title: How effective is melatonin as a preventive treatment for hemicrania continua? A clinic-based study.
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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Geisinger Health System, Department of Neurology, Geisinger Headache Clinic, Wilkes-Barre, PA, USA.
authors.forename: Todd D
authors.initials: TD
authors.lastname: Rozen
mesh_terms: D000328:Adult; D000368:Aged; D002492:Central Nervous System Depressants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008550:Melatonin / Q000627:therapeutic use*; D008875:Middle Aged; D008881:Migraine Disorders / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D002492:Central Nervous System Depressants; D008550:Melatonin
keywords: hemicrania continua; indomethacin; melatonin; trigeminal autonomic cephalalgia