Hi MARC1985, Mike and all,
I watch this with interest as my specialist has proposed similar treatment for me. My specialist (Clinical Pharmacologist, triptan designer, Headache researcher and CH expert extraordinaire) has obtained approvals through the drug approvals board and ethics committees of our local public teaching hospital for one patient to trial Ritalin in CH. By all accounts, the patient has experienced absolutely no reduction in frequency of attacks, but a significant reduction in severity.
Hopefully this will soon be drafted as a case study and submitted for publication.
It may seem, from the very little we know about it, that we may speculate that a morning dose of Methylphenidate may assist in "resetting" circadian rhythm. All very speculative, indeed...
Now I can't preempt outcomes, I just hear the occasional whisper from the long hallways of the University... It seems the success of Ritalin in this Patient's individual case shows enough merit for similar approval(s) to be granted for use in my case. It's ready to roll when I am...
Personally, I think Ritalin is a bad choice for my own medical circumstances, it will work against every drug I am taking and probably increase anxiety for me.
I am very reluctant to take it.
There is also another regulatory hurdle to overcome here in Oz, in that of it works after an initial short trial, I report any benefit, I am then subject to supervision by a "Drug dependency Unit". Whilst this is certainly appropriate for this drug, it only adds to my reluctance to try it.
On the other hand, the desperation and duress of chronic CH does give one cause for considering any options... as you all know.
MARC,
I think you are referring to the only work in Ritalin and CH that seems to appear online, or anywhere in the literature - Dr Gary Mellick's work. I see you've not got link posting privileges yet, so I will drop these here:
A letter, written by the patient, to J.M and G.A Mellick, in which one can clearly feel the desperation of the patient's inquiry:
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I will post a link to the now, rather old case report that is hosted here on the site:
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Here is the same case study, as it was eventually published and appeared in the October 1998 edition of
Headache Journal:
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Some input from Gary Mellick:
Quote:Department of Neurology at Massachusetts General Hospital
HOW HAVE PATIENTS RESPONDED TO RITALIN THERAPY?
1. Most patients have had rapid abortive headache relief. Prevention of future headaches occurs with a morning dose of Ritalin SR (20 mg). Being a chronic cluster patient does not doom you to failure. Several weeks ago two chronic cluster patients were able to stop their daily Ritalin SR after taking it for only six weeks and two months. They had NO headaches while on Ritalin. They are now headache free and not on Ritalin. For the first time in 30 plus years they are headache free! They are and their wives are happy campers and their wives with a new beginning in life
2. A few patients are less responsive to therapy and require chronic daily Ritalin. They still have headaches but experience a lessening of the headache pain levels from a 10/10 to a more tolerable 3 to 5/10 intensity.
3. Unfortunately, several patients have failed completely. Two patients who had undergone surgery did not respond to Ritalin. (One patient lived in Mississippi).
This should remind us that Ritalin therapy failures are bound to occur in some patients.
To the person posting the last note. If you are concerned about investing money in any new treatment that might not help you, my advise is don't do it. In fact the
treatment may not be safe for patients with mood disorders, glaucoma, hypertension, etc. It is not FDA approved and is not yet standard therapy but some patients might find it helpful.
The thought that these headaches happen as many as 5-6 times per night (or day) can be quite discomforting. My staff and I now better understand how cluster headaches can make life hell on earth how and how this affliction destroys people's lives. Hopefully, Ritalin will provide a much-needed, God-given respite for many people with cluster headaches.
I hope this answers your questions. We are about to publish a series to help further answer this important question.
God Bless,
Dr. Gary Mellick
Mike, I think Ritalin SR 20mg may be key here.
It seems Ritalin (Methylphenidate) may also be cause for concern for those already taking drugs that prolong QT intervals. As this quote from
| Headache | January 2013 points out
"HEADACHE MEDICATIONS, DRUG–DRUG INTERACTIONS, QTc PROLONGATION, AND OTHER CARDIAC ARRHYTHMIAS" Quote:Medications used to treat adult attention deficit disorder such as amphetamines and methylphenidate are also QTc-prolonging drugs and are frequently coupled with antidepressants in migraineurs.
See PDF attached (hopefully, sorry I could no longer locate a direct link for this paper, nor have I attached a file to this site before...)
I know I am going to ask some serious questions in relation to heart, request baseline ECG/EKG tests and have them closely supervised. I have heart arrhythmia from an "incident" shall we say... many years ago with unmonitored escalating doses of Verapamil for CH. I take Atenolol, a Beta-blocker. So my concerns in approaching Ritalin in CH are quite justified.
It may appear, from very old studies, that Ritalin has some varying effect on Vascular function, although any bearing on CH or how it is likely to be affected by Ritalin is sketchy...
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We need more studies and participants for them.
Good on you Marc for giving it a go.
My specialist does ask me to seek out any anecdotal, or reported patient accounts online, as supporting evidence for approaching the approvals process.
Your input helps others.
I hope it goes well for you and please, keep us posted.
In the bigger picture, I seriously doubt that even the best reported relief from Ritalin would be any contest for the D3 regimen. The best patient accounts (very few they are) are no match for the sustained relief Batch's collected D3 regimen figures are showing.
However, the mind must remain open!
Keep us posted Marc.
Cheers, Ben.
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