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The association between melatonin and episodic migraine: A pilot network meta-analysis of randomized controlled trials to compare the prophylactic effects with exogenous melatonin supplementation and pharmacotherapy |
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| Authors: | Ping-Tao Tseng Chun-Pai Yang Kuan-Pin Su Tien-Yu Chen Yi-Cheng Wu Yu-Kang Tu Pao-Yen Lin Brendon Stubbs Andre F. Carvalho Yutaka J. Matsuoka Dian-Jeng Li Chih-Sung Liang Chih-Wei Hsu Yen-Wen Chen Yow-Ling Shiue |
| Affiliation: | 1. WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan;2. Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan Department of Nutrition, Huang-Kuang University, Taichung, Taiwan;3. Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan;4. Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan;5. Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan;6. Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan;7. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;8. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK Faculty of Health, Social Care Medicine and Education, Positive Ageing Research Institute (PARI), Anglia Ruskin University, Chelmsford, UK;9. Department of Psychiatry, University of Toronto, Toronto, ON, Canada Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada;10. Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan;11. Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan;12. Department of Psychiatry, Beitou branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan;13. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan;14. Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan;15. Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan |
| Abstract: | Although exogenous melatonin supplementation has been suggested to be effective for episodic migraine prophylaxis, there is no conclusive evidence comparing the efficacy of exogenous melatonin supplementation to the other FDA-approved pharmacotherapy for episodic migraine prophylaxis. The aim of the current network meta-analysis (NMA) was to compare the efficacy of exogenous melatonin supplementation in patients with episodic migraine. The randomized placebo-controlled trials or randomized controlled trials (RCTs) incorporating a placebo in the study designs were included in our analyses. All of the NMA procedures were conducted under the frequentist model. The primary outcome was changes in frequency of migraine days and response rate after migraine prophylaxis with melatonin supplementation or pharmacological interventions. We included 25 RCTs in total with 4499 patients (mean age = 36.0 years, mean female proportion = 78.9%). The NMA demonstrated that migraine prophylaxis with oral melatonin 3 mg/d (immediate-release) at bedtime was associated with the greatest improvement in migraine frequency [mean difference = −1.71 days, 95% confidence interval (CI): −3.27 to −0.14 days compared to placebo] and the second highest response rate (odds ratio = 4.19, 95% CI = 1.46 to 12.00 compared to placebo). Furthermore, oral melatonin 3 mg (immediate-release) at bedtime was the most preferred pharmacological intervention among all of the investigated interventions when improvements in migraine frequency, response rate, dropout rate, and rates of any adverse events were taken into account. This pilot NMA suggests the potential prophylactic role of exogenous melatonin supplementation in patients with episodic migraine. |
| Keywords: | circadian rhythm melatonin migraine network meta-analysis sleep |