Migraine prevalence in visual snow with prior illicit drug use (hallucinogen persisting perception disorder) versus without

Among 24 people with hallucinogen persisting perception disorder (HPPD) presenting as visual snow syndrome, none had migraine, whereas 20 of 37 (54.1%) people with visual snow who had never used illicit drugs before onset had migraine. Symptom severity, measured by the Visual Snow Handicap Inventory, was similar between the groups, with a median score of 38 out of 100. In most HPPD cases (70.9%), visual snow began after ecstasy use; other drugs reported included cannabis, psilocybin mushrooms, and amphetamine. The findings suggest different pathophysiological factors underlie HPPD and visual snow syndrome without prior drug use. Users of ecstasy and other hallucinogens should be warned about the risk of visual snow.

Study at a glance

Abstract

Abstract Background and purpose This study was undertaken to investigate migraine prevalence in persons with hallucinogen persisting perception disorder (HPPD) presenting as visual snow syndrome (VSS). Methods Persons with visual snow as a persisting symptom after illicit drug use (HPPD) were recruited via a Dutch consulting clinic for recreational drug use. A structured interview on (visual) perceptual symptomatology, details of drugs use, and medical and headache history was taken. As a control group, persons with visual snow who had never used illicit drugs prior to onset were included. The primary outcome was lifetime prevalence of migraine. Symptom severity was evaluated by the Visual Snow Handicap Inventory (VHI), a 25‐item questionnaire. Results None of the 24 HPPD participants had migraine, whereas 20 of 37 (54.1%) controls had migraine ( p < 0.001). VHI scores did not differ significantly between the two groups; in both groups, the median score was 38 of 100. In most HPPD cases (17/24, 70.9%), visual snow had started after intake of ecstasy; other psychedelic drugs reported included cannabis, psilocybin mushrooms, amphetamine, 4‐fluoroamphetamine, 3‐methylmethcathinone, 4‐Bromo‐2,5‐dimethoxypenethylamine, and nitrous oxide. Conclusions Whereas none of the HPPD participants had migraine, more than half of the visual snow controls without prior use of illicit drugs had migraine. This suggests that at least partly different pathophysiological factors play a role in these disorders. Users of ecstasy and other hallucinogens should be warned of the risk of visual snow. Further studies are needed to enhance understanding of the underlying neurobiology of HPPD and VSS to enable better management of these conditions.