The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature

We searched English and non-English language articles in the following databases: MEDLINE (1966–February 2004), AMED (1995–February 2004) and Alt HealthWatch (1990–February 2004).Nine articles were found to meet the inclusion criteria and were included in this systematic review. Hypothetical reasons for niacin's effectiveness include its vasodilatory properties, and its ability to improve mitochondrial energy metabolism. Important side effects of niacin include flushing, nausea and fainting.Although niacin's mechanisms of action have not been substantiated from controlled clinical trials, this agent may have beneficial effects upon migraine and tension-type headaches. Adequately designed randomized trials are required to determine its clinical implications.Migraines and tension-type headaches impose an important burden upon society and the working public. According to the National Headache Foundation, some 45 million Americans suffer from chronic, recurring headaches and 28 million of these suffer from migraine headaches annually [1]. Furthermore, the work force loses approximately 50 billion dollars per year due to absenteeism and medical expenses caused by headaches, with more than 157 million workdays lost each year to migraine sufferers alone [1].Even though advances have been made with regard to the treatment of acute migraine headaches (i.e., the triptan formulations), many patients often discontinue their migraine interventions due to treatment dissatisfaction [2]. Among individuals seeking treatment for tension-type headaches, the frequency of such headaches is often daily or almost every day [3]. Unfortunately, chronic tension-type headaches are associated with analgesic abuse [4], and are difficult to manage in a primary care setting due to frequent comorbid psychiatric or analgesic use problems [5]. Thus, it is imperative that other methods of treatment be researched and developed in order to increase satisfaction, therapeutic response, and compliance amo