Ramelteon for prophylaxis of cluster headache
Cluster headache (CH) is a primary headache characterized by severe pain with most attacks occurring during sleep. Cluster headache is an uncontrollable headache that reduces the ability of the patient to perform daily activities. These occur daily and may be caused by a decrease in nocturnal melatonin levels and a loss of melatonin rhythm.
Due to relatively long time required for a response, glucocorticoids are used as adjunctive therapy. CH patients occasionally fail to respond to conventional preventive treatments. Thus, for rapid and effective pain control, therapeutic agent is required. Ramelteon is the first new class of sleep agent that is a melatonin receptor agonist with both high affinity and selectivity for melatonin MT1 and MT2 than for MT3 receptors. The activity of ramelteon is believed to improve sleep and maintenance of circadian rhythm that determines normal sleep-wake cycle.
One of the previous case report in Japan has documented the effectiveness of Ramelteon in a patient with CH. As the attacks occurred during sleep, ramelteon was started at a dosage of 8 mg at bedtime. During sleep, the attacks completely stopped with ramelteon and the attacks began to occur early in the morning. Moreover, headache attacks decreased from approximately 10 times a week to 2-3 times a week. In this time period, patient experienced no adverse effects associated with the ramelteon. This report used ramelteon for a very short period.
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.