NEW YORK (Reuters Health) – Preventive treatment with melatonin provided complete relief in two patients with long-standing chronic cluster headache, clinicians at the Thomas Jefferson University Hospital in Philadelphia report.
Drs. Mario F. P. Peres and Todd D. Rozen describe the cases in the December issue of Cephalalgia. Both patients experienced daily and nightly headache that began within 40 minutes to an hour after falling asleep.
The first patient, a 38-year-old man with a 20-year history of headaches, had been experiencing approximately six headaches per day for at least 10 months a year. As the authors discuss, remission had never lasted longer than 14 days.
After the patient had tried steroid tapers, valproic acid, verapamil and lithium, the authors started him on a dose of melatonin 9 mg daily at bed time. After 2 days, the headaches disappeared for the duration of the 6 months' follow-up.
The second patient was 40 years old with an 8-year history of excruciating headaches 3 times a day. Like the first patient, he had experienced no headache-free periods lasting longer than 2 weeks. The authors documented that the 9-mg daily dose of melatonin resulted in remission for 8 months.
Drs. Peres and Rozen note that this is the first report of chronic cluster headache responding to melatonin, and that both nocturnal and daytime cluster attacks were prevented.
In an interview with Reuters Health, Dr. Rozen, who is currently affiliated with the Cleveland Clinic in Ohio, claimed that "melatonin is completely underused."
"The average dose of verapamil required is above 700 mg, more than the PDR recommends," he said. "With Depakote, we often need 2000 mg. So if we can use an agent like melatonin that is so benign, that is a real plus."
While the two patients described here continued using the preventive agent they were previous prescribed, "I've found patients who respond to melatonin alone," Dr. Rozen noted. In other patients, the dosage of the prophylactic agent could be cut in half.
He advises that melatonin be the first line of treatment for cluster headaches, both episodic and chronic. He has also found success in using melatonin to treat some migrainous headaches, hypnic headache, delayed sleep phase headache and seasonal hemicrania continua.