DMT, the smallest microdose of maybe 5mg with a vape pen stops the worst pain known, in literally 10–20 seconds. Acid and mushrooms as well, but they take time to come up. Even the smallest sub-perceptual dose of DMT stops the pain.
- Yiftach Yerushalmy, cluster headache patient
One inhalation [of DMT] will end the attack for most people. Everybody is reporting the exact same thing. […] It could end that attack in less than a minute. […] You can take one inhalation, you can wait 30 seconds, and if that cluster is not gone completely, then you know it's time to take another inhalation. You don't have to wait 2h into a psilocybin trip.
- Bob Wold, president of Clusterbusters and cluster headache patient
I use the word game changer because a lot of times our attacks will come at night after we go to sleep. Usually after an attack, half an hour to 40 minutes later, I try to go back to sleep knowing full well that in another hour or so I'm going to get another attack. But having a DMT vape pen right next to my bedside allowed me to hit that pen and within a minute or two I'm closing my eyes and going back to sleep.
- Joe McKay, retired NYC firefighter, cluster headache patient and advocate
One of the most incredible experiences of my life was when I first aborted a cluster headache with DMT. That feeling of going from a place of excruciating pain… and feeling the pain fizzle away and die in a matter of seconds.
Cluster headache patient
If we knew that thousands of Americans were being tortured in prison camps every year, no political issue would be more important than making sure to end such a tragedy as quickly as possible, especially if cheap solutions existed. Yet this is essentially the reality for cluster headache patients.
Eradicating the torture caused by cluster headaches globally demands finding the most effective treatments and making them universally accessible to sufferers as soon as possible. In recent years, DMT has emerged as potentially the most effective acute treatment for cluster headaches, yet only a tiny minority of patients have access to it. Most don’t even know about it, especially given that psychedelics more generally are often considered a last resort option when nothing else has worked. Worse still, sometimes patients even face criminal charges for treating their unbearable pain with psychedelics (1, 2).
This post summarizes a few things we know about using DMT to treat cluster headaches, as well as open questions and potential next steps. The appendix also includes Bob Wold's guide to using DMT to abort attacks. This post was written by me (Alfredo) after many conversations with and input from Curran and Andrés, so any errors are mine.
How DMT is used for cluster headaches
DMT is a psychedelic of the tryptamine family (as psilocybin, which has been known for nearly 30 years to be highly effective in treating cluster headaches). It is typically inhaled in vaporized form using a vaping pen.
Most testimonials of patients using DMT report it being highly effective as an acute treatment, namely, to stop an attack when it starts. This is in contrast to preventive treatments, which aim to prevent attacks from starting in the first place.
The two most commonly used acute treatments are high-flow oxygen and triptans (especially injectable sumatriptan). A large fraction of patients (60–80%) respond positively to either. However:
1. Patients often struggle to get prescriptions for high-flow oxygen, even in developed countries. The Will Erwin Headache Research Foundation (2022) stated that “Clearly, [oxygen] is a viable option for people dealing with cluster headaches, however, it is close to impossible to receive coverage for oxygen treatment with Medicare.” In 2020, about 41% of patients in the US were denied treatment by their insurance company. As late as 2021, home oxygen therapy was not covered by Medicare/Medicaid, stating that the evidence for its effectiveness was insufficient. It is also difficult to carry around large oxygen tanks. The pain relieving effects take 10–15 minutes to kick in, which can be considered slow given the severity of the pain.
I've not been all that successful with oxygen... it’s very difficult to prescribe, I have in the past but nowadays, I can only think of two patients in the recent past where we’ve managed... I normally ask the GP to prescribe it but I think they find it pretty challenging to actually get it.
- UK neurologist (Buture et al. 2020)
2. Triptans can only be used sparingly, since repeated and long-term use can often cause more frequent and more severe attacks, as well as prolonged cluster cycles. Patients often get multiple attacks per day, but they may only be able to abort a couple per day using triptans.
Personally I am not a fan of Imitrex [sumatriptan] and have mixed feelings. It’s a bit like having a relative you can’t stand but is the only one that will watch your dog for a week while you go on vacation. Yes, it is effective and there is no doubt that it has saved many lives over the years. In the throws of an attack and having an injection sitting there offering relief, it’s difficult to leave unused. On the other hand, as it has been proven through studies that it can make cycles last longer and add to the frequency and intensity of attacks.
- Bob Wold, president of Clusterbusters and cluster headache patient
Even in the EU, only 47% of the population had unrestricted access to effective treatments against cluster headaches (primarily oxygen and triptans) in 2019.
By comparison, as far as we can tell, DMT:
- Aborts attacks within seconds, or at most a couple of minutes, even at sub-perceptual doses.
- Only causes mild side effects—negligible compared to the pain of a cluster.
- Does not build tolerance. Patients seem to be able to take it as often as needed and it remains equally effective.
- Is known to have a very positive safety profile.
- Can be easily titrated. If a patient takes an amount that is too small, they will know immediately (because the pain isn’t completely gone), and they can take another small amount right away.
- Is convenient to carry around (using a vape pen).
Much less is known about the efficacy of DMT as a preventive treatment. Historically, patients have used low doses of psilocybin to prevent cluster cycles (or to end them sooner), following the so-called “busting protocol” developed by Clusterbusters. This protocol involves taking 3 low doses of psilocybin 5 days apart shortly before the start of a cycle (or during an active cycle if needed). Patients (and scientific studies) report similarly positive effects from other psychedelics used as preventives, in particular LSD, LSA, 5-MeO-DALT, and BOL-148 (a non-hallucinogenic LSD analog). Note that all of these substances can also be highly effective at aborting attacks acutely, but the effect usually takes 30–60 minutes to kick in (and every minute is critical during a cluster headache attack).
The evidence
Currently, there exist no published studies on the efficacy of DMT to treat cluster headaches. The bulk of the evidence comes from testimonials of patients and advocates, which we argue is highly credible and should be weighted heavily, especially given that:
1. The effect sizes of the testimonials are very large, with patients often reporting immediate and total pain relief after just a few seconds of vaporizing small amounts of DMT. This includes chronic patients who have battled with cluster headaches for decades saying that they’ve “never had a treatment so effective with no side effects whatsoever.”
We have now entered into a new era of treatments for CH. Let's hope the data gathering and research into DMT currently under way will turn into something that benefits the broader cluster community. In the meantime, I abort every single attack in seconds with my vape pen, and it's now to the point where I returned all my oxygen equipment after so many years of leaning on it as my primary abortive. When combined with busting to break our cycles, we are finally in control!
- VALIS3000, chronic CH patient and advocate
2. Advocates such as Bob Wold (President of Clusterbusters), who has talked to thousands of patients over decades of work, being so unambiguously enthusiastic about it. (See his testimonial at the beginning of this article. See also the new section on DMT in his pocket guide, a widely read patient resource. You can also find the section on DMT in the Appendix, which we’re reproducing here for visibility.)
Interest in DMT for cluster headaches is growing as a result of these testimonials. A survey study is being carried out at Yale to assess the efficacy of DMT. The study is led by Dr. Emmanuelle Schindler, arguably the leading researcher on the topic of psychedelics for cluster headache.
The Qualia Research Institute (through an initiative soon to be launched) is advocating for its adoption and has published pieces on cluster headaches more generally, notably:
Also, a retreat center in Mexico is offering DMT to patients who seek to treat their cluster headaches.
Below you can find a few testimonials on DMT for cluster headaches:
How and why would DMT work to treat cluster headaches?
We are still far from a mechanistic understanding of DMT’s pain relieving effects on cluster headaches, but we can suggest a few reasons why we should expect it to work.
First, DMT is chemically similar to other substances that are known to help with cluster headaches, most notably psilocybin (also a tryptamine) but also sumatriptan (a sulphonated indole). Sumatriptan is thought to abort attacks through its 5‑HT₁B/5‑HT₁D (and possibly 5‑HT₁F) agonism. 5‑HT₁B agonism likely causes the constriction of cranial vessels, which inhibits trigeminal neuropeptide release like CGRP (5‑HT₁D), presumably shutting down the excessive trigeminal–autonomic activity. DMT is also structurally very similar to serotonin, which is known to have pain-relieving effects. It is also a sigma-1 receptor agonist, which is implicated in inflammation (and cluster headaches are thought to involve inflammation of the trigeminovascular system).
Second, there have been reports of DMT working to treat another condition of the trigeminal autonomic cephalalgia (TAC) family, namely SUNCT (Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing). See this case study.
Third, psychedelics more generally have been found to help with a wide range of chronic pain conditions, including various headache disorders. See, e.g., the work of the Psychedelics & Pain Association.
Very speculatively, Bob Wold has hypothesized that cluster headaches may actually be the result of having too low endogenous levels of DMT. If so, then perhaps microdosing DMT could be an effective way to prevent clusters (though microdosing could still be helpful even if a different mechanism of action is responsible for the pain).
Challenges
Beyond the legal barriers, there are other challenges to overcome before DMT can be fully adopted to treat cluster headaches:
- Patients sometimes describe not knowing exactly how to take DMT. One person we know reported trying it multiple times without success, before going to a retreat center where the method and technique finally worked for him.
- We therefore need detailed guides by users who successfully use DMT, as well as delivery devices designed to minimize misuse errors.
- Some patients describe needing to take larger doses, which can trigger psychedelic effects. While DMT’s safety profile is generally very safe, it can be challenging for patients to experience intense psychedelic trips multiple times a day.
- This could be overcome either by finding a non-hallucinogenic DMT analog or by testing a combination of DMT with Ketanserin, which is known to block psychedelic effects of various substances (including DMT). Volinanserin may also work, since it is also a highly selective 5-HT₂A receptor antagonist.
- It is likely that the psychedelic effect is indeed not necessary for the analgesic effect. DMT’s agonism of the 5‑HT₂A receptor is implicated in its psychedelic effects, but we know that BOL-148 (a non-psychedelic LSD analog which either only weakly binds to 5‑HT₂A or might even act as an 5‑HT₂A antagonist) is effective in treating cluster headaches.
- DMT can cause moments of intense anxiety in some people.
- Adding something like gabapentin or phenibut, which have anxiolytic effects, can greatly reduce anxiety.
- The social stigma around psychedelics means that some patients may risk losing close partners, friends, or jobs if they decide to take illegal drugs.
What is needed next
More scientific data on DMT for cluster headaches is urgently needed. Prof. Schindler’s survey is a great first step in this direction, but proper clinical trials would be even better.
Given the difficulties in recruiting cluster headache patients for RCTs (due to the low prevalence and the non-overlapping cluster periods of patients), perhaps an RCT on DMT for migraines could also be valuable. We have come across anecdotal reports of DMT helping with migraines, and while the results might not be generalizable to cluster headaches (given the distinct pain mechanisms), a positive result could incentivize bringing DMT vaping devices to market faster, which could then be used by cluster headache patients.
However, given the severity of the suffering, we cannot wait for all scientific data to be gathered and validated, which could take years. Every year we wait results in ~3 million Days Lived in Extreme Suffering globally that could have been prevented. At the very least, we should make sure that no cluster headache patient gets prosecuted for treating their pain with psychedelics. Governments should also create or expand compassionate access programs to make it easier for patients to access psychedelics immediately (which might be easier for psilocybin given the published data on its efficacy, but might not be possible for DMT given the lack of data).
We need to bring DMT to cluster headache patients as fast as possible, or to find a treatment that is at least as effective as DMT. The ideal substance would be a non-hallucinogenic DMT analog that isn’t yet illegal/scheduled, though we expect that most patients will respond positively with low doses. Perhaps 5-MeO-NMT or 5-MeO-DALT? (See more suggestions by Claude.) We strongly encourage someone to do some research on this question.
Generally, we urgently need donors and philanthropists to rise to the challenge, as well as entrepreneurs (for- and non-profit) and advocates who are motivated to contribute in various ways. The amount of funding directed to cluster headaches and the number of people globally working on this problem is minute and vastly disproportionate to the scale of suffering at stake.
We will announce an advocacy initiative soon, so get in touch if you’d like to help somehow, or keep an eye out for our upcoming EA Forum announcement.
Appendix: Bob Wold’s Pocket Guide to Cluster Headaches: DMT
Full guide here (last updated June 10, 2025). Check this page for updates to the guide.
You've probably been waiting to get to this. Thank you for reading everything else before you got here.
DMT, in general (although there is very little that is general, about DMT) is about 10x more powerful than the equal amount of LSD.
Let's start the discussion with this information: A little scientific information. Also a look at where we are in our study of DMT and especially how early on in looking at it for treating cluster headache we are currently.
DMT is naturally produced in your body.
The exact amount of naturally occurring DMT (N,N-Dimethyltryptamine) in the human body is still not fully established due to how tiny the concentrations are and the challenges in detecting it. However, here's what's known so far according to science.
- Detected Levels (Quantitative Data) Studies have found trace amounts of DMT in various parts of the human body, including:
- Blood: Concentrations in human blood have been reported in the range of 0.05 to $1.8~ng/mL$ (nanograms per milliliter), depending on the study and method used.
- Urine: DMT can also be found in human urine in small amounts.
- Brain (in rats and potentially humans): A 2019 study from the University of Michigan showed that DMT is produced in the pineal gland and other brain regions in rats, with concentrations in the low nanogram per gram of tissue range - levels comparable to known neurotransmitters like serotonin.
While there's still no definitive study measuring total DMT content in the entire human body, the amounts are considered to be very small, on the order of nanograms to low micrograms in total at any given time.
- Where It's Produced The human body can synthesize DMT endogenously from the amino acid tryptophan, via intermediate compounds like tryptamine and methyltransferases (such as INMT - indolethylamine-N-methyltransferase).
Detected sources include:
- Lungs
- Thymus
- Brain (possibly including pineal gland)
- Spinal cord and cerebrospinal fluid (CSF) and
The human body produces DMT in trace amounts - mostly again, in the nanogram range it is present in blood, brain, and other tissues. These amounts are biologically significant but far below the levels needed for a psychedelic effect. We don't know why it's there or what its purpose is, but I have my theory, that is evolving. Will share another time so they don't lock me up in a padded room.
DMT Vape pens and cartridges. For use in treating cluster headaches.
Cartridges
These cartridges are becoming more available in many areas. Finding a reliable source, for access and for content, is a serious challenge. Cost can also be an issue but will become more affordable as more competition enters the marketplace. The vape cartridges that contain the DMT solution are pretty universal and can be used with the different types of battery packs that are available. There are also three different types of vape pen units. All three are available for vaping DMT.
A. There is one option available in some areas that is an all-in-one unit. It's about as long as a cigarette and about as wide around as a AA battery. All you need to do is take off the plastic cover that is on the top of the unit and covers the tip and opening. Just inhale and the built in battery automatically and immediately lights the solution upon inhalation. These can be charged but the charged pen usually lasts until all the solution is used up.
B. There are two types of separate battery packs that are used. These are also the same types of cartridges and battery packs that are used for many of the widely used vapes for smoking nicotine and replacing cigarettes, and most people are walking around and traveling with them. No one can tell the difference, including airport security. No one knows or cares what is in your vape pen. They just don't like you using it on a plane, no matter what is in it.
C. The first of these is a simple attachment that threads onto the base of the vape cartridge. It has to be charged and can be recharged if necessary. This battery is usually about 4-5 inches long and again, the diameter of an AA battery. Same diameter as the cartridge. These are usually made to turn on and off with a number of clicks (usually 5 very quick clicks) to turn on and off and then while on, can be started with one click and holding down the button while inhaling. Release the button and it shuts off but remains in standby for future one-click use, until shut off fully again with those same 5 fast clicks. Charging device shown in picture below.
D. The second type of battery pack is a bit more complicated. With these, you can adjust the voltage that heats the solution. This option is important but not necessary for cluster headache treatment, especially while learning what the best process is for each patient. The higher the voltage, the hotter the heating element gets and then each inhalation will deliver more DMT. The hotter it can be set for will then also use up the solution quicker and possibly deliver more than you need to treat the attack.
Once the unit is turned on, by clicking the start button a set number of times (usually 5 clicks), you can then click and hold down the button while inhaling. There will also be buttons that you use to adjust the heat and voltage. We suggest using a setting between 2.0 volts and 3.4 volts. Some units can go as high as 4-5 volts and this is higher than we need and can actually burn the solution over time. The higher temps can also irritate your throat. These higher settings are used more for recreational use, delivering more DMT at one time.
With this sort of battery pack, the cartridge will need a metal adapter that is supplied with the battery pack, screwed onto the threaded end of the cartridge and then inserted into the battery pack.
Inhalations
This is where each person needs to discover what works best for them and then knows what to do to get the quickest results for them each time.
A. Try to measure how deeply you inhale each time so you can repeat something similar each time. Measure how strongly you inhale. You don't need to breathe in as hard as possible, and should not. A measured breath in is perfectly fine. If you're a smoker, start your learning process just as you would inhale your cigarettes. If you're not a smoker, think of drinking a smoothie with a straw.
B. Try to remember how long you breathe in with the cartridge each time and try to keep them close to the same inhalation time, each time. 4-5 seconds? maybe up to 8 seconds?
If you can actually time your inhalations this is very helpful. Maybe your caregiver can keep time on their phone. Collecting data on length of time you inhale will be helpful for you as well as for research that is coming and we are collecting this sort of data so we can compare dosing. You'll find the perfect time and how deep of a breath works for you. Once inhaled, hold you breath as long as you can (10 seconds or so) but get used to keeping your inhalation time and the time holding your breath close to the same each time. You don't need to stop-watch to time it but try to stay pretty constant. You will need to make adjustments on this until you arrive at YOUR best and quickest abort. If you don't keep track on your timing early on, you won't be able to make adjustments. You most likely will be making adjustments that will change your time of start until the time your attack disappears. Can you end an attack in 1 minute? Probably. With adjustments can you end the attack in 45 seconds? Very possible.
C. It may take a few attempts at aborting an attack before you find the right combination.
C.1. How quickly you were able to grab your vape once an attack starts.
C.2. How bad the attack had gotten before your first inhalation.
C.3. Possibly how bad this particular cycle has been and if you are in the beginning of the cycle, the high point of the cycle, or coming out of the cycle. These things all can play a role in many of the things we use to treat our attacks. Not just with DMT treatments.
D. Most of the cartridges will have enough solution in them to treat 40-50 attacks. But this will be determined by many things. Including the type of treatment that you settle in using, like the number of breaths that it takes, how much lung capacity you have, etc.
E. These pens are known to just treat one attack, very similarly to treating an attack with oxygen. But seem to work more quickly (within seconds many times) vs minutes with oxygen (if O2 works for you). Personally, the vape works more quickly than I can walk to my oxygen tank. It's also so much more easily carried around with you. Drop it into your pocket and it'll go everywhere you go.
Pro tip #1. If it's a bad attack that will take a couple of inhalations, and my O2 set up is close, I have used the O2 between vape inhalations. While you're catching your breath from the first inhalation, put on your O2 mask and take a couple breaths between inhalations.
F. Timing
Take in the first inhalation. Hold it in your lungs for a while. 10 or more seconds if you can but no need to push it.
Wait for 30-45 seconds to a minute to see if that's all you need. You'll know, because it will seem like an off switch was flipped.
If the attack hasn't changed, take a second inhalation. Hold it in as before. Wait another 30-45 seconds to see if you need a third inhalation.
G. DMT in this delivery system.
Each person will be different as to how much DMT they will be getting. We all end up it seems with just about the same amount in total but it may take some of us three inhalations when others will get enough in one inhalation.
When people use these for recreational purposes, they usually start with 3 inhalations. Increasing from there to get the level of effects they want. They also use higher heating ranges which will deliver more DMT. These higher rates aren't best suited for treating clusters. The higher/hotter settings will make the inhalations more harsh and may also burn the solution inside and wasting the rest of the cartridge. (Keep it under 3volts if you have an adjustable battery pack.)
DMT is the most powerful psychedelic that we know of. Very powerful in very small amounts. About 10 times more powerful per mg than LSD, I believe. But, it's not all DMT that you are inhaling. Most of the liquid solution is not DMT but the liquid transport system into your lungs. Similar to the amount of nicotine in a cigarette. All the smoke is not nicotine.
The descriptions of DMT used recreationally can be interesting but scary. One of the best things about DMT is how quickly it leaves your system. It's gone in 15 minutes on average. Sometimes 10, sometimes 20 at most. Recreational users use a lot more DMT than we need to treat a cluster attack. Recreational users talk about seeing robotic aliens and fractal light shows with closed eyes.
If you end up taking a lot more than is needed to work, and at worst and scariest you see some lights and at most extreme, you see an alien, you need to talk to them quickly with your questions, as you only have 15 minutes to ask about the universe. Honestly, reports of anything that seems scary to them at these doses, is a very rare report. Even for those of us that are more sensitive to psychedelics than others.
DMT - Alternative Source - Delivery System
This method can be sourced through underground suppliers of psychedelic compounds. There are a few sources for the vape pens that exist at some brick and mortar stores, usually under the counter, but this other source isn't something that these places carry.
You can also find DMT in pulp form that is then smoked in a glass pipe usually. It does not take much pulp in the pipe to get the results you'd like but it has its issues. Loading the pipe with the pulp can be a hassle, especially if you're trying to do this while a cluster attack is building. It becomes more of an issue if you need to use more than 1 dose. Packing this little amount of pulp into a very tiny hole in the top of the pipe becomes more difficult with each packing process.
It is also very difficult to get a constant dose and also difficult to adjust the dose each time. If you need more, it's difficult to add a little more without adding too much. This stuff is powerful in very small amounts.
General notes on psychedelic treatments
Yes, everyone is different. I have been using mushrooms for over 25 years. I have been able to avoid many cycles but not all. If they start again, it can take a few doses again to try to break the cycle.
Usually if an episodic cycle is broken with mushrooms, it won't come back until the next cycle is due to start again. Sometimes it isn't just a clean break and you might need a few more doses as the cycle plays out but hopefully the mushrooms provide a lot more relief and cuts way down on intensity. Also, sometimes that first cycle you're trying to break is more difficult (most likely from the different medications people have been on and for how long) Future cycles can often be broken more easily than the first. It's best to "be prepared" and not wait until August if your cycles start in September, to start asking questions about growing.
An important note pertaining to high flow oxygen. If you've had difficulty getting high flow oxygen to work for you or it hasn't worked at all, it's a good idea to give it a try again as it seems that for many people, oxygen works much better after starting on psychedelic therapy.
If O2 works well for you, it is also the best abortive to use while treating your cycles with psychedelics.
When to begin dosing with psychedelics
At the first hint of an oncoming new cycle, dose. If it continues to come on, dose again.
Chronics need a more regular schedule but can usually get the doses spread out over extended times.
If you think the cycle has broken, most people can drink again without much trouble. If it's only been a few days, alcohol can still trigger an attack. If you are continuing to show improvements but still not completely broken, it's best to stay away from alcohol. The more attacks you trigger, the longer it takes to heal.
Relevant abstract just published in Neurology: DMT use in Cluster Headache: Interim Analysis of an International Survey (S23.003)