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232 Relevant to migraine, serum melatonin may be lower in a sub-group of patients, 233 and alterations in melatonin could play an important role in migraine pathophysiology via modulation of several neural pathways involved in the generation of migraine attacks

It enhances adiponectin expression, suppresses resistin, inhibits NF-B activation, and reduces hepatic stellate cell activation as well as pro-inflammatory cytokines such as TNF-, IFN-, and interleukins [84, 85]

Nonmetabolic factors, including genetic susceptibility, age, sex, smoking, and alcohol consumption, have also been identified as potential risk factors, although their precise contributions remain unclear (96)

Nevertheless, these data should be borne in mind when interpreting the results from regular monitoring of the viral load in HIV infected patients receiving valproate or when following CMV infected patients clinically

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