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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\u2010item questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>None of the 24 HPPD participants had migraine, whereas 20 of 37 (54.1%) controls had migraine (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). 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\u2010fluoroamphetamine, 3\u2010methylmethcathinone, 4\u2010Bromo\u20102,5\u2010dimethoxypenethylamine, and nitrous oxide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.14914","type":"journal-article","created":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T14:52:37Z","timestamp":1620831157000},"page":"2631-2638","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Migraine prevalence in visual snow with prior illicit drug use (hallucinogen persisting perception disorder) versus without"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7946-0485","authenticated-orcid":false,"given":"Robin M.","family":"van Dongen","sequence":"first","affiliation":[{"name":"Department of Neurology Leiden University Medical Center Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard J.","family":"Alderliefste","sequence":"additional","affiliation":[{"name":"National Recreational Drugs Consulting Clinic Brijder Addiction Care Center Alkmaar the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0958-4754","authenticated-orcid":false,"given":"Gerrit L. 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