Response to memantine in a patient with refractory chronic cluster headache: Case report
Emmanuelle AD Schindler, Maxine C Coore, Alexander B GuirguisBackground
The management of cluster headache, an uncommon and exquisitely painful headache disorder, sometimes requires the creative incorporation of off-label treatments.
Case
In this case report, a 69-year-old man with chronic cluster headache developed cardiomyopathy precluding continued use of verapamil, a gold-standard preventive medication, prompting additional treatment trials. After unsuccessful trials of conventional preventive treatments, he enjoyed relief after initiating memantine, achieving an approximate 70% reduction in attack frequency at 10 mg twice daily and then an 85% reduction with 20 mg twice daily.
Conclusion
Off-label use of memantine in headache disorders has been described, including in cluster headache; however, this case suggests that additional benefit may be obtained with gradual uptitration of the dose above what is commonly used in dementia, as tolerated.