Patient Case Report: Memantine for the Treatment of Occipital Neuralgia

Abstract

Occipital neuralgia (ON) is described as a shooting, stabbing pain in the posterior part of the scalp that involves the occipital nerve. The epidemiology and pathophysiology are uncertain, but ON is considered distinct from other headache types. At the time of this writing, memantine for the treatment of ON has not been described in the literature. The following details a case report of successful treatment of ON with memantine. A 64-year-old, 91-kg, White man presented with severe headache associated with ON. Previous trials of oral medications, acupuncture, or physical therapy did not provide relief. The patient reported 15 ON headache days per month, use of 18 sumatriptan tablets per month, and daily use of as-needed ibuprofen. Because of inadequate relief of ON from other treatments, memantine was started. After titration to memantine 10 mg by mouth twice daily, the patient reported he was “100% headache free” from his ON pain. The patient tolerated memantine well without adverse effects. This case report displays safe, effective, and novel treatment of ON with memantine 10 mg by mouth daily, twice daily. The known safety, tolerability, and pharmacodynamics of memantine may warrant its off-label use in future studies exploring efficacy in ON.

Cranial Neuralgias

“…37 One reported case of occipital neuralgia was 100% responsive to therapy with memantine. 39 NECK-TONGUE SYNDROME While not formally termed a "neuralgia," the characteristics of neck-tongue syndrome fit well within the spectrum of cranial neuralgias. This entity is typified by immediate-onset, unilateral, sharp or stabbing, and usually severe pain in the occiput, upper neck, or both, brought on by sudden head turning.…”

“…Besides nerve blockade, medications typically used for neuralgiform or neuropathic pain are utilized, along with physical therapy to reduce muscular tension, and in appropriate cases, decompression or ablative procedures are warranted ( case 10-2 ) 37 . One reported case of occipital neuralgia was 100% responsive to therapy with memantine 39 …”

Occipital Neuralgia

“…Infliximab, a tumor necrosis factor antibody, was studied in cervicogenic headaches with decreases in pain scores in a small sample of patients, but its use is still unexplored for ON [22]. The successful use of memantine, a N-methyl-d-aspartate (NMDA) antagonist, in a patient with ON refractory to medications and occipital nerve blocks has been described [23]. Erenumab, a calcitonin gene-related peptide (CGRP) monoclonal antibody, was effectively used to treat a patient with ON and known migraines; the patient failed conventional pharmacological therapy and occipital nerve blocks [24].…”