Melatonin in hemicrania continua and paroxysmal hemicrania

Area of Science:

• Neurology
• Headache Medicine
• Pharmacology

Background:

• Hemicrania continua (HC) and paroxysmal hemicrania (PH) are trigeminal autonomic cephalalgias.
• Indomethacin is the gold standard treatment but often causes intolerance.
• Melatonin, structurally similar to indomethacin, is explored as an alternative therapy.

Purpose of the Study:

• To evaluate the clinical use and efficacy of melatonin in managing HC and PH.
• To assess melatonin's safety and tolerability as a preventive headache treatment.

Main Methods:

• Retrospective audit of patient records from King's College Hospital (2014-2023).
• Inclusion of patients diagnosed with HC or PH treated with melatonin.
• Descriptive statistics were used to analyze patient demographics, melatonin dosage, and treatment outcomes.

Main Results:

• In 56 HC patients, 41% received melatonin, with 83% of them having stopped indomethacin due to side effects. 61% reported headache relief with melatonin (median dose 10mg).
• In 22 PH patients, 27% received melatonin, with 50% reporting symptom response (median dose 8mg).
• Melatonin was generally well-tolerated with rare side effects.

Conclusions:

• Melatonin demonstrates some efficacy in treating HC and PH, offering a favorable side effect profile.
• It serves as a valuable, well-tolerated alternative for patients who cannot tolerate indomethacin.
• Melatonin provides significant symptom amelioration for a substantial number of patients with these headache disorders.