Melatonin
Abnormal 24-hour urinary excretory pattern of 6-sulphatoxymelatonin in both phases of cluster headache.
Leone M, Lucini V, D'Amico D, Grazzi L, Moschiano F, Fraschini F, Bussone G
Neurological Department and Headache Centre, Istituto Nazionale Neurologico C. Besta, Milan, Italy.
The typical cyclic occurrence of cluster headache suggests the
involvement of hypothalamic rhythm regulating centers in the
pathogenesis of this primary headache. In previous studies, reduced
24-h plasma melatonin levels during the cluster period, loss of
circadian melatonin secretion in remission, as well as permanently
reduced excretion of urinary melatonin in both illness phases have been
reported, supporting the hypothesis of a hypothalamic derangement. In
this study, the 24-h urinary excretion of the main melatonin
metabolite, 6-sulphatoxymelatonin, was evaluated in 20 cluster period
cluster headache patients. Thirteen were retested 12 months later, in
the same period of the year, during remission. Fourteen age- and
sex-matched healthy subjects were the controls. As expected,
significantly higher levels of 6-sulphatoxymelatonin were present in
nocturnal urine than in day-time urine in controls, while in both
cluster headache groups urinary levels of this metabolite did not
differ between day and night. Nocturnal levels of 6-sulphatoxymelatonin
were significantly lower in both cluster headache groups than controls.
Day-time levels did not differ significantly between the groups.
Altered excretion of urinary 6-sulphatoxymelatonin even during
remission indicates that at least some of these anomalies are
independent of the pain, and provides further evidence of involvement
of the hypothalamic rhythm regulating centers in cluster headache.
Melatonin-responsive headache in delayed sleep phase syndrome: preliminary observations.
Nagtegaal JE, Smits MG, Swart AC, Kerkhof GA, van der Meer YG
Department of Clinical Pharmacy, Hospital 'de Gelderse Vallei' Ede/Bennekom, The Netherlands.
The occurrence of headache and its change after treatment with
melatonin 5 mg were studied in 30 patients with delayed sleep phase
syndrome. The medication was taken 5 hours before the endogenous
nocturnal plasma melatonin concentration had reached 10 pg/mL. Three
women (aged 14, 14, and 23 years) suffered from chronic tension-type
headache. Their headache disappeared within 2 weeks after the start of
treatment with melatonin. One 54-year-old man suffered from disabling
migraine attacks without aura, twice a week. After starting melatonin
treatment, only three migraine attacks were reported in 12 months. Ever
since his 40s, a 60-year-old man complained of cluster headache
episodes lasting about 2 months, twice a year. In the year since
starting melatonin treatment, only one 5-day cluster episode occurred.
Nocturnal melatonin secretion in the patients
with delayed sleep phase syndrome and headache did not differ
significantly from that in the patients with the sleep disorder but
without headache. Melatonin may be helpful in patients with headache
who are suffering from delayed sleep phase syndrome. Its effectiveness
may be due to modification of vascular and nociceptive systems or to
its chronobiological action which adjusts the patient's biological
clock to his/her life-style.
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