Hoppy,

Great question and the short answer is no... I may have confused this issue in the earlier post.  If you're taking 320 mg of calcium citrate, you're taking 320 mg of elemental calcium.  See the following for details.

Per the CFR - Code of Federal Regulations Title 21 which governs supplement labeling...

Dietary Supplement Labeling Guide: Chapter IV. Nutrition Labeling

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Amounts

    If the calcium carbonate in my product supplies calcium , should I list the weight of the entire salt or just of the calcium?

    You must list the weight of calcium, rather than the weight of the calcium carbonate, the source ingredient, in the "Supplement Facts" panel.

    21 CFR 101.36(b)(2)(ii)

Hope this helps.

Take care

V/R, Batch

Hey Payg,

Great question and the answer is there is every reason to expect your friend with chronic paroxysmal hemicrania (CPH) has a vitamin D3 deficiency (likely a magnesium deficiency as well), and this deficiency is contributing to her intractable CPH.

Accordingly, I would be surprised if your friend with intractable CPH didn't respond to vitamin D3 and the rest of the anti-inflammatory regimen including a week to 10 day course of Benadryl (Diphenhydramine HCL). 

The first step is to have her see her PCP for the 25(OH)D lab test and discuss the anti-inflammatory regimen.  She can download a copy of the treatment protocol at the following link. 

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Please download a copy and email it to her if possible.  Once your friend has had her blood drawn for the 25(OH)D lab test and discussed this regimen with her PCP, I suggest she start this regimen asap using a 12-Day vitamin D3 loading schedule at 50,000 IU/day for 12 days.

Regarding others with CPH using the anti-inflammatory regimen and experiencing a favorable response... I'm not sure.  As one of the trigeminal autonomic cephalalgias (TAC), CPH is an evil sibling of CH.  The two headache disorders share much in common, so it's entirely possible that some of the 600 to 700 CHers who have stared this regimen since 2011 are likely CPHers.

My theory on the intractable nature of CH and CPH is centered on an underlying allergic reaction.  The pathogenesis of allergic reactions involves allergens attaching to Mast Cells throughout the body and brain.  Mast cells are a special type of white blood cell that's part of the immune system. They are loaded with "granules" containing histamine, prostaglandins and other pro-inflammatory agents.

When allergens attach to mast cells, this triggers the Mast Cells to degranulate releasing the histamine, prostaglandins and other pro-inflammatory agents.  Histamine and prostaglandins have been shown to stimulate the release of calcitonin gene-related peptide (CGRP) from neurons.  Several studies have also found serum concentrations of CGRP elevated during the pain phase of CH, CPH and migraines, but absent during pain free periods.

Accordingly, allergens can trigger a circular chemical chain reaction where histamine and prostaglandins released by mast cells trigger neurons within the hypothalamus and trigeminal ganglia to release CGRP and that signals the pain and inflammation we know as CH. 

It gets worse... CGRP in turn, can also stimulate mast cells to release more histamine which keeps the above circular chemical chain reaction going until one or more of the reactants are consumed and the headache ends... for now...

This is where Benadryl (Diphenhydramine HCL) comes into play.  As a first-generation antihistamine, Diphenydramine crosses the blood brain barrier to block H1 histamine receptors on neurons throughout the brain and in particular, the hypothalamus and trigeminal ganglia.  This inhibits the histamine reaction and that helps stop the circular chain reaction.  Stopping the histamine chain reaction enables vitamin D3 to initiate the genetic expression that downregulates/suppresses the production of CGRP.

Enough of my theory of intractable CH and CPH for now... It's time to get the ball rolling with your friend.

Take care and please keep us posted on your friend's progress should she decide to give the anti-inflammatory regimen a try.

V/R, Batch

Hey Slacker,

Great question regarding alternatives to Diphenhydramine.

As Mike pointed out, there's a big difference between a week to 10-day course of Benadryl (Diphenhydramine) and taking it daily for many years.

I don't have all the answers regarding the efficacy of second- and third-generation antihistamines in counteracting the effects of histamine during an allergic reaction, or in preventing CH.   What I do know is we need to block H1 histamine receptors on neurons within the trigeminal ganglia to prevent a circular chain reaction between CGRP and mast cells containing histamine.  I also know that once that circular chain reaction starts, we're in for some heavy sledding until one or more of the chemical reactants runs out and the CH stops...

The problem with second- and third-generation antihistamine alternatives to Diphenhydramine HCL is they were designed to be "Non-Drowsy" so their molecular size, shape and function prevents them from crossing the blood brain barrier...  That means these second- and third-generation antihistamines will be less effective or not effective at all in blocking H1 histamine receptors on neurons within the brain and in our case as CHers, neurons within the trigeminal ganglia.

Now, with that said, some of the second-generation antihistamines may have the capacity to cross the blood brain barrier with a high enough concentration to block enough of the H1 histamine receptors to help us out...  That will take some dedicated experimentation.  In the mean time, a week to 10 day course of Diphenhydramine shouldn't pose a significant risk.

It's also becoming clear as more CHers take the online survey, that some of us need a higher maintenance dose than 10,000 IU/day vitamin D3 and a resulting higher 25(OH)D serum concentration.  Survey data to date indicate episodic CHers need an average 25(OH)D serum concentration of 80 ng/mL to remain CH pain free while chronic CHers need an average 25(OH)D serum concentration of 100 ng/mL to remain CH pain free. 

I'm a chronic CHer and after 3 years of frequent labs for 25(OH)D, I've maintained an average 25(OH)D serum concentration of 140 ng/mL.  My PCP is comfortable with this as long as my serum calcium remains within its normal reference range and my PTH is in the lower third of its normal reference range.

If you connect the dots... it appears a higher dose of vitamin D3 and higher responding 25(OH)D serum concentration may be effective in preventing CH even with an allergic reaction cooking away...

Please understand I'm not suggesting CHers maintain a 25(OH)D serum concentration higher than 100 ng/mL without having a PCP willing to assist with more frequent labs for serum calcium and PTH.

Hope this makes sense...

Take care,

V/R, Batch

Bump