Melatonin

Melatonin is a naturally occurring hormone synthesised in the pineal gland from serotonin. Its levels are high during sleep, and low during wakefulness. It can interfere with GABAergic neurotransmission (it enhances it) and and can reduce synthesis of pro-inflammatory mediators such as prostaglandins.

Headache disorders that have been treated with this hormone include:

1. Cluster Headache
2. Hypnic Headache
3. Idiopathic stabbing or ice-pick headache
4. Hemicrania continua
5. Status migrainosus
6. Chronic cluster headache

In cluster headache results from randomised trials of 10mg versus placebo are positive, although the effect is not that powerful. Nonetheless there is a modest effect and could be used if lithium or verapamil were ineffective.

Hypnic headache occurs exclusively during sleep, but there are no randomised trials. However, I, like others, have had some limited success with 3-12mg doses.

All these headache disorders have periodicity in common - i.e. they can vary with the night-day cycle or circadian rhythm.

References

Leone M et al. Mela-tonin versus placebo in the prophylaxis of cluster headache: a double-blind pilot study with parallel groups. Cephalalgia 1996; 16: 494–6 (Free Abstract only)

Peres MF et al Cluster headache and mela-tonin. Lancet 2000;355:147 (Free Abstract only)

Capo & Esposito. Hypnic headache. a new Italian case with a good response to pizotifene and mela-tonin. Cephalalgia 2001; 21: 505–6 (Free Abstract only)

Rozen TD. Mela-tonin as treatment for idiopathic stabbing headache. Neurology 2003; 61: 865–6

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