Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.
National Recreational Drugs Consulting Clinic, Brijder Addiction Care Center, Alkmaar, the Netherlands.
Eur J Neurol. 2021 Aug;28(8):2631-2638. doi: 10.1111/ene.14914. Epub 2021 Jun 15.
This study was undertaken to investigate migraine prevalence in persons with hallucinogen persisting perception disorder (HPPD) presenting as visual snow syndrome (VSS).
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.
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.
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.
本研究旨在调查表现为视觉雪综合征（VSS）的幻觉药物持续知觉障碍（HPPD）患者偏头痛的患病率。
通过荷兰娱乐性药物咨询诊所招募了视觉雪作为持续症状的患者（HPPD）。对（视觉）知觉症状、药物使用细节、医疗和头痛病史进行了结构化访谈。作为对照组，纳入了从未在发病前使用过非法药物的视觉雪患者。主要结局是偏头痛的终生患病率。采用视觉雪障碍量表（VHI）评估症状严重程度，这是一个 25 项的问卷。
24 名 HPPD 患者中无人患有偏头痛，而 37 名对照组中有 20 名（54.1%）患有偏头痛（p<0.001）。两组 VHI 评分无显著差异；两组中位数均为 100 分中的 38 分。在大多数 HPPD 病例（24 例中的 17 例，70.9%）中，视觉雪是在摄入摇头丸后开始的；报告的其他致幻药物包括大麻、裸盖菇素蘑菇、苯丙胺、4-氟苯丙胺、3-甲基甲卡西酮、4-溴-2,5-二甲氧基苯乙胺和一氧化二氮。
虽然 HPPD 患者中无人患有偏头痛，但超过一半的视觉雪对照组患者在未使用非法药物的情况下患有偏头痛。这表明在这些疾病中，至少部分不同的病理生理因素发挥了作用。摇头丸和其他致幻剂的使用者应该被告知视觉雪的风险。需要进一步的研究来增强对 HPPD 和 VSS 潜在神经生物学的理解，以便更好地管理这些疾病。
