Case report: Primary stabbing headache treated with melatonin in Saethre-Chotzen syndrome

Background: Primary stabbing headache (PSH) is a rare primary headache presenting with short, stabbing pain sensations of unknown etiology. Owed to the rare prevalence of the disease, only limited data exists on possible treatment options. The most cumulative expertise exists for indomethacin as a potential treatment in PSH. However, known side effects and long-term tolerability issues have urged the FDA to restrict the use of indomethacin as long-term medication. In about 35% of the cases indomethacin does not provide sufficient relieve, demanding for efficacious and well tolerable alternatives. Case: Herewith we report a case of a young female adult presenting with PSH treated with melatonin resulting in an outstanding and long-lasting response. The patient has a rare underlying genetic disorder leading to facial dysmorphia, which according to the scarce literature, is not associated with PSH so far, but requires extensive exclusion of secondary causes of headaches. Conclusion: Given the exceptional tolerability of melatonin with low concern even on a long-term use, we discuss an indomethacin trial in PSH might be a diagnostic approach rather than a therapeutic one in the future.