Posted by Dr. Gary Mellick on August 07, 1998 at 22:40:42:
In Reply to: Re: CASE REPORT: CLUSTER HEADACHE MANAGEMENT WITH METHYLPHENIDATE (RITALIN) posted by Mark on August 07, 1998 at 18:02:22:
I don't have my medical records with me but I will venture that I have treated a treated between ten or twelve patients with the number increasing each week.
HOW MANY ARE EPISODIC AND HOW MANY ARE CHRONIC CLUSTER HEADACHES?
Episodic cluster headaches: five or six
Chronic cluster headaches: five or six
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. Just this week two chronic cluster patients were able to stop their daily Ritalin SR after taking it for only six weeks and two months. During this time, 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 happy campers and their wives are happy too! Now they have a new beginning of the
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, 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.
The thought that these headaches happen as many as 5-6 times per night (or day) can be quite discomfiting. My staff and I now better understand how cluster headaches can make life hell on earth how this affliction destroys people's lives. Hopefully, Ritalin will provide a much-needed, God-given respite for many of you.
ADDENDUM:
When we first initiated Ritalin testing, patients consented to videotaping of the nitroglycerin oral challenge followed by "Ritalin rescue". The resulting headaches were furious and unsettling but believe it or not, a few brave souls have volunteered to have the headaches induced a second time and professionally videotaped to educate the public about cluster headaches.
Dr. Gary A. Mellick