The Experts Speak
Migraine and Melatonin
Mario F. P. Peres, M.D., Ph.D.
Al. Joquim Eugenio de Lima
881 cj 708, 01403-001
Sao Paulo, SP, Brazil
E-mail: Mario F.P. Peres, Ph.D., M.D.
“Melatonin, 3 mg, is Effective for Migraine Prevention,”
Neurology, August 2004(2 of 2);63:757. #42194 (11/2004)
Kirk Hamilton: Could you please share with us your educational background and current position?
Mario F.P. Peres: I graduated in medicine in São Paulo, Brazil, did residency in Neurology, and started my interest in melatonin during my Ph.D. program. A fellowship in headache at the Thomas Jefferson University, Philadelphia, PA was done in 2000-2001. I currently run the São Paulo Headache Center and work at the Albert Einstein Hospital in São Paulo.
KH: How did you come to believe that melatonin might be of benefit in the treatment of migraine headaches?
MFPP: Melatonin is a very interesting compound. It is responsible for the synchronization between the organism and the environment. Migraine is thought to be a disorder in which the individual is not adjusted to the environment. Melatonin has several mechanisms potentially related to the pathophysiology of migraine, such as its antiinflammatory effect, free-radical scavenging, modulation of dopamine, serotonin, opioid analgesia, enhance GABA and decrease glutamate activity.
KH: Why did you choose a 3 mg dose of melatonin, and was this a time-release or immediate-release product?
MFPP: We chose 3mg because it is an intermediate dose, between the physiological and pharmacological (supraphysiological) dosage. We did not use the time-release formulation.
KH: Can you tell us a little about your study and the basic results?
MFPP: Our study is the first to demonstrate the potential benefit of melatonin for migraine prevention, we studied 34 patients for three months of treatment. The results were positive as early as the first month of therapy with a significant reduction in headache frequency, intensity, duration. Analgesic consumption and headache impact were also decreased.
KH: Were there any side effects as a result of the use of melatonin?
MFPP: Melatonin has a very low side effect profile. It causes somnolence, which is why it is prescribed 30 minutes before bedtime.
KH: Were there any surprise findings other than a reduction in headache intensity, frequency and duration that were of benefit to the subjects, i.e. , libido?
MFPP: A few patients reported an increase in libido. It is something to study that in more detail.
KH: How effective is melatonin in treating menstrually-related migraines?
MFPP: Menstrually-related migraines were equally effected by the treatment. Since melatonin levels are decreased in menstrual migraines, its supplementation should be helpful. Further studies are necessary to confirm our results, a placebo-controlled clinical trial should be done.
KH: Were there any long-term side effects as a result of taking melatonin at 3 mg over several months or potential concerns?
MFPP: Melatonin increases the immune response, so it may increase activity in auto-immune disorders, however little is known about it. Melatonin therapy should be recommended only by physicians and self-medication is not recommended. If melatonin is taken at the wrong time, it may cause opposite effects.♦