Innov Clin Neurosci. 2025;22(1–3):11–13.

Dear Editor:

Thank you for your interest in this case report¹ and for your insightful comments. I appreciate the thoroughness of your feedback and concur with many of your points, including the limitations raised. In fact, several of these concerns were addressed in the original manuscript, but I am grateful for the opportunity to further clarify these important aspects. 

You raised valid concerns about the threshold of evidence required to recommend a novel pharmacological intervention, which you effectively emphasized in both the title and body of your letter. I agree with your focus on the necessity of randomized, double-blind, placebo-controlled trials (RCTs) and the need for further evidence before recommending psilocybin for the treatment of migraines. This is addressed explicitly in the original manuscript,¹ but it is helpful to emphasize this further.

Additionally, you highlight that the psychotropic effects of psilocybin are not reported in the results of the original manuscript but would provide important context when interpreting the results. This was also explicitly acknowledged as a limitation in the original.¹ This aspect indeed remains important for future research. 

The remaining limitations you highlighted are equally valid and important to consider when interpreting the findings of this case report. For instance, the lack of imaging findings is a significant point, although they were not available at the time of the study. Regarding your statement that reporting electroencephalography (EEG) findings is “mandatory,” I would argue that while helpful, its necessity is still under exploration in the literature. To note, the findings of the study referenced in your letter “suggest the potential of quantitative EEG (QEEG) as a diagnostic biomarker for migraine and as a tool for monitoring treatment response,”² while a 2023 review concluded, “EEG studies in migraine were heterogeneous and limited in terms of grouping, spatial undersampling (position and number of electrodes), data acquisition, and unstandardized analysis methods between studies.” ³ 

Thank you for highlighting the limitations regarding the use of dried fruiting bodies of Psilocybe cubensis in this case report. The lack of discussion on this point was indeed an oversight in the original manuscript. The potential for an entourage effect, along with the variable and unknown concentrations of psilocybin, psilocin, and other alkaloids remains an important consideration.⁴ Including this as a limitation would have provided greater depth to the original manuscript, and I appreciate your attention to this crucial detail. 

Thank you for drawing attention to the classification of the migraine in this case as “complex” and for underscoring the significance of family history in such instances. We also are in agreement that the pathophysiology and etiology of migraines remain incompletely understood and inadequately elucidated, highlighting the need for further investigation in this domain.

Finally, while the colloquial term “magic mushrooms” may be acceptable in popular media, I recommend the use of scientifically accepted terminology—namely, psilocybin-containing mushrooms or the specific genus (e.g., Psilocybe) and species (e.g., Psilocybe cubensis)—in academic discourse. Indeed, while the subjective effects of these substances may be described as “magical,” referring to psilocybin-containing mushrooms as “magic mushrooms” within scholarly literature could be perceived as dismissive of the rigorous and comprehensive body of research dedicated to this field.

I appreciate your thoughtful critique, which strengthens the discourse surrounding this case report.

With regards,

David W. Lawrence, MD, MPH

Dr. Lawrence is an assistant professior, Temerty Faculty of Medicine, University of Toronto in Toronto, Ontario, Canada.

Funding/financial disclosures. The author has no conflicts of interest relevant to the content of this letter. No funding was received for the preparation of this letter.

References 

1. Lawrence DW. Self-administration of psilocybin for the acute treatment of migraine: a case report. Innov Clin Neurosci. 2023;1;20(7–9):37–39.
2. Kim SJ, Yang K, Kim D. Quantitative electroencephalography as a potential biomarker in migraine. Brain Behav. 2023;13(12):e3282.
3. Zhang N, Pan Y, Chen Q, et al. Application of EEG in migraine. Front Hum Neurosci. 2023;17;17:1082317. 
4. Shahar O, Botvinnik A, Shwartz A, et al. Effect of chemically synthesized psilocybin and psychedelic mushroom extract on molecular and metabolic profiles in mouse brain. Mol Psychiatry. 2024;29(7):2059–2073.