Offering Hope and Recovery to Chronic Pain Sufferers

migraine,narcolepsy, and ritalin

I continue to be impressed with the efficacy of stimulants( ritalin is perhaps the best known) in the treatment of migraine, if that person also suffers narcolepsy.

A 45 year old woman with years of uncontrollable migraine headaches came to see me not too long ago. I inquired, as I now invariably do, if she experienced daytime sleepiness or if she was subject to vivid, realistic dreams. There are other indicators of narcolepsy, but in my mind those two are sufficent to at least make a tentative diagnosis. I prescribed ritalin and the results were near miraculous. Her headaches abated promptly and her sleepiness and nightmares also.

On a later visit she described an interesting experience. On a routine visit to her primary care physician, she told him that she was now taking ritalin for her headaches and doing quite well. He told her that she shouldn't take ritalin be cause it was addicting. She replied that she was taking it for narcolepsy as well as migraine. His response was to tell her that the only way to diagnose narcolepsy was with an overnight sleep study and short of that she certainly should not be on ritalin.

My patient is now looking for a new PCP.

A few points. Narcolepsy has been around for over a hundred years or so, the sleep study for maybe 15 or 20. We diagnosed narcolepsy simply my obtaining a good medical history and treated it successfully (most of the time) with stimulants. I'm not disparaging the sleep study. It can be very helpful in a number of ways but it is really not necessary for the diagnosis of narcolepsy. The medical history is the best diagnostic tool. Now, a sleep study is a rather expensive test. A therapeutic trial with a few days of ritalin costs but a few dollars and the answer, for good or bad will be known in short order. If our patient's sleepiness and dreams go away, isn't that enough to diagnose narcolepsy? And the headaches also. When they go away, does that not tell us that there is a close link between narcolepsy and migraine since both are controlled by a single drug?

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Kristan Posts: 1

Maybe A Link?
Reply #1 on : Fri July 31, 2009, 17:09:11

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All through Juniour high and hight school I suffered sever headachs. Junior hight was by far the worst. Every day after school I would hold my forhead to ease the pain. Doctor after Doctor the answer was always the same. The school lights were the problem....Ten years later and I am wondering if the puzzle was just to far apart to put together. Ten years later my intense sleepover and nap test gave the answers. Sever Narcolepsy with Cataplexy. I have been on Ritlin over a year and a half. By my early twentys I believe I out grew my headachs. But I agree Narcolespy and headachs sure mix well with Riltlin....