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Title: Ritalin(long post cut down) Post by SteveY on Sep 3rd, 2002, 11:27am Case Report Cluster Headache Management with Methylphenidate (Ritalin) Gary A. Mellick, D.O. and Larry B. Mellick, M.D. Abstract. The authors report rapid cluster headache relief in a 43 year-old male with a 5-year cluster headache history that was refractory to medical therapy. The patient described complete headache relief within 10 minutes of taking 10-mg of methylphenidate (Ritalin) when used to abort the onset of his headaches. Subsequently, a scheduled Ritalin dose taken each morning was sufficient to prevent his nightly headaches. In addition, one week of prophylactic methylphenidate therapy halted the series of cluster headaches. This is the first reported case of relief of cluster headaches with methylphenidate. All other headache medications were discontinued and several days later, the patient was administered nitroglycerin as a provocative agent to induce cluster headache.(11,12,13) Sublingual nitroglycerin (0.8 mg) resulted in the onset of his typical markedly painful right-sided cluster headache. This induced headache was successfully relieved with orally administered methylphenidate (10 mg) within 10 to 15 minutes. The patient complained of feeling "washed out" once the headache was relieved. Over the subsequent week, methylphenidate continued to successfully abort cluster headaches that occurred one or two times per night. When switched to a regimen of one morning dose of Ritalin SR, his nighttime headaches completely ceased and when the medicine was discontinued one-week later, the ongoing cluster headaches were no longer present. Discussion. Methylphenidate HCL is methyl alpha-phenyl-2-piperidineacetate hydrochloride, a mild CNS stimulant. The mode of action is not completely understood but methylphenidate presumably activates the brain stem arousal system and cortex to produce its stimulant effect.(14) Ritalin is available as tablets of 5, 10, and 20 mg for oral administration. Ritalin-SR is available as sustained-release tablets of 20 mg for oral administration.(14) Although the primary indications for methylphenidate are the treatment of attention-deficit hyperactivity disorders and narcolepsy,(14) it has previously been successfully used in the treatment of postoperative pain and vasoconstriction,(15) cancer associated pain,(16,17,18,19,20,21) and pain in Parkinson's disease.(22) These reports suggest that oral administration of low to medium-dose methylphenidate produces a potent and sustained analgesic effect on various pain states. Its mechanism of action in cluster headache is unknown. Kuczenski(23) and Geyer, et al.(24) showed that the primary effect of methylphenidate on the CNS is to amplify catecholaminergic transmission, but this drug also alters serotoninergic function in the brain stem. Experiments by Cantello et al(22), using beta-adrenergic and serotoninergic blockers showed that both the norepinephrine and serotonin systems were involved in the genesis of the methylphenidate-mediated analgesia. Conclusion. In this report, methylphenidate (Ritalin) successfully stopped a cluster headache provoked by nitroglycerin and halted a cluster headaches series in our patient. The application of methylphenidate in this headache sufferer suggests that methylphenidate may have value in the management of cluster headaches. Although an interaction with the sympathetic nervous system is postulated, the mechanism by which Ritalin relieved the headaches is unknown. Anyone know any more? Posted in 1998. Ueli? |
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Title: Re: Ritalin(long post cut down) Post by Drk^Angel on Sep 3rd, 2002, 11:36am I've noticed a few ppl on the board being prescribed Ritalin for their clusters lately. I wonder if any of them will be willing to discuss their experiences with the drug. PFDAN......................... Drk^Angel |
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Title: Re: Ritalin(long post cut down) Post by eyes_afire on Sep 3rd, 2002, 4:33pm Here comes one out of the woodwork ::) (how and why it was prescribed is a long still-unresolved story which I'm not even going to get into ::)). I have taken up to 60mg per day of Ritalin. I don't think it helped much. I don't know, maybe just a wee bit. But the CH beast still steamrolled all over the Ritalin with an evil laugh. Ritalin may inhibit REM sleep, but I wouldn't advocate playing with such biological functions. BTW... Ritalin is a schedule II controlled substance classified as being habit-forming (but I didn't have any problems with addiction). In my experience, pharmacies frown upon adults trying to obtain Ritalin. |
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Title: Re: Ritalin(long post cut down) Post by Ueli on Sep 3rd, 2002, 8:08pm Methylphenidate (Ritalin) has been discussed a lot on this board 4 and 3 years ago. It seems to be the wonder drug for a few, but for others it bring nothing or even bad side effects. On the survey on this site http://www.clusterheadaches.com/graphics/button_survey.jpg (http://www.clusterheadaches.com/survey/) out of 11'000 respondents there are 21 who name it their best preventative and 15 as the 2nd best. In the World's Only Live CH Medication Survey http://www.clusterheadaches.com/graphics/button_meds.jpg (http://www.clusterheadaches.com/meds/) out of 3209 respondents 134 have tried Ritalin and of these 33 had success of some kind. A Google search of the old message board (http://www.google.com/search?q=+methylphenidate+OR+ritalin+site:clusterheadaches.com&num=100&hl=en&lr=&ie=UTF-8&as_qdr=all&filter=0) lists 200 hits on Methylphenidate + Ritalin. Here are some of the threads: http://www.clusterheadaches.com/wwwboard/messages/1674.html http://www.clusterheadaches.com/wwwboard/messages/2123.html http://www.clusterheadaches.com/wwwboard/messages/2139.html http://www.clusterheadaches.com/wwwboard/messages/2267.html http://www.clusterheadaches.com/wwwboard/messages/3940.html http://www.clusterheadaches.com/wwwboard/messages/5541.html http://www.clusterheadaches.com/wwwboard/messages/20000.html http://www.clusterheadaches.com/wwwboard/messages/23228.html http://www.clusterheadaches.com/wwwboard/messages/29571.html http://www.clusterheadaches.com/wwwboard/messages/31770.html PFNADs Ueli |
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Title: Re: Ritalin(long post cut down) Post by SteveY on Sep 4th, 2002, 4:29am Thanks Ueli, Looks like another damp squib. Back to the verapamil and Imitrex. Steve |
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