Ramelteon in the Prophylaxis of Chronic Cluster Headache-Case Report

Abstract

Cluster headache is a primary headache characterized by severe pain with most attacks occurring during sleep. This is a case report on the use of ramelteon as a treatment for chronic cluster headache. A 42-year-old businessman, who had been experiencing episodic cluster headaches for 10 years, was diagnosed with chronic cluster headache in the past year during which time his activities of daily living had been greatly reduced because of daily cluster headache attacks. We initiated treatment with ramelteon (8 mg/day) prophylactically before sleep, and his average attack frequency per day after taking the drug was less than that before taking the drug. The elimination half-life of ramelteon is typically under 2 h, whereas that of melatonin is typically 30 min. This difference in the elimination half-life may have caused the better response to ramelteon treatment than to melatonin. We conclude that ramelteon may be useful as a new agent in both the prevention and prophylaxis of chronic cluster headache, when attacks occur at the same time during the night and that cluster headache is related to circadian rhythm.