is unpleasant (one reason patients use tea or capsules), but there is no detectable smell after eating.
• LSD on blotter paper has no detectable smell or taste.
• 5-MeO-DALT powder has a faint chemical smell when handled. Once it is in a capsule, there is no smell or taste at all.

During the dose itself, you will look like a person sitting quietly. There is no overt outward sign that someone in another room would notice.

How long until I can drive or go back to normal?

It depends on the substance. Plan for the longer end of these ranges to be safe.

• Psilocybin: plan for 6 hours from the time of dosing. Effects peak around 1.5 to 2 hours and taper off over 4 hours, with some lingering tiredness or "afterglow" for another hour or two. Do not drive or operate machinery during this window.
• LSD: plan for at least 10 to 12 hours from the time of dosing. Even at small preventive doses, LSD lasts longer than the others. Do not drive on dosing day. Many patients dose in the morning so they can sleep normally that night.
• 5-MeO-DALT: plan for 3 hours from the time of dosing. Effects begin in about 10 minutes, peak around 30 to 60 minutes, and resolve within about 2 hours. After 3 hours, most people feel fully back to normal.

What if it does not work for me?

Not everyone responds to these substances. But before concluding that they do not work for you, work through this checklist:

1. Make sure no blocker is in your system. The single most common reason the protocol fails is residual triptan, ergot, antidepressant, verapamil, or other blocker. If you took any blocker recently, wait the full five-day washout (longer for SSRIs and frovatriptan) before trying again.

2. Make sure your dose is right. A dose that is too low does not work. If 0.5 g of mushrooms or 25 mcg of LSD or 10 mg of DALT did nothing, try a slightly higher dose on the next round. Do not exceed the upper end of the recommended ranges.

3. Make sure your material is potent. Old or poorly stored psilocybin and LSD lose potency. Mushrooms stored in a freezer can degrade significantly. Buy from a trusted source or grow fresh.

4. Try several rounds. Some patients break the cycle on the first round, others need two or three. Keep going for at least five doses before deciding the protocol does not work.

5. Try a different substance. Patients sometimes respond to one but not another. If psilocybin does not work, LSD or 5-MeO-DALT might. The opposite is also true.

6. Re-examine the diagnosis. A small number of people who think they have cluster headache actually have a different condition (paroxysmal hemicrania, hemicrania continua) that needs different treatment. If nothing is working, ask your neurologist to revisit the diagnosis.

If, after all of this, the protocol genuinely does not work for you, oxygen and the new CGRP-blocking medications (galcanezumab) remain useful options that work through different mechanisms.

How do I minimise the psychoactive effects?

For many patients, the main reason they avoid this protocol is the prospect of an altered state. Several things help:

1. Use 5-MeO-DALT. At preventive doses, 5-MeO-DALT produces almost no hallucinogenic effects. For patients who specifically want to avoid the psychedelic experience, this is usually the answer.

2. Start at the lowest effective dose. 0.5 g of mushrooms or 25 mcg of LSD is the threshold. The therapeutic effect is largely independent of the size of the trip,^[3] so a lower dose can still work without producing strong effects.

3. Eat shortly before the dose (psilocybin and LSD only). A small meal an hour before slows absorption and softens the peak. This is the opposite of what recreational users do. For 5-MeO-DALT, this matters less because effects are mild already.

4. Take it in a calm, familiar setting. A novel or stressful setting amplifies subjective effects. Your usual chair at home, in soft light, is the best environment.

How do I explain this to my family or partner?

This can be a difficult conversation, especially because of the stigma around psychedelics. It often helps to frame it the way it actually is: a medical tool you are using to manage a severely painful condition, similar to how you would explain any other treatment. Some specific suggestions:

• Lead with the pain, not the substance. Cluster headache is one of the most painful conditions known to medicine. Patients call it "suicide headache" because of the rate of suicidal ideation. Most people who hear that take the rest of the conversation more seriously.
• Show them this guide. The intro and the safety chapter give a balanced picture of what these substances are, what the science says, and how the doses used here compare to recreational use.
• Explain the dose context. A preventive dose of psilocybin is roughly a quarter to a half of a recreational dose. A preventive dose of LSD is a quarter or so of a recreational tab. A preventive dose of 5-MeO-DALT produces almost no psychedelic effects at all.
• If they will be your sitter, show them the safety page. It explains exactly what to expect, what is normal, and when to call for help.

How long until I see results?

Most patients who respond start to notice changes within the first one to three doses. Look for:

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

Some patients break the cycle within a week. Others need a couple of full rounds. If you reach dose five with no change, work through the "What if it does not work for me?" section above.

Some attacks got worse after my first dose. Should I stop?

No, not necessarily. In the day or two after a dose, some patients experience temporarily worse cluster attacks, called slap-back attacks. They are uncomfortable but often a sign the treatment is working. Better days usually follow within a few days. Do not reach for triptans or other medications that block the protocol; that can undo the work of the dose. Use oxygen or DMT for relief.

Stop the protocol and seek medical attention if you experience any of the severe symptoms listed in the Safety chapter (chest pain, seizures, severe confusion, etc.).