Congratulations on an excellent year of research and thank you for your contributions to this cause area!
To offer a perhaps under-explored research thread in the treatment and mitigation of cluster headaches and migraines, which I haven’t seen in pieces from HLI or OPIS, there appears to be moderately high efficacy (for n=18) of a ketogenic diet on reduction in incidence of such headaches:
“Of the 18 CCH patients, 15 were considered responders to the diet (11 experienced a full resolution of headache, and 4 had a headache reduction of at least 50% in terms of mean monthly number of attacks during the diet)” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816269/).
Keto diets are quite restrictive, require an adaptation period (anywhere from 2 days − 2 weeks, the above study utilized an 18-day period, https://hvmn.com/blogs/blog/ketosis-how-long-does-it-take-to-get-into-ketosis-and-keto-adapt) and are often not particularly animal wellfare-friendly.
I’d be interested to explore the cost-effectiveness of an intervention based on using exogenous ketones, especially those derived from plants (somewhere around $1-2 per day? e.g. https://shop.perfectketo.com/products/powdered-mct-oil-from-coconuts-for-keto-and-ketosis, https://rspnutrition.com/products/ketobhb) as an alternative to drug-based treatment of CH. Although research is sparse, it seems probable that exogenous ketones also decrease the adaptation period to a keto diet (ethically important due to the extreme nature of these conditions). There are some reported, rather mild side effects to exogenous ketones (https://perfectketo.com/why-ketones-cause-stomach-pain/), but these seem negligible in the case of treating CH and migraines.
Thank you. I certainly agree that in most occupations (operating large machinery, doing difficult cognitive tasks) and studying, it is not of benefit to feel high on the job. However, I would note important to note that 1) partial opioid agonists have significantly more mild euphoriant properties than full agonists and 2) Kratom, which contains a partial mu-opioid agonist, has traditionally been used in Southeast Asia by field laborers as a ‘labor enhancement’ to enjoy their work more and combat their pain problems (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657101/). For individuals who spend the majority of their lives in grueling conditions and who appear to be facilitated rather than harmed by the effects of partial agonist opioids, I see more benefit than harm to having a slightly euphoria-inducing agent. For other occupations, this makes less sense.