Vogler Barbara, Rapoport Alan M, Tepper Stewart J, Sheftell Fred, Bigal Marcelo E
Jefferson Headache Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
CNS Drugs. 2006;20(5):343-50. doi: 10.2165/00023210-200620050-00001.
The pineal gland and its secretory product, melatonin, have been implicated in the pathophysiology of migraine, as well as some of its comorbid disorders. Supporting this view, many migraineurs are susceptible to various environmental triggers that influence the secretion of melatonin from the pineal gland, and many prodromal symptoms are probably generated in the hypothalamus, a brain region that provides input into the pineal gland to modulate the secretion of melatonin. In addition, studies have shown abnormalities in melatonin secretion in patients who experience migraine and an improvement in migraine following administration of melatonin. However, the dysfunction in melatonin secretion in migraineurs may simply be a marker of hypothalamic dysfunction or neuronal hyperexcitability, leading to migraine susceptibility. It is also possible that abnormal melatonin secretion leads to decreased inhibitory neurotransmitter activity, decreased inhibition of the release of calcitonin gene-related peptide (CGRP) from activation of the trigeminal system, or less analgesia. Whatever its role in the pathogenesis of migraine, melatonin may prove to be a useful therapy. Future studies are necessary to further elucidate whether melatonin is a well tolerated, beneficial therapy, and to determine the optimal dose and formulation of melatonin for use in migraine therapy.
松果体及其分泌产物褪黑素与偏头痛及其一些共病的病理生理学有关。支持这一观点的是，许多偏头痛患者易受各种影响松果体褪黑素分泌的环境触发因素影响，而且许多前驱症状可能在下丘脑产生，下丘脑是一个向松果体提供输入以调节褪黑素分泌的脑区。此外，研究表明偏头痛患者存在褪黑素分泌异常，且服用褪黑素后偏头痛症状有所改善。然而，偏头痛患者褪黑素分泌功能障碍可能仅仅是下丘脑功能障碍或神经元过度兴奋的一个标志，导致偏头痛易感性。也有可能是褪黑素分泌异常导致抑制性神经递质活性降低、三叉神经系统激活后降钙素基因相关肽（CGRP）释放的抑制作用减弱，或镇痛作用减弱。无论褪黑素在偏头痛发病机制中起何种作用，它都可能被证明是一种有用的治疗方法。未来的研究有必要进一步阐明褪黑素是否是一种耐受性良好的有益治疗方法，并确定用于偏头痛治疗的褪黑素的最佳剂量和剂型。
