Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece.
Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece.
Rev Neurol (Paris). 2021 Oct;177(8):871-880. doi: 10.1016/j.neurol.2021.01.014. Epub 2021 Jun 22.
BACKGROUND-PURPOSE: A bidirectional relationship appears to connect tension-type headache (TTH) and circadian dysregulation. The present systematic review examined the published evidence for melatonin (MT) supplementation in the prophylaxis of TTH. Initially, we reviewed case-control studies investigating nocturnal MT or 6-sulphatoxymelatonin (aMT6s, a urine-discarded metabolite) in TTH individuals and healthy controls (HC). Secondly, we reviewed studies appraising the use of MT in the prevention of TTH.
The search strategy involved MEDLINE EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar and OpenGrey. Case-control studies were appraised according to the Newcastle-Ottawa-Scale, whereas randomised controlled trials were assessed based on the risk-of-bias Cochrane tool. Infrequent, as well as frequent, episodic, and chronic TTH patients were evaluated separately in children and adults.
Our search strategy yielded two case-control studies. One (high-quality) did not reveal any difference in morning salivary MT concentration between children with frequent episodic TTH and HC. The second (moderate-quality) was indicative of a disturbed nocturnal secretion pattern in adults with chronic TTH. For the second part, five uncontrolled studies were retrieved. In total, 94 adults with chronic TTH were assessed and results were suggestive of a beneficial effect of MT on headache frequency, intensity, induced disability, and induced analgesic consumption. However, the uncontrolled-unblinded designs may have induced an important placebo effect. Non-adult populations and frequent TTH were substantially understudied.
There are not enough studies to designate the role of MT in the prevention of TTH. Given the disease's background, additional relevant research is warranted for chronic TTH.
紧张型头痛（TTH）和昼夜节律失调之间似乎存在双向关系。本系统评价审查了褪黑素（MT）补充剂预防 TTH 的发表证据。最初，我们回顾了调查 TTH 个体和健康对照者（HC）夜间 MT 或 6-硫酸褪黑素（尿液中丢弃的代谢物 aMT6s）的病例对照研究。其次，我们评估了评估 MT 在预防 TTH 中的使用的研究。
搜索策略涉及 MEDLINE EMBASE、CENTRAL、PsycINFO、试验登记处、Google Scholar 和 OpenGrey。病例对照研究根据纽卡斯尔-渥太华量表进行评估，而随机对照试验则根据 Cochrane 风险偏倚工具进行评估。儿童和成人分别评估偶发性、频发、偶发性和慢性 TTH 患者。
我们的搜索策略产生了两项病例对照研究。一项（高质量）研究并未发现频繁发作性 TTH 儿童与 HC 之间早晨唾液 MT 浓度有任何差异。第二项（中等质量）表明慢性 TTH 成人夜间分泌模式紊乱。对于第二部分，检索到五项非对照研究。总共评估了 94 名慢性 TTH 成人，结果表明 MT 对头痛频率、强度、诱发残疾和诱发镇痛药消耗有有益作用。然而，非对照非盲设计可能会引起重要的安慰剂效应。未研究非成人人群和频繁 TTH。
没有足够的研究指定 MT 在预防 TTH 中的作用。鉴于该疾病的背景，需要对慢性 TTH 进行更多相关研究。
