Melatonin and Migraine Study – and the investigation continues…

Another study on melatonin is out – this time telling us that it’s not helpful for migraine.  But, as usual, that’s not the end of the story.

The study published in Neurology wasn’t huge, but it was a randomized, double-blind, placebo-controlled crossover study.  Both men and women with 2-7 migraine attacks per month were a part of the study, and 46 people completed the study.

This time 2mg of extended-release melatonin was given 1 hour before bedtime for 8 weeks.  To find out more about the details of the melatonin study, read here.

Migraine frequency decreased quite a bit – on average, the patients had one or two fewer migraine attacks per month.  But… that includes all the patients.  The results were almost the same for the patients taking a placebo.

So, we have another study confirming the placebo effect, which has been much in the news lately.

But does this study tell us that melatonoin doesn’t work for migraine?

As with any good scientific study, this one tells us something, but it has boundaries – it’s limited.  Questions such as,"would melatonin be a help to certain subgroups of migraine patients?" remain unanswered.

But the bigger debate at the moment is about the quantity of melatonin.  For example, a 2004 study suggested that 3mg (instead of 2) would be helpful.  Others have suggested that 0.3mg of melatonin is as good, or better, than a higher dose.

Why are we even having this discussion about melatonin?  There are many reasons, actually.  We do know that sleep cycles are closely related to disorders like migraine.  Melatonin may also be helpful in comorbid conditions such as fibromyalgia, and related conditions such as cluster headache.  Melatonin is also a part of the chain reaction in the body that involves serotonin, which has long been linked to migraine.

But the connections are complex, and because we don’t understand exactly how melatonin may help with migraine attacks, it takes a lot of time and trial and error to find out if it could actually be an effective treatment.

So, this trial doesn’t invalidate the use of melatonin for migraine prevention – it just suggests that 2mg may not be the best dosage for many (most?) people.

So, should you try it?  Here are a few things to think about if you’re considering it:

• As with any natural treatment, be sure to discuss it with your doctor (preferable a migraine specialist) before you start.  This should be a doctor that knows your medical history.
• The good news is, melatonin is fairly mild in the doses we’re talking about.  You should experience very few problems trying it for a short period of time under a doctor’s care.
• Be extra sure that your doctor knows what medications you’re taking.  Taking melatonin with antidepressants and antipsychotics, sedatives, anticonvulsants (such as topamax), and certain other drugs, can be dangerous.
• Investigation has found significant impurities in some brands of melatonin, and related products suchs as L-tryptophan and 5-hydroxytrytamine.  Use a well recognized brand you trust. (see Cauffield JS, Forbes HJ. 1999)
• If you’re simply having trouble sleeping (or, I should say, "only" or "mainly" – sometimes insomnia isn’t so simple!), talk to your doctor about other methods – other medications, and better yet lifestyle changes (a darker room, less caffeine, a better rhythm of life in the evening, exersize, etc).

I continue to hear about migraineurs that have been helped by melatonin.  It’s still worth considering, though it won’t be at the top of your list.

Read more about melatonin
A specialist’s opinion on the new study