A lot of CH'ers are experiencing a higher than normal frequency of their CH this time of year and that includes a few of us on the anti-inflammatory regimen who are also experiencing some burn through hits.

There's a high probability this increase in CH activity is due to the spring pollen causing allergic reactions that flood our systems with histamines.  When that happens nearly every form of CH intervention is less effective or not effective at all.

The insidious thing about pollen allergies is they can be sub-clinical with no outward symptoms so you could be having an allergic reaction and never know it.  Pollen can also lay around the house, car and workplace for months. 

All it takes is a little movement to send the pollen airborne and it hits the nasal passages.  When that happens, mast cells in the mucus membranes start dumping histamines into the local area and bloodstream.  When the histamines reach the trigeminal ganglia, they trigger neurogenic inflammation and we're off to the races with another bout of CH.

There are other sources of allergens that are with us year round.  Any damp areas can generate mold spores and the biggest source is dust mites.  They live with us year round in bedding and pillows...  They may not be enough to trigger an allergic response on their own, but throw in a little more spring pollen and you reach a tipping point where there's enough to trigger an allergic response.

Here's my story...  I'm a chronic type and have kept my CH in full remission with the anti-inflammatory regimen (10,000 IU/day vitamin D3, Omega-3 fish oil and all the vitamin D3 cofactors: magnesium, zinc, boron, vitamin A (reinol) and the vitamin K2 complex MK4 and MK7).

I live in the Puget Sound area of NW Washington state. I started falling out of remission in mid March as soon as I returned from a stay with friends down in Key West, FL where I had been CH pain free taking 15,000 IU/day vitamin D3. 

Alder tree pollen was sifting out of the mature trees that surround our house like a dust storm that coated my black pickup turning it gray with a very sticky and heavy dusting that acts like powdered weldwood glue when the rains hit it.  See photo below.

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It took less than 24 hours after I returned home for allergy symptoms to appear and that was when I had the first outbreak of CH.  I realized what was happening so started taking vitamin D3 at 50,000 IU/day as loading doses thinking that would overpower the flood of histamine triggered by the pollen allergy.  A week of loading cut the frequency a little but not completely. I was still getting hit one or two times a night while sleeping

At that point the clue bird made a low pass and the good idea light came on bright... Treat the allergy! 

It took a little reading to identify the best treatment option and I finally settled on benedryl (diphenhydramine), a first-generation antihistamine.  I started taking it as directed at 25 mg four times a day, every 4 to 6 hours...  It took a day for the benedryl to start working, but by the second day I was back in a CH pain free state...

The rationale for benedryl is it passes through the blood brain barrier to block histamine receptors in brain cells. Benedryl doesn't stop the mast cells from releasing histamine and other cytokines, but it does help block the allergic reaction and associated inflammation.

The only downside of benedryl is it acts as a CNS depressant so I've been a bit drowsy and napping frequently...  Second- and third-generation antihistamines can't get past the blood brain barrier so don't pose a problem with drowsiness, but as they can't pass through the blood brain barrier, they would likely be ineffective in this case. 

It's been a month and so far so good.  The Alder pollen drop is over, but it's been replaced by an equally heavy pollen drop from the Bigleaf Maple trees...

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We've several 200 year old Bigleaf Maple trees near the house and they're loaded with blooms that drop a yellow pollen that collects on my pickup like finely ground cornmeal.

I've managed to cut back on the vitamin D3 to 25,000 IU/day and three benedryl tabs/24 hours... and still remain pain free...  Lesson learned!

Hope this helps...

Take care,

V/R, Batch

Hey TDU,

Thanks for the update...  The anti-inflammatory regimen can work that fast for many of the CH'ers who start this regimen.

The following chart illustrates data from the online survey of CH'ers taking this regimen (March 2015 harvest).  As you can see better than 50% respond in the first week after starting this regimen.

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It may not mean too much to you at this point, but the exciting news is it appears that vitamin D3 is also entering target brain cells in the hypothalamus and trigeminal ganglia and not just 25(OH)D, the first metabolite of vitamin D3 that triggers the genetic expression we think is responsible for preventing CH.

It takes the liver roughly 6 days to a week to metabolize each dose of vitamin D3 as indicated by a maximum 25(OH)D serum concentration from a single dose of vitamin D3 that occurs 6 to 7 days after the vitamin D3 dose while vitamin D3 reaches a maximum serum concentration within 2 days of the initial dose as shown in the following chart.

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Accordingly, my thinking at this point given some CH'ers start responding within 12 to 48 hours... is un-metabolized vitamin D3 is entering target brain cells making it also responsible for the reduction in CH symptoms.

As most CH'ers are vitamin D3 deficient, i.e., a 25(OH)D lab test less than 30 ng/mL, (75 nmol/L), and as there are other major consumers of vitamin D3 and 25(OH)D within the body that compete with brain cells, it takes a day or two to fill up some of the other empty vitamin D3 storage areas.  When that happens, as long as the vitamin D3 cofactors are present, most CH'ers start experiencing a reduction in the frequency, severity and duration of their CH.

Take care and please keep us posted on your progress with this regimen.

V/R, Batch

Hey Mike,

Your observations are spot on as is your suspected reason for the peaks in responses at two weeks and 31 days...  The rest of the distribution tracks with the profile of typical physiological responses to medications and nutrients.

I had another question in the survey that addressed the confounding factor of episodic CH'ers confusing a favorable response to the anti-inflammatory regimen with end of cycle...

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As you can see, roughly 17% of the episodic CH'ers indicated a favorable response within the last 20% of their estimated cycle length... 

Of the 17% that fell into that category, I checked and most of them indicated a 25(OH)D serum concentration at 80 ± 5 ng/mL, well within the typical response range to this regimen...  Accordingly, I suspect the confounding factor is closer to 7% for episodic CH'ers.  You be the judge.

Take care and thanks for the comments.

V/R, Batch

Hey 3-Foot,

Thanks for the update...  The evidence surrounding the use of vitamin D3 to help prevent sunburn has been sketchy at best. Your experience adds another dimension.

Dr. Reinhold Veith has an interesting perspective on the evolution of lighter skin types as early homo sapiens migrated North from Equatorial East Africa.  Vitamin D3 is so essential for human and most mammal biological functions including reproduction, our skin makes it when exposed to the UVB in sunlight.

Accordingly, as early man migrated North from Equatorial East Africa over hundreds of generations, they lost skin pigmentation to compensate for the lower sun angle with a concomitant maintenance of essential cutaneous vitamin D3.   

If they didn't adapt with lighter skin types as they migrated to the Northern latitudes, they produced much less vitamin D3 and as a result, had poor bone formation and overall size.  Veith opines, women who failed to adapt to the lower sun angle with lighter skin types, died in childbirth due to the restricted size of their pelvic girdle birth canal and as a result, they dropped from the surviving gene pool.

Where all this gets even more interesting deals with seasonal variations in sun angle where humans and nearly all other mammals in the Northern latitudes built up more vitamin D3 reserves in the form of 25(OH)D and stored it in fatty tissue during the summer then coasted through the winter where the low sun angle is insufficient to produce the needed cutaneous vitamin D3.

Not surprisingly, conception takes place at the peak of the late summer 25(OH)D serum concentrations and birth during the following spring as 25(OH)D serum concentrations start rising again...

The following links provide some interesting reading on the relationship between cutaneous vitamin D3 production and skin type.

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The only thing I would note is the recommended 25(OH)D serum concentration of 50 ng/mL, (125 nmol/L) represents levels for normal healthy people...  As CH'ers... we're not normal as our disorder requires a 25(OH)D serum concentration range of 60 to 110 ng/mL in order to maintain a CH pain free status.

Take care,

V/R, Batch

Hey Zeitgeist,

Thanks for the straight forward update and candid assessment of the anti-inflammatory regimen's capacity to prevent your CH...  Your comments bring up a general topic that I think worth discussing... and that's the commonly used statements about efficacy of CH preventatives... 

"What works for some CH'ers, may not or does not work for other CH'ers."

and

"What worked well last cycle is not working now."

Being an analytical type... I'm always asking "Why?"

After nearly five years taking the anti-inflammatory regimen to prevent my CH, reading hundreds of posts, PMs, email and online survey results from CH'ers taking this regimen as well as reading hundreds of studies on the efficacy of vitamin D3 in treating a wide range of medical disorders, I've come up with a framework I think is worth sharing.

Dose-Response... There's a clear dose-response relationship between the dose of vitamin D3 and a CH pain free response.  I selected 10,000 IU/day vitamin D3 as the standard maintenance dose for a number of reasons, the first and foremost is this is the highest vitamin D3 dose the real vitamin D3 experts consider safe. 

Data extracted from posts here at CH.com and the online survey of CH'ers taking the anti-inflammatory regimen to prevent their CH indicate an average efficacy of 80% by the end of the first month of treatment.  Some CH'ers need more vitamin D3 and a few have been relatively pain free taking 5,000 IU/day.

Time-Course 25(OH)D response...  There's also a time-course 25(OH)D response relationship with a CH pain free response as serum concentrations of 25(OH)D build towards what I call the "Green Zone" of 60 to 110 ng/mL.  In other words, some CH'ers require up to a month to respond to this regimen although the majority respond within the first two weeks.

These first two factors account for a little over 80% efficacy for the anti-inflammatory regimen in preventing CH...  The other 20% who don't respond is were I've devoted the majority of my time.

There are several factors that prevent CH'ers in this category from experiencing a favorable response.

Infections, allergies and trauma/surgery are the three most prevalent reasons why some CH'ers do not respond to this regimen even with a 25(OH)D serum concentration in the green zone at or above a concentration of 80 ng/mL. 

These three factors have three things in common.  They trigger inflammation, they increase immune system activity and in doing so, place a demand on serum vitamin D3 and 25(OH)D concentrations lowering them by as much as 40%.  The net effect is a reduced capacity of the anti-inflammatory regimen to prevent CH.

We've had a statistically significant number of CH'ers post comments to the effect their CH returned or increased in frequency during viral and bacterial infections...  In most cases, increasing the vitamin D3 intake from the 10,000 IU/day maintenance dose up to 20,000 or 50,000 IU/day for a week usually resulted in a pain free response.

This Spring I discovered that taking Benadryl (Diphenhydramine) worked effectively in lowering the histamine inflammatory response due to an allergic reaction to tree pollen and that this made the anti-inflammatory regimen effective enough to stay CH pain free.  Several CH'ers have reported a similar response after starting Benadryl.

I cracked a large filling on an upper molar a couple weeks ago.  The molar was otherwise healthy with no evidence of periodontal disease six months ago during an annual dental checkup.

This molar had been a candidate for extraction and implant following a bone graft for the last four years due to looseness caused by a filling that allowed food to wedge between it and the adjacent tooth forcing it aft when chewing.  A proper restoration eliminated the gap and the anti-inflammatory regimen with vitamin K2 stopped the looseness.  My dentist was amaze when he checked molar for mobility and found it sound.

Last week the tooth started to become tender while chewing so I went in to have it checked.  The X-ray indicated an infection had set as the crack had extended through the silver amalgam filling and into the lower crown splitting one root so they put me on oral penicillin and scheduled the needed procedure for later this week.

Two weeks ago when the molar cracked I'd been on a maintenance dose of 10,000 IU/day vitamin D3, down from an average of 20,000 IU/day during the heavy pollen earlier this summer.  Within a few days of the molar cracking and the tenderness setting in, I noticed the lymph nodes in my neck were shot up and swollen...  About that time, the beast started prowling around so I upped the vitamin D3 back up to 15,000 IU/day.  This increase in CH activity was clearly due to the tooth infection...

Moreover, within 24 hours of starting the penicillin, the tenderness while chewing subsided and so did the swollen lymph nodes in my neck.  Two days after starting the penicillin, I was back at 10,000 IU/day vitamin D3 and the beast has been conspicuously absent.

Edited to add... I'm also taking a probiotic to counteract the loss of friendly colonies of GI tract bacteria caused by the penicillin.

Bottom line and contrary to popular belief, a tooth problem can lead to an increase in the frequency and severity of CH... particularly if its infected...  See your dentist for regular checkups.

Getting back to the framework...  It really doesn't matter what CH'ers take as a preventative... If there's any other comorbid medical condition that results in inflammation, (and that's nearly all of them...) the preventative will be less effective... if it's effective at all.

Take care,

V/R, Batch