34 year old with ADHD newly diagnosed with headache on ritalin

[nadri]

I am a newbie to the board. I am a 34 year old man recently diagnosed with ADHD. I have been successful in my education and career. However, in my current job no matter how good I am at doing my work I am dogged with comments about inattentiveness at meetings, lack of engagement with clients. These personal skills have seen me reviewed badly at my performance appraisal as I do not conform to the social norms.

I have had coaching paid by my work and the coach usually tells me to focus on the other person and realise that as another person I need to give them adequate attention in the same way that I would want. This has helped but I still have a lot of slip ups. Also the coach wanted to understand what the underlying cause was of my poor social skills.

Having recently visited from the US from the UK, I had a look into the symptoms of Adult ADHD. They seemed a mirror of my traits and I have been diagnosed last week by a psychiatrist in London as having adult adhd.

He has prescribed a 10 day trial of ritalin as follows: Starting on day 1 I take10mg of ritalin and then I add 10g of ritalin up to 100mg a day. When I get to the point where I am agitated by the ritalin, I take one less dose as my main dose. So if I am agitated at 50mg, I take 40mg a day.

On day 1, I had 10mg and I felt great and well focussed and able to focus on what people said (even people who I usually find a bit annoying). On day 2 with 20 mg I had a pounding headache all day and did not feel great. I tried 10 mg on day 3 in the morning and felt fine. I tried 10mg at lunch time and then had a pounding headache by lunchtime.

The other side effect which I see as beneficial (as I snack too much) is that I am not as hungry!

Tomorrow I think I will go back to 10mg as I can't take the headaches. The only problem is that I think the 10mg wears off so I suppose I should ask for a long release form.

So not sure overall, how I am doing so far. When I had it on the first day, I do feel noticeably calmer, I got up and down much less from my desk and did less fidgeting so it seems to have helped. Just need to work out the dosage and deal with the side effects.

Any comments on headaches and anything else would be appreciated.

Nadri

[wifeandmom]

You may not be drinking enough water. Most people on stimulants find that they need to make an effort to drink more water than previously to stay hydrated. You may also be having problems with low blood sugar. Search the nutrition section here for discussions on the importance of breakfast, eating enough protein with complex carbohydrates, etc. Try increasing your fluids and eating healthy small meals several times a day until you can get a definitive answer from your doctor.

I'll bet lots of Ritalin users here will chime in with what helps them. Good luck!

[nadri]

Thanks for this, I have oatmeal for breakfast and a good lunch. I tried glass after glass of water this afternoon and headache painkillers but this did not help. I did not have this problem with the 10mg dose and do not normally get headaches. So I think this means that 10mg is the max dose I can take. Any other comments would be appreciated.

Nadri

[ADHDTigger]

I don't know how helpful I can be as it has been years since I was on Ritalin. I take Adderall currently. What I DO know is that the long acting form of Ritalin would be a once daily dose that time releases. If your optimal daily dose was 10 mg twice daily, you would take a single 20 mg dose and it releases 10 mg initially and 10 mg later in the day. I tend to prefer the fast acting as it is significantly easier to control.

The headache you describe may be the effect of the med wearing off. It can be tough to tell. One thing that may help is that very often an initial side effect will go away as you become accustomed to the med. One way to reduce the side effect is to titrate slowly. Give yourself at least several days at a dose before increasing. I infrequently get the headaches now but have had them. Generally, I take a low dose aspirin (88 mg baby aspirin) when I get them and they go away quickly.

You may want to check out the Ritalin sub-forum in the Medications forum. You should find good information there.

[steven d]

The headache may go away after a while. I remember when I was using Ritalin (and that was some time ago) I would sometimes develop a headache. It was usually the headache that felt like stinging or thunder/ electricity (if you know what I mean). It usually would come after dosage adjustment. But after time the headache would go away. It usually takes a day or two.

[halusk]

Hey! Like someone said it will probably go away with continued use.

However, when adderall gave me headaches I would take 1 or 2 asprin about 30 minutes before i took the adderall and it did wonders. not sure if it works for ritalin but u might try it. (assuming u have no contraindications from any blood pressure/thinner meds)

[BobRobertson]

I don't take Ritalin, but the headaches you describe are very common, especially for those who do not use stimulants otherwise.

I'm on Vyvanse and experienced the same thing when increasing. In my case, it took a couple of weeks to get use to a lower dose enough to step up to the next dose.

Patience is key (yeah I know, we ADDers don't generally have a lot of that). Your headaches might go away if you hold of on the increase for a few days at least.

[nadri]

So I guess my psychiatrist is expecting me to titrate up too quickly then and that I need to do it slowly. I also presume that ritalin is one of the older drugs and not necessarily the best. He told me to take it once a day in the morning but with a half life that is quick. Probably not best.

[BobRobertson]

Originally Posted by nadri

So I guess my psychiatrist is expecting me to titrate up too quickly then and that I need to do it slowly. I also presume that ritalin is one of the older drugs and not necessarily the best. He told me to take it once a day in the morning but with a half life that is quick. Probably not best.

There are a number of different philosophies on prescribing. I've heard some like to start on Ritalin because it is fast acting and short half-life. They use it as a test to see how you will react to stimulants.

That is just one example. There could be other reasons. It is a good idea to ask why that particular medication and what advantages he sees in that one over other (i.e. newer) meds.

[ADHDTigger]

Originally Posted by nadri

So I guess my psychiatrist is expecting me to titrate up too quickly then and that I need to do it slowly. I also presume that ritalin is one of the older drugs and not necessarily the best. He told me to take it once a day in the morning but with a half life that is quick. Probably not best.

Ritalin is a very common med for ADHD and is most commonly prescribed. If you are being treated by the NHS, the formulary is somewhat limited compared to the US. Titrate slowly, allowing a minimum of several days to pass before stepping up. When you see your psychiatrist again, ask him about twice daily dosing.

When I was on Ritalin, I took a morning and lunchtime pill. They tried three times daily at one point but it tended to interfere with sleep even more than my usual insomnia.

The General Med and Ritalin forums will be helpful for learning what kind of nutritional support will serve you best. If you are drinking caffeinated beverages, you might want to cut back. Same goes for sugars. I also cut out starch wherever possible. The reason to restrict caffeine is because it impacts your brain and you want to let the med work there. Consider shifting to a protein fortified oatmeal so that you are starting the day with something substantial that has protein.

It can take months to find the right regimen. Be willing to stick with it.

[nadri]

Thanks for all your replies. Much appreciated. I am not absolutely overwhelmed by the experience so far. I felt very sweaty in the night and work up a couple of times. Today at work on a 10mg dose, I feel a little bit sickly. So not sure whether to persist or not!

Nadri

[Destracted_UK]

Hi Nadri

I'm taking ritalin, around 20mgs a day, in 4 small doses. I take the last one around 7pm so it doesn't interfere with my sleep. It took me a few weeks to settle into it. I've been on that dosage schedule for a couple of months now, might ramp it up slightly soon though and see if get even more benefit.

I find taking mine every 3.5 hours I don't get any drop off. As already said, it's all about tweaking times and dosage.

I also found that orange juice was affecting it's efficacy - citric acid in orange juice was was altering that with me. So I've cut that out.

Good luck with your treatment, check out all the ritalin threads, there's great info in them.

Oh, are you taking Ritalin or a generic? (I found a massive difference).

[nadri]

Thanks for your message. The box has the generic name and says ritalin on it so I presume it is ritalin. I spoke to the PA of my psychiatrist and he seemed suprised at my symptoms and said it could be caffeine withdrawal from tea and diet coke. I was told to try 20mg for the next couple of days and consider whether I was calm and focussed in spite of the headaches. Your suggestion of breaking up the dose seems a good one. Has the side effects faded over time for you and are the meds worthwhile?

Nadri

[Destracted_UK]

If it says Ritalin then yep, proper Ritalin. I only asked, as often you are prescribed methylphenidate in the form of a generic - e.g. Equasym - I found that to be no good at all.

Ahh yeh, it could totally be caffeine withdrawal : ) *fingers crossed*

Yeh I pretty much have zero side effects, maybe the slightest of comedowns in the evening but they are hardly worth mentioning.

I found the meds have helped a lot of my symptoms. I am a lot more organised, my mind is quiet (that's a massive relief for me!) and my focus is laser like.

However that focus has a flip side - I have to make sure it's on something I planned to be doing, or else I can hyperfocus on nearly anything. And lose hours. So I try and check myself to see if I am doing what I am supposed to be.

There are still many aspects that aren't touched, but overall a good improvement. I am hoping that the other areas may improve with time now that some of my basic functioning has improved.

I have also got to a point where I just accept that I am different in some areas - it's alot easier than fighting it everyday.

As you can see from this forum, there are a lot of different meds to try if this one doesn't work out - but fingers crossed it does.

[nadri]

Very helpful. I think it does help a lot. I think I have been a lot more productive, although as everyone around me is less productive it can be a bit frustrating to be held up by them!

Hope it all works out. Had some aspirin which worked better than ibuprofen.

The thing that makes the psychiatrist think it is caffeine withdrawal is that I am feeling nausea and sweating a lot. They think that indicates cold turkey symptoms of coming off a drug! I am not sure if I could be classified as an addict. I typically have a 500 ml (17 oz) bottle of diet coke a day and 3 -4 mugs of tea. So it is a bit but not a tremendous amount of caffeine.

Just out of interest, will your GP prescribe ADHD meds on the NHS or do you have to pay privately for the prescription?

Nadri