How Effective Is Melatonin as a Preventive Treatment for Hemicrania Continua? A Clinic-Based Study

• Published in: Headache Vol. 55; no. 3; pp. 430 - 436
• Main Author: Rozen, Todd D.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.03.2015; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Central Nervous System Depressants - therapeutic use; Female; Headaches; hemicrania continua; Humans; indomethacin; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; melatonin; Melatonin - therapeutic use; Middle Aged; Migraine Disorders - prevention & control; Pain; trigeminal autonomic cephalalgia; Young Adult; hemicrania continua; trigeminal autonomic cephalalgia; melatonin; indomethacin
• ISSN: 0017-8748; 1526-4610; 1526-4610
• DOI: 10.1111/head.12489

Objective To assess the efficacy of melatonin as a preventive therapy for hemicrania continua in a larger population of patients than has previously been studied. Background Hemicrania continua is defined by its sensitivity to indomethacin. Rarely can patients be fully tapered off indomethacin without headache recurrence; thus, the risks associated with chronic indomethacin usage are substantial for these individuals. Melatonin, a pineal hormone with a similar chemical structure to indomethacin, has shown efficacy as a preventive agent for hemicrania continua in isolated case reports. Melatonin would be a preferential alternative prophylactic treatment to indomethacin because of its minimal side effect profile. How truly effective melatonin is as a preventive for hemicrania continua is unknown at present and needs further study. Methods Retrospective analysis of all International Classification of Headache Disorders‐3 beta diagnosed hemicrania continua patients treated with both indomethacin and melatonin at the Geisinger Headache Center from July 2011 to January 2014. Results Eleven patients were treated (9 women, 2 men). Two patients became pain free on melatonin, while partial relief was noted in 3 other patients; thus, they were able to lower their dose of indomethacin but could not achieve pain freedom with melatonin alone. Six patients had no response. Melatonin dosing needed for response ranged from 3 to 30 mg. In the partial relief responders, indomethacin dosing decreased by 50% to 75%. Conclusion From this single clinic investigation, only a small percent of subjects with hemicrania continua (less than 20%) will achieve pain freedom on melatonin, thus clearly not matching the effectiveness of indomethacin. However, the addition of melatonin to indomethacin may allow around 45% of patients to have complete or partial relief of their headache with the subsequent ability to reduce or eliminate their indomethacin dosage, which may lead to a decrease in medical morbidity over time secondary to less exposure to indomethacin.