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melatonin

More on Melatonin for Migraine (and a recipe thrown in)

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Last month a meta-study was published in the Journal of Oral & Facial Pain and Headache, focusing on the use of melatonin supplements for migraine. The results are pretty encouraging for a supplement that is generally considered safe in small doses.

cat nap

The helpful thing about this new study is that it didn’t just evaluate if melatonin “helped”, but it got specific into the “how”. Researchers found the following benefits:

  • Less frequent migraine attacks
  • Shorter migraine attacks
  • Less severe migraine attacks
  • Less use of “painkillers”

Why exactly melatonin works so well is not entirely understood. Obviously, if melatonin helps you sleep, improved sleep will certainly help fight migraine. But there may be more to it than that.

Melatonin is also an antioxidant, which may provide a number of benefits. Headache researchers have especially honed in on the anti-inflammatory powers of melatonin. More recently, melatonin gained traction as part of the COVID-19 fighting toolbox (see for example this study).

Melatonin is, of course, produced naturally in your body. At a 2019 Migraine World Summit event, migraine expert Dr. Christine Lay provided some very helpful advice for migraine patients:

I think there are ways to promote your own melatonin. When we come home after a busy day, I encourage patients to keep their room dim. And so not to have every single light on in the house, every, you know, television going, but rather to keep the room fairly dim and to use lamp lighting, perhaps, rather than overhead lighting so our own natural melatonin will kick in. But for some patients supplements can be very effective. I think we have to be mindful as migraine patients that you’re not spending all of your money on the most expensive one but you’re not buying the cheapest one because we know these things are not really mandated. We don’t know about quality control, necessarily. So you want to make sure you’re buying a good product.

The other thing I think is important: there are sometimes what we call sublingual, or melt-in-your-mouth, melatonin. I tend to tell patients to avoid those because they usually have additives in them or they may have an artificial sweetener which could then provoke a migraine attack. So they need to stick, primarily, with tablets or pills. In terms of amounts, it’s quite variable. There’s a lot of research showing that melatonin can help patients with chronic migraine, even chronic migraine people who feel like they don’t have a sleep problem. There’s something positive about melatonin. It may actually have even an antiinflammatory benefit to some degree. So melatonin can be very effective. I usually have patients start at a lower dose, perhaps three milligrams, and then work slowly to build up depending on how they tolerate it. I don’t think patients, without discussing with their doctor, should go beyond 10 milligrams because you have to be mindful of how much you’re taking. And most experts will say you need a melatonin break. It’s something that’s naturally produced in our brains by the pineal gland, and so, if you’re continually supplementing the melatonin, your brain might get used to not making its own. So you do need to take periodic breaks every few weeks or couple of months.

Dr. Christine Lay

Dr. Lay also recommends foods with melatonin, such as walnuts. (Make yourself some Morning Glory Muffins. Seriously.)

For a highly-rated melatonin without a lot of the additives that Dr. Lay talks about, try Natrol Melatonin. It’s very inexpensive right now, and has even bigger savings with Subscribe & Save. Be sure to get this particular version – Natrol has various others, such as the fast dissolve version that has additives that you’ll want to avoid.

ConsumerLabs has tested and recommends Source Naturals Time Released Melatonin, also a good price but a little more than Natrol.

More information on melatonin at the Mayo Clinic.

Read the study abstract here: Efficacy and Safety of Melatonin as Prophylaxis for Migraine in Adults: A Meta-analysis.

Headache Waking You Up? Could Be Hypnic Headache.

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You’ve noticed it’s starting to happen on a regular basis. All of a sudden, you wake up with a headache.

You didn’t have the headache when you went to sleep. Where did it come from? It may just be mild, but it could be severe – you might even feel sick.

Hypnic Headache - waking you up?Now that you’re awake, the headache lasts for a few minutes – but could even last up to four hours.

And it’s happening several times a week now – twice a week, maybe four times, or even every night.

It’s possible that you have a rare kind of primary headache known as hypnic headache.

But don’t jump to conclusions too quickly. This headache, sometimes known as the “alarm clock headache”, really is quite rare. It tends to happen in people over the age of 50, and it can easily be misdiagnosed.

The reason is that there are many other reasons why you may wake up with a headache. Sleep apnea is a common trigger of certain headaches, for example.

If you wake up feeling restless, it probably isn’t hypnic headache. A hypnic headache generally won’t last for more than 4 hours. And it will wake you up quite often – more than twice a week, often every day.

If you suspect you have hypnic headache, your doctor will want to ask some questions to try to find an underlying cause. Chances are she will give you a different diagnosis. Like I said, it’s rare.

However, if you are diagnosed with hypnic headache, there are some excellent treatments.

A recent study suggested that lithium is the best treatment for these types of headaches. Oddly enough, caffeine consumption upon waking is the second-best treatment. Melatonin or indomethacin may also be tried if these are not effective.

For more information about hypnic headache, check the links below:

New Migraine Research – MRF Announces Grants (podcast)

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In this podcast, I discuss some of the migraine-fighting research that the Migraine Research Foundation is supporting in the months ahead.

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Here are some of the links related to the podcast:

Important note: Yes, FirstGiving is accepting donations. There was a temporary problem, but it has been fixed.

Hemicrania Continua: Is Melatonin an Alternative to Indomethacin?

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If you’ve never heard of hemicrania continua, you’re already lost.  If you have hemicrania continua, you know exactly what I’m talking about.

Briefly, for the fortunate ones who don’t have this condition, hemicrania continua is a constant one-sided headache which is often accompanied by watery eyes and congestion.  It’s often misdiagnosed as migraine or sinus headache.  For more quick info, see Hemicrania Continua Facts.

There are some unique things about this condition.  For example, the headache is always one-sided.  And although it may wax and wane, the headache is always there.

But for our purposes, the important thing is that it it treated with indomethacin, a non-steroidal anti-inflammatory drug (NSAID) (similar to ibuprofen).  And this treatment always works.  Well, mostly.

Although hemicrania continua always responds to indomethacin, dosages may vary and its effectiveness may change over time.

But there’s a worse problem – side effects.  Stomach problems, ringing in the ears – and even more headaches, to name a few of the more common issues.

So although patients are encouraged to periodically try to lower the dosage (once they’re stabalized), the possibility of new treatments is very attractive.

Melatonin for Hemicrania Continua

Melatonin is one of the main alternative treatments for hemicrania continua.  There are few other treatments, and even melatonin has been studied very little.  This is mainly because this is such a rare disorder.

However, more and more patients are trying melatonin as a safer alternative to indomethacin.  Some patients start taking melatonin and are able to phase out indomethacin use.  The melatonin may be taken during the day (it’s usually taken before bed as a sleeping aid).

Researchers at the University College London Medical School are encouraging doctors to take this treatment more seriously, after describing the case of another patient who found relief with melatonin.

Melatonin is inexpensive and widely available.  Although it’s considered generally safe, do talk to your doctor if you plan to take it for more than a few days.

Melatonin and Migraine Study – and the investigation continues…

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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.

Melatonin and Migraine - the Investigation Continues

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

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Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.