Hey Ernie,
Thanks for the update. You're not alone. Roughly 10% of CH'ers on this regimen experience an outbreak of CH after two years or so...
Fortunately, I think we've a handle on this phenomenon... Bump your daily intake of vitamin D3 to twice what you've been taking as a maintenance dose or 20,000 IU/day for a week or two. Add a single 50,000 IU loading dose of vitamin D3.
You'll also need to increase your magnesium intake up to 600 mg/day or 750 mg/day. After a couple weeks, try to taper back down to 10,000 IU/day and a serum concentration around 80 ng/mL.
Doing this should buy you some relief, but try to see your PCP for a lab test of your serum 25(OH)D, total calcium, PTH, magnesium and vitamin B12.
While you're doing this pick up some vitamin B 50 and take a tablet a day for three months. If you can't find any vitamin B 50, get the vitamin B 100s and take one every other day for three months. The vitamin B 50 tablets are formulated with 50 mg of each B vitamin plus 400 mg of folic acid. Try to avoid the B complex or Super B complex as they are light on some of the B vitamins.
It pays to be connected... I got in touch with Dr. Stasha Gominak, MD and shared the data I've been collecting on the anti-inflammatory regimen preventing CH and migraine headahes. She's a neurologist practicing in Tyler, Texas who has been prescribing a vitamin D3 regimen very similar to the anti-inflammatory regimen for her patients suffering from sleep, chronic pain and headache disorders. The difference is she tests for vitamin B12 and adds a 3-month course of vitamin B 50.
She's been using this regimen a lot longer than the anti-inflammatory regimen and had quite a few of her patients report a loss of effectiveness after a couple years of pain free existence... It took her a while, but when a couple of her patients reported the regimen was working again after taking some B vitamins, she did the clinical research and came up with the 3-month course of vitamin B 50 as a solution.
We don't know why, but maintaining a 25(OH)D serum concentration up around 80 ng/mL causes us to burn down one or more of the B vitamins causing a deficiency. When that happens, the wheels fall off and the headaches return.
The 3-month course of vitamin B 50 takes care of any B vitamin deficiencies. I've also modified the anti-inflammatory regimen by dropping the Kirkland brand calcium citrate and adding the Kirkland brand Mature Multi.
The Mature Multi has less calcium, more vitamin A (retinol) and all the B vitamins at RDA. It doesn't have enough magnesium so I also suggest the Kirkland brand of magnesium citrate 250 mg liquid softgels... Two to three of these (500 to 750 mg of magnesium) helps prevent any calcium-magnesium imbalance.
Dr. Gominak has a great website with videos well worth the time watching. You can find it at the following link:
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Dr. Gominak comes at the treatment of sleep, chronic pain and headache disorders from a slightly different perspective... As you'll see in her videos, 8 hours a day of "quality" sleep is very important. She's also a big fan of maintaining beneficial colonies of GI tract bacteria. The vitamin B 50 helps in this area but a healthy diet of whole foods with lots of green veggies is also important.
Take care and please keep me posted.
V/R, Batch