It’s Festival Season! How Should We Group Dose MDMA?

I get killer headaches after a journey when I drink mushroom tea or do a larger dose of mushrooms. Why is that and is there anything I can do about it? Is it hurting me in any way?

Headaches aren’t fully understood, and there are lots of things that can cause them. Paradoxically, both vasoconstriction AND vasodilation (tightening or widening blood vessels) seem to be a cause of headaches, as well as muscle tension, dehydration, air pressure, and loads of metabolic factors. Pinning down the true root of headaches can be – I’m going to say it – a headache. Ha ha.

I’m not a medical professional, so take all of this with a grain of salt and ALWAYS consult a medical professional if you’re unsure. I am, however, an experienced headache-haver who is prone to a whole range of headache types, including migraines. I actually had a medical emergency-type headache (speculated to have been a stimulant-induced cerebral hemorrhage) when I was 17. So I do have some tips for evaluating and responding to situations like this.

First, it’s actually pretty common for people to experience headaches with psychedelics, but mostly (as you’ve indicated) after the trip. A 2012 study investigated this very circumstance, drawing the tentative conclusion that this side effect might be dose-dependent. The study makes a few suggestions about potential metabolic and serotonergic causes of these headaches, but as far as I’m aware none of them have been completely substantiated.

What’s really interesting about this is that mushrooms and LSD are actually being studied as an effective treatment for cluster headaches, a different type of condition from other kinds of headaches. As this research continues, we’re seeing mixed reports of classical psychedelics either helping or inducing migraines. So there doesn’t seem to be a ton of certainty around the cause-and-effect relationship here in general, aside from it being complex and worth investigating. More research is needed to say anything with certainty.

Second, in my experience, truly dangerous headaches are 1) a different level of agonizing pain and 2) accompanied by other effects as well. I’m not saying it’s impossible, but I would be very surprised if any psilocybin-induced headache was acutely dangerous. Headache red flags include extremely sudden onset, severity that is debilitating, slurred speech, stiffness, vision problems, movement problems, or onset that occurs immediately after intensive aerobic activity. 

These issues might be signs of hemorrhage or related bleeds, and I believe are most commonly seen with stimulants due to a spike in blood pressure. See reports of 4-fluoroamphetamine’s stroke trail in the mid-2010s. Always seek medical attention for headaches that are unusually severe in their onset, intensity, and symptoms.

In the meantime, it sounds pretty obvious that this side effect is disrupting your experience. I suggest covering your obvious basis as thoroughly as you can (food, water, electrolytes, lower physical or emotional intensity, good sleep, reasonable temperatures). This will help you identify negatively contributing factors. It’s also just a good practice in general that everyone (including myself) seems to neglect despite it seeming so basic. 

Additionally, consider trying lemon tek which helps ease stomach upset for some people ingesting mushrooms. Use half of your normal dose when you first try this method, as it can significantly concentrate the trip and make it much more intense. Or you can just reduce your dose. You might find that you need to take mushrooms in lower stimulation environments, or your headaches might be partially related to jaw clenching and the resulting tension. Perhaps taking a little magnesium and ibuprofen will help with the muscular bit enough to ease the headaches. It’s also possible that maybe your trips are just intense enough that your blood pressure fluctuates, or you’re actually dehydrated AND salt-deprived and your electrolytes are out of whack.

The only way to really find out is to experiment, make micro-changes, and ideally keep a log of your experiences. For the time being, I suggest starting with lower doses and making changes to your behaviors and environments as you gradually titrate back up. Good luck!

If you are doing MDMA with a group of people of various sizes and experience levels, what are some different dosages that might be considered with this kind of mixed group?

Great question! I used to suggest giving people the standard 1.5 mg/kg dosage, but I think there are a few ways to go about this (and my own protocol has changed). Before anything happens, though, you should set the stage and collect some information. 

There are two pieces of critical info that you always need to ask about before dosing someone else with any drug: 1) Medications they’re on, and 2) any health conditions they have. Usually this occurs in a one-on-one interaction, but sometimes it can be helpful and desired to share with others in the group as well. 

There’s a lot of nuance to this because these conversations can pose issues with privacy, which I won’t get into here, but in short: Establish consent and the boundaries of confidentiality before someone tells you their health information. For instance, who can know about their medication(s) or health condition(s)? Friends? First responders? Just you? Are they okay with this information being written down somewhere for reference? If so, have you discussed how it will be destroyed after?

If you’re the person who’s dosing everyone in a group, I strongly recommend writing down a checklist of the questions above (and some others if you think of them) and sharing them with the group before talking to everyone individually. You can even print them out as sheets to use during your 1-on-1 check-ins. 

Another extremely helpful tool is tracking dosages. Make a grid with spaces for everyone’s name, the time, the drug consumed, and the quantity consumed. Establish a system of accountability where everyone adds to the grid whenever they consume a new dose or substance. I recommend a whiteboard for this, but a piece of paper (with vague, non-incriminating language) works fine too. 

These steps may seem excessive, but they are invaluable if someone in your group starts feeling unwell or has an unexpected reaction. I’ve personally used these systems many times, and have referenced someone’s dose time, quantity, mixtures, or medications on multiple occasions while responding to an adverse response. This kind of specific information can help medical professionals treat someone much faster.

Here are some thoughts about the actual dosing. In MDMA-assisted therapy trials, active initial doses of 75 to 125 mg are given. I find that 125 mg is usually a sweet spot for most people, but if someone is a lightweight with other drugs (especially amphetamines like Adderall) or would simply like to start with a lower dose, a solid 100 mg is a great option. On very rare occasions I have indeed met people (of widely varying body types) who have been natural tanks and legitimately required 180 mg of MDMA to get off the ground, with no prior experience, and others who have been floored by 75 mg.

You should, of course, ask the more experienced people what their dose is. Many folks have no idea, so this is a good opportunity to learn together. I’d base a more experienced person’s dose off of the frequency and recency of their rolls and their self-reports of how much they usually take (Multiple capsules? Multiple pressed pills?). 

If someone is rolling frequently or has rolled very recently, I’d first ask if they want to have a conversation about spacing. It’s possible that they simply don’t know that rolling too often can “lose the magic,” increase natural tolerance, or be risky to their mental health in the short term. It’s also possible that they’re aware and they want to roll anyway. If someone has rolled recently or is rolling often, I suggest starting with 130 mg and seeing how it goes.

I do not suggest giving MDMA to anyone who is on SSRIs, and MDMA could be life-threatening for someone who’s on MAOIs. You can check out the Spirit Pharmacist’s guides on medication interactions here.

When taking ayahuasca, do you always have to throw up during the journey? The idea of vomiting while tripping seems awful.

I’ll start with my annoying semantics about the word “always.” It is extremely rare that anything is truly “always” or “never” the case, especially with drugs. I would say that it is very common to throw up during an ayahuasca journey. What I’m more interested in is your statement about how vomiting while tripping seems awful. 

Vomiting during an ayahuasca (or mescaline) experience is often known as the purge, a metaphorical expulsion of things that you fear, hold you back, or are otherwise plaguing you. Purging is a very meaningful practice for many cultures and people. That doesn’t mean that people actively love puking, but in U.S. culture in particular, we are very distress-avoidant. This means many people have an active fear of puking as opposed to merely a dislike. I’m sure that’s a thing globally too, but I know for sure that it’s particularly prevalent here.

Think of it this way: Vomiting is your body’s way of pushing you into the next stage of whatever it needs to do. I have no way of knowing your history with puke, but it is pretty much always the case that the worst part of it isn’t the act of throwing up. It’s the foreshadowing, the panic, the sometimes hours-long attempts to avoid having to endure the 30 seconds of purging that will definitely make you feel better. (Well, dry heaving also sucks, but you can’t always win.)

I too hated the idea of puking while tripping for most of my life, but one miraculous night at Afrikaburn in 2017 I contracted a severe bout of norovirus. I spent hours trying to prevent myself from throwing up. It was some of the worst physical discomfort I’ve ever been in while ill, to the point where I was actually trying to vomit for the first time ever. Finally, a few hellish hours later, I stuck my finger into my throat and immediately started purging profusely. My body instantly settled and became calm. Boy, did I feel like an idiot for trying to put it off for so long. (As an essential medical addendum, if you’re vomiting constantly for a prolonged period of time you should try to seek medical attention in case of dehydration.)

I’ve been an advocate for yakking ever since, including and especially while tripping. Nausea can frequently be abated if you just allow your body to even attempt to do what it’s trying to get you to do. What an exercise in releasing control! What an exercise in surrender! What an exercise of following your body’s natural inclinations as it works to protect you! What else are you even there for? Lean into it. The purge awaits you.

About Your Psychedelic Auntie

When we have questions about psychedelics, we often consult our Auntie. An Auntie can be a person of any gender who offers wise advice about psychedelic substances and how to effectively use them. Lucid News is asking a collection of well-informed people to step in as Auntie and answer your questions about psychedelics. Some of the best peer-based, accurate information about psychedelic substances and harm reduction comes from DanceSafe, a nonprofit educational organization founded in 1998. DanceSafe provides health and safety services at festivals and events. This month, our Psychedelic Auntie is DanceSafe Programs and Communications Coordinator Rachel Clark. Send your questions to the Psychedelic Auntie via the Lucid News contact page and watch this space for the answers.

Update: This column has been updated to reflect a lower end dosage for MDMA.