MJ,

The simple solution is to put the kids on this regimen at 50 IU per pound of body weight per day of vitamin D3 AND have your wife start a week to 10 day course of Benadryl (Diphenhydramine HCL).  I'm quite confident maternal instincts will override any drowsiness associated with Diphenhydramine...

My youngest two grandchildren and grand niece have been bathed in maternal vitamin D3 at 10,000 IU/day since concetption and through breast feeding...  They're awesome!

Take care and please keep us posted.

V/R, Batch

Hey MJ,

Your wife is off to a good start on the anti-inflammatory regimen.  She needs to double the magnesium dose while loading to 800 mg/day split 400 mg with breakfast and 400 mg with the evening meal.  10 to 12 hours between magnesium doses =10 to 12 feet of GI tract travel so that minimizes the possibility of osmotic diarrhea. 

I suspect her response to the anti-inflammatory regimen will improve when she completes her steroid taper.  Although vitamin D3 has no effect on the physiological activity of steroids like prednisone, steroids slow vitamin D3 hydroxylation (metabolism) and this will slow the vitamin D3 capacity to prevent CH.  Fortunately, this effect is minimized while loading vitamin D3.

You can safely tell your wife that dehydration increases CH and migraine pain levels.  Drinking 2.5 liters of water a day increases absorption of vitamin D3 conutrients making this regimen more effective. 

If you don't get the Adult 50+ Mature Multi soon, pick up some 3 mg Boron tablets and have her take one a day.  Boron down-regulates 24-Hydroxylase, the enzyme that decreases the effectiveness vitamin D3 by converting it to inactive metabolites the body dumps over the side in urine.

Take care and please keep us posted.

V/R, Batch

Hey MJ,

Thank you for the reply and the wonderful news your wife is CH pain free.  As your wife is already responding to this regimen, it's dealers's choice on taking the extra magnesium.  I say she's responding to this regimen because if she wasn't, the end of her steroid taper wound have been marked with an increase in CH frequency.

That said, as vitamin D3 metabolism consumes magnesium and your wife is taking 50,000 IU/day, it's still a good idea to double the dose while loading vitamin D3.

Please remember to have your wife see her PCP/GP for lab tests of her serum 25(OH)D, calcium and PTH after 30 days on this regimen.  You're looking for an initial 25(OH)D target serum concentration around 80 ng/mL with calcium and PTH concentrations within their normal reference ranges.

Take care and please keep us posted.

V/R, Batch

Hey MJ,

I'm sorry your wife is having such a rough time.  The Rx for oxygen therapy is essential at this point.  Make sure the Rx is written as follows, "Oxygen therapy at a flow rate of 15 liters/minute with a non-rebreathing oxygen mask as an abortive for cluster headache'. 

If it's not written this way, O2 providers will assume COPD is the condition being treated and require your wife's doctor to provide oxygen saturation data.  This will slow down and prevent the Rx from being filled promptly.  The MRI is prudent.

Has your wife started the Atkins-Ketogenic diet with zero sugars and zero wheat products?  This is essential for CHers having trouble kick starting the anti-inflammatory regimen.  Sugars and wheat products tend to stimulate food borne allergic reactions.  During an allergic reaction, mast cells degranulate (dump) histamine and other neuroactive compounds into the blood stream and surrounding tissues.

On a related note, I'd also suggest your wife shift her Benadryl (Diphenhydramine HCL) dosing to 25 mg every four hours throughout the day and 25 mg at bed time. 

The reason for this dosing schema is simple once you understand what's happening.  Histamine released during allergic reactions triggers neurons within the trigeminal ganglia to express calcitonin gene-related peptide (CGRP) that's responsible for the neurogenic inflammation and pain we know as CH. If the histamine H1 receptors are already occupied with histamine, first-generation antihistamines like Diphenhydramine will be ineffective. 

Maintaining a constant serum concentration of Diphenhydramine with frequent doses increases the probability it will find an unoccupied histamine H1 receptor before a histamine molecule arrives. When the majority of histamine H1 receptors have been blocked, the genetically active vitamin D3 metabolite, 1,25(OH)2D3 will be able to down-regulate the expression of CGRP and this is the mechanism of action that prevents cluster headache.

Take care and please keep us posted.

V/R, Batch

Hey Kevin,

As your wife is having a high frequency of CH/day it's very likely she's experiencing a CGRP cascade.  Have her start a week to 10 day course of a first-generation anithistamine like Benadryl (Diphenhydramine HCL) at 25 mg every 4 hours during the day and at bedtime.  Make sure she doesn't drive as this much Diphenhydramine will make her drowsy.  Have her continue the vitamin D3 loading schedule at 50,000 IU/day, double the magnesium to 800 mg/day and bump the Omega-3 fish oil to 4000 mg/day while loading. Above all, make sure she's drinking at least 2.5 liters of water a day.  Soda and coffee don't count.

The rationale for the first-generation antihistamine is she is likely experiencing an allergic reaction to either airborne or food borne allergens.  These allergic reactions are frequently subclinical with no outward or obvious symptoms, but the allergic reaction is still there causing mast cells to degranulate (dump) histmine into surrounding tissues and bloodstream.

Histamine triggers neurons within the trigeminal ganglia to express calcitonin gene-related peptide (CGRP), the nasty neuropeptide responsible for the neurogenic inflamation and the terrible pain we know as CH.  It gets worse.  The CGRP in turn triggers mast cells to dump even more histamine.  This becomes a brutal, circular chemical chain reaction called a CGRP cascade characterized by a high frequency of CH >4/day and frequently up around 8 to 10/day-night. This CGRP cascade continues until one or more of the reactants are consumed at which point the chain reaction stops and so does the CH... for now...  Unfortunately, the body recharges mast cells and neurons with the nutrients to synthesize more histamine and CGRP.  This process takes roughly an hour.  After that, the CH beast is ready to jump ugly and frequently does.

The Diphenhydramine crosses the blood brain barrier (BBB) from the bloodstream into the brain where it enters neurons within the brain to block histamine H1 receptors at the genetic layer.  Blocking these histamine H1 receptors interrupts the circular chemical chain reaction, stops the CGRP cascade and this allows vitamin D3 to further down-regulate the expression of CGRP.

Food borne allergens are actually very common.  The best way to find out if this is the case is to start the Atkins-Ketogenic diet.  There are several recent studies that have found the Atkins-Ketogenic diet is an effective migraine and cluster headache preventative.

This diet is actually very easy.  Start it with a 24-hour fast drinking only water and taking the anti-inflammatory supplements.  When the fast is over, it's zero sugar  (no fruit juices), zero wheat products (Bread, pasta, cookies, crackers or pizza).  Avoid grain oils like Canola and Corn Oil.  Good oils/fats include organic butter, extra virgin olive oil, avocado oil and my favorite, extra virgin coconut oil.

Your wife can eat all the free range organic meats, poultry, eggs and cheese she wants.  A serving or two of wild caught fish a week is great.  She can even eat at Mickey D's if she orders her Big Mac with no bun or fries and drinks water (I do this when I need a Big Mac fix). She can eat all the organic Non GMO green and colored veggies she wants, but should avoid high starch veggies and fruits like potatoes and bananas.  Limit fruits during the first month to a handful a day of dark berries like blackberries, blueberries, raspberries and dark grapes.  Again make sure she's drinking at least 2.5 liters of water a day.

The following chart illustrates responses by day of CHers starting the anti-inflammatory regimen.

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Other things to add if there's no response after a few days on the Benadryl include, 300 mg/day CoQ10, 1000 mg/day Turmeric (Curcumin).

Now is also a good time for your wife to see her PCP/GP for lab tests of her serum 25(OH)D, calcium and PTH.

Take care and please keep us posted.

V/R, Batch

Mike,

Great point.  Mixed headache pathologies have a higher incidence than available open source data would have you believe.  These mixed headache pathologies can also confuse diagnosis as well as treatments, particularly when patients present with both pathologies for the first time.

A CHer in Finland sent me the results of a survey of CHers there who also suffered from mixed headache pathologies.  252 CHers took part in the FaceBook survey, 115 CHers (45.6%) reported they also suffered from Migraines. 13 CHers (5%) reported they've been diagnosed with two additional headache pathologies.  When you consider that half of Finland lies above the Arctic Circle where cutaneous vitamin D3 from sunlight is lowest of any nation, a higher incidence of mixed headache pathologies like this are not all that surprising.

As a side note, I've just started working with two CHers also diagnosed with migraine, one CHer also undergoing chemotherapy, and one migraineur with aura.  Although not a pathology, I'm also working with an episodic CHer who is 4 months pregnant.  All five have started the anti-inflammatory regimen.

Take care,

V/R, Batch

Hey SECA,

Thanks for the feedback.  It's always great to hear another CHer has found this regimen effective in preventing CH.

Thanks again and take care,

V/R, Batch.