How effective is melatonin as a preventive treatment for hemicrania continua? A clinic-based study

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)430-436
Number of pages7
JournalHeadache
Volume55
Issue number3
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Melatonin
Indomethacin
Headache
Therapeutics
Pain
Headache Disorders
Aptitude
Hormones
Morbidity
Recurrence

Keywords

  • hemicrania continua
  • indomethacin
  • melatonin
  • trigeminal autonomic cephalalgia

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

How effective is melatonin as a preventive treatment for hemicrania continua? A clinic-based study. / Rozen, Todd.

In: Headache, Vol. 55, No. 3, 01.01.2015, p. 430-436.

Research output: Contribution to journalArticle

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abstract = "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.",
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AB - 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.

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