Migraine induced by Melatonin withdrawal: a clue for future trials?

Background: Melatonin supplementation has been suggested as influencing migraine frequency, but the few published studies on this subject have arrived at differing conclusions. Case: A 37-year-old white male, who had experienced four to six attacks of migraine with aura yearly over the previous nineteen years, noticed repeated morning migraine attacks with aura 24 to 48 hours after the intake of melatonin (patient’s estimate of frequency was 80% of the events), which was being used as a sleep inducer at a dose of 3–6 mg. The intensity of pain was independent of duration and quality of sleep. Such attacks were considered to be provoked by the melatonin withdrawal. Conclusion: This case illustrates the complexity of the relationship between melatonin and migraines, and suggests that the selection of certain migraine phenotypes and the manipulation of the melatonin doses could be of value in further studies.