This is taken from www.migraineagain.com
Melatonin and Migraine: Can This Sleep Hormone Put the Headache Nightmare to Rest?
When you have migraine, good quality sleep can slip away as easily as migraine attacks can sneak in. Pain and poor sleep — rinse and repeat. What can help end this nightmare? According to research, a natural sleep aid known as melatonin may be able to help with migraine prevention.
What Is Melatonin?
Melatonin is a hormone that's secreted by the pineal gland and signals sleep.
“Melatonin promotes relaxation, reduces alertness, and helps initiate and maintain sleep,” explains Lauren R. Natbony, MD, medical director, Integrative Headache Medicine of New York. “In addition to its role in sleep regulation, melatonin has antioxidant and anti-inflammatory properties,” she says.
Melatonin supplements can be purchased over the counter, but it's also available in another place: your own body! It's possible to boost your body's own natural melatonin production through diet and lifestyle changes.
Melatonin and Migraine Prevention
But can this sleep hormone help reduce headache frequency or the severity of migraine attacks?
Although commonly advertised as a supplement to help with sleep, research shows melatonin can be an effective migraine preventive. Before exploring how melatonin can improve migraine, let’s revisit the importance of sleep, especially for those with chronic migraine.
Sleep: Trigger, Symptom, and Treatment for Migraine
When it comes to migraine, sleep is a jack of all trades. Poor sleep can be both a trigger or symptom of migraine, while good quality sleep can help treat a migraine attack.
“Sleep is a trigger when it's irregular: Either too little or too much sleep at inconsistent hours can exacerbate migraine,” says Andrew Charles, MD, professor of neurology and director of the UCLA Goldberg Migraine Program. “However, when someone has an attack, sleep can be helpful for treatment,” he says.
Whichever placeholder sleep occupies, its influence is widely felt among those with migraine.
Melatonin Regulates Processes That Affect Migraine
When you’re managing migraine, you’re also dealing with a host of other issues, such as sleep disorders, hormonal fluctuations, and inflammation. While many biological processes can become entangled with migraine, these issues in particular are directly impacted by melatonin.
Melatonin Influences Circadian Rhythms
Ever found that staying on your devices at night disrupts sleep? Well, you can thank the pineal gland, which releases melatonin, for that. Melatonin is like a biological vampire, releasing in darkness and retreating in light. It operates our sleep-wake cycles, aka circadian rhythms, a process that increases alertness during the day and sleepiness at night.
When this system functions optimally, we can function optimally. Unfortunately, circadian rhythms can become disrupted in people with migraine, and melatonin release can be delayed. However, Dr. Natbony notes that “by optimizing the timing of melatonin release, we can potentially reduce the risk of migraine attacks triggered by circadian rhythm disturbances.”
In order to help restore circadian rhythms back to optimal functioning, increase your exposure to natural light during the day and avoid blue light near bedtime. If you do choose to use a melatonin supplement, taking it 1 to 2 hours prior to bedtime can also help regulate circadian rhythms.
Melatonin Regulates Hormones
“Hormones play a key role in influencing migraine disease,” says Dr. Charles. “The prevailing hypothesis is that it is due to falling levels of estrogen that happen when estrogen peaks and then falls throughout the month, such as with the menstrual period.”
Fortunately, mediation is potentially nearby, as melatonin also oversees hormone function. “Melatonin helps regulate the secretion of various hormones, including estrogen,” says Natbony. “By promoting hormonal balance, melatonin may help reduce the likelihood of hormone-related migraine triggers.”
Melatonin Is Anti-Inflammatory
Migraine and inflammation, another closely linked pair, contribute to the neurological disruptions many of us experience. The trigeminovascular system, a branch of nerves responsible for that awful facial and head pain characteristic of migraine, jumps into action when neurogenic inflammation occurs.
As a result, a protein called calcitonin gene-related peptide (CGRP)floods nearby blood vessels, causing dilation and discomfort. One way this inflammatory cascade is countered is through melatonin, which regulates the release of CGRP. By means of this modulation, melatonin can interfere in trigeminal activation and migraine.
Additionally, melatonin scavenges free radicals, which are the unstable molecules that increase the risk of developing disease. Acting as an antioxidant, melatonin doubles down on its anti-inflammatory properties. “By diminishing inflammation and oxidative stress, melatonin may help prevent or lessen the severity of migraine attacks," says Natbony.
Melatonin Levels Are Lower in People With Migraine
Given melatonin’s numerous benefits, you may be wondering if something may be amiss in your melatonin levels. According to research, it’s certainly possible. One study found that people with chronic migraine had lower levels of melatonin than those without chronic migraine. Additionally, this study also concluded that decreased melatonin levels were correlated with the presence of anxiety and depression, conditions that are often comorbid with migraine.
Melatonin and Migraine: What the Research Says
While the link between melatonin and migraine is evident, studies show conflicting evidence for melatonin as a migraine preventive. One randomized controlled trial found that 2 milligrams (mg) of extended-release melatonin was ineffective for migraine prevention. However, a later study concluded that 3 mg of immediate-release melatonin was more effective than the placebo and safer to use than 25 mg of amitriptyline, an antidepressant that’s often prescribed as a first-line migraine preventive.
Additionally, another study found that melatonin may hold benefits for children and teens with migraine. According to Alexander Mauskop, MD, director and founder of the New York Headache Center, “Melatonin may be effective as an acute treatment for pediatric migraine.”
Although the dropout rate for this study was high, Dr. Mauskop says that “both low and high doses of melatonin were associated with pain reduction.” He also notes that higher doses of melatonin in conjunction with a nap produced greater benefits in this study. A possible reason for this finding may be that sleep can help relieve migraine attacks, especially in children.
What Dosage of Melatonin Is Most Effective?
While melatonin doses may vary, Natbony recommends a starting dose of 3 mg for migraine. However, higher doses may be necessary for other headache conditions, including cluster headache, she says.
But, don’t expect to see results right away. Natbony cautions: “It may take up to three months of therapy to see a benefit.”
Natbony recommends taking melatonin 1 to 2 hours before bedtime. Additionally, she says extended-release tablets may be helpful for people who struggle to stay asleep.
Conversely, Mauskop believes that “the immediate-release form could be more effective than the sustained-release one.” Further, he says that “it is possible that, unlike with insomnia, a higher dose is more effective for the prevention of migraines.”
If you’re unsure which type of melatonin is best for you, reach out to your doctor to discuss the possible benefits of each.
What Are the Side Effects of Melatonin?
Natbony states that melatonin is safe when used for short periods of time. In fact, most experts prefer patients to take “melatonin breaks.” Why?
“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,” explains Christine Lay, MD, professor of neurology and founding director of the headache program at the University of Toronto, in her 2019 talk on sleep for the Migraine World Summit. “So you do need to take periodic breaks every few weeks or couple of months,” she says.
While melatonin is considered safe, Natbony cautions that melatonin can interact with certain medications, including blood thinners, sedatives, anticonvulsants, and immunosuppressants.
“Speaking with your doctor before starting any supplement, including melatonin, is crucial,” she says.
Can Melatonin Give Me a Headache?
“Headaches caused by melatonin are relatively rare,” says Natbony. If you do find yourself experiencing any side effects, she cautions to avoid excessively high doses. In addition, be mindful when you take melatonin — taking it too early or too late may cause unwanted side effects.
More Research Is Needed
Though some scientific evidence exists for melatonin as a migraine preventive, more research is needed. Because the aforementioned studies are limited in scope, future studies examining the difference between melatonin doses and its effect on other headache disorders and comorbidities should be considered.
4 Ways to Boost Melatonin Naturally
Whether you’re waiting for melatonin to kick in or are looking for an alternative solution to supplements, there are other more natural sources of melatonin to help with sleep:
- Diet. Walnuts, goji berries, bananas, and tart cherries are all good sources of melatonin, says Lay. Warm milk and almonds also contain this sleep-inducing hormone.
- Avoid caffeine. While incorporating certain foods into your diet can increase melatonin, research shows that avoiding caffeine in the evening can help prevent any dips in melatonin levels.
- Limit screen time in the evening. Given that melatonin responds to environmental cues, Natbony advises to “avoid bright lights, especially blue light from electronic devices, as it can suppress melatonin levels.” Interestingly, a small study published in 2012 found that red light therapy increased melatonin levels. And green light has been shown to have a calm, soothing effect on the brain.
- Go outside. Getting your daily dose of sunshine can help regulate your circadian rhythm, which in turn affects melatonin function.
What the Community Says About Melatonin for Migraine
Real-life experiences can be almost as valuable as research. We asked members of the community about their experiences with melatonin. Some said melatonin has improved their migraine:
Krista T.: “I take it for my insomnia, and I no longer wake up at approximately 4 a.m. with a migraine that won’t let me go back to sleep.”
Karlie S.: “I wake up with fewer migraines than before.”
But others said melatonin actually worsens their migraine attacks:
Gaby R.: “It helps for going to sleep, but it gets worse for my migraines ?”
Mourad: “I’ve tried it for migraines and for sleeping, but it increases my migraines.”
And still others said melatonin does absolutely nothing at all for them:
Georgia S.: “So far the 5 mg per night is NOT helping me sleep. Haven’t noticed migraine changes.”
Anna Belle L.: “I take it because I have insomnia. It’s never helped my migraines, though.”
Final Thoughts
Melatonin is a hormone produced in the brain, but for some people with migraine, melatonin production may be diminished. As a result, this can negatively affect circadian rhythms, hormone function, and inflammation. Taking 3 mg of melatonin for three months may help recalibrate these processes and decrease migraine attacks. Eating certain foods can also boost melatonin production. Though considered a safe and cost-effective treatment for migraine, more research is needed for conclusive results.
Whether you're looking to improve sleep quality or implement an additional migraine prophylaxis, increasing your melatonin levels through diet, lifestyle changes, and/or a supplement could be a simple and helpful addition to your migraine toolbox.