Hey Unclebbq,

Thanks for posting your results after starting the anti-inflammatory regimen with 10,000 IU/day vitamin D3.

Joe is correct...  It's true...  This regimen is that simple... and it works!  The evidence is mounting with sufficient numbers and statistical significance, that the relationship between a vitamin D3 insufficiency/deficiency and cluster headache is clearly causal and not just a coincidence...

At this point I think it's safe to say that cluster headaches, and likely the other trigeminal autonomic cephalalgias including migraines, are either a direct result of a vitamin D3 deficiency/insufficiency or their triggering mechanism(s) are aggravated by this condition lowering the triggering threshold.

If you stop and think about it, this is essentially no different than rickets, osteomalacia or osteoporosis being caused by the same vitamin D3 deficiency.

The important thing to remember is the anti-inflammatory regimen with vitamin D3 is not a cure...  If you're a chronic CH'er and you stop the intake of supplemental vitamin D3, your cluster headaches will return within a matter of 10 days to two weeks.   

If you're an episodic CH'er and you stop the intake of supplemental vitamin D3, your cluster headaches will return with your next regularly scheduled cycle.

Bottom line...  It's prudent to take this regimen for life...  The odds are you'll likely live longer too.

Brew is also correct...  This regimen doesn't work for all CH'ers...  That said, the present efficacy is 81%, up from 75%, and edging higher so we are learning how to make it effective for an even greater percentage of CH'ers who start this regimen. 

Determining why 19% of the CH'ers who start this regimen don't experience a favorable response takes up a lot of my time.  It's been worth the effort because we do have some fascinating answers...

Based on my analysis of related posts here at CH.com, the online survey of CH'ers using this regimen, PMs, email, Skype and phone calls with CH'ers having problems achieving a favorable response, I've come up with likely reasons that fall into three categories:

The first category was easy to spot.  Too many CH'ers give up and stop taking the anti-inflammatory regimen after a few weeks or less when they don't have a favorable response. 

It's this category where feedback from other CH'ers and lessons learned have resulted in the most progress...

• Knowing that 5% of the CH'ers taking this regimen don't respond until they've been taking this regimen for a month or two has given several CH'ers hope and courage to stick it out a little longer.

• Getting tested for 25(OH)D after a month on this regimen, no matter if there was a favorable response or not, has also helped.  Knowing their 25(OH)D serum concentration was below the "green zone" (60 to 110 ng/mL), where 81% of CH'ers respond, also motivates CH'ers to stick it out a little longer.

The final area of helpful feedback and lessons learned, deals with "Tuning" this regimen.  Tuning includes:

• Take vitamin D3 and Omega 3 fish oil with the largest meal of the day - This improves absorption

• Vitamin K2 (MK-7) plays a far more important than originally thought. Vitamin K2 is an important part of calcium homeostasis and vascular health. It works in concert with vitamin A to make vitamin D3 even more effective. The latest data on vitamin K2 (menaquinone-7 (MK-7) indicates we should take between 100 µg/day up to 1000 µg/day (1 mg/day) menaquinone-7 (MK-7) to send calcium to the bones and away from the arteries to prevent plaque buildup.

• Without vitamin A at RDA, the peripheral or autocrine path of vitamin D3 metabolism where 25(OH)D is converted to 1,25(OH)2D3 at the cellular level throughout the body would not be possible.  It's becoming more evident this path of vitamin D3 metabolism is an essential part of the mechanism of action that prevents our CH

• Use a more aggressive vitamin D3 dosing strategy and so far we have two that appear equally effective:

[1.] 20,000 IU/day vitamin D3 + a 50,000 IU loading dose once a week.  Maintain this dosing schedule for a month then get your 25(OH)D serum concentration tested.  If you're in the green zone by then, drop back to a maintenance dose of 10,000 IU/day.

[2.] 50,000 IU/day vitamin D3 X 2 weeks followed by 20,000 IU/day X 2 weeks then get your 25(OH)D serum concentration tested.  If you're in the green zone by then, drop back to a maintenance dose of 10,000 IU/day.

• Stopping the calcium intake for a couple weeks has also made a difference for some.

• The final area of tuning doesn't involve any of the supplements in this regimen but rather arterial/systemic pH.  Our normal pH range of arterial blood is 7.35 to 7.45.  As the pH drops to the lower end of this range towards 7.35 making the blood more acidic, the body's homeostatic mechanism that tries to keep arterial pH near 7.4 cuts in.  It signals the arteries, arterioles and capillaries to dilate, the heart to beat faster and the respiration rate to increase.  This speeds up the flow of blood to the lungs in order to pump out as much CO2 as quickly as possible as the body senses the low pH is the result of too much CO2.  Accordingly, if the arterial/systemic pH is at the low end of the normal reference range or below, the increased level of acidity results in a constant state of vasodilation which in turn makes nearly all CH abortives and preventatives much less effective and in some cases, totally ineffective.  The best way to test for this condition is to take a couple Alka Seltzers or a baking soda tonic four times a day and right before bedtime...  You make this tonic with a half teaspoon of good old Arm & Hammer baking soda in 4 ounces of water.  If either of these antacids result in a decrease in the frequency of CH, then a longer term solution of an alkalizing diet or GOMBS diet consisting of Greens, Onions, Mushrooms, Beans/Berries and Seeds may be effective.

The second category of reasons why some CH'ers don't respond to this regimen is due to comorbid medical conditions that either interfere with vitamin D3 metabolism, calcium homeostasis, or both.  These include insufficiencies of the:

• Liver

• Kidneys

• Thyroid

• Parathyroid

• Pancreas

• GI Tract

Bacterial and viral infections as well as allergies can consume 1,25(OH)2D3 (calcitriol) making less of this active hormonal metabolite of vitamin D3 available to prevent our CH. 

The lesson learned here is simple.  Even though vitamin D3 helps prevent colds and flu, when we do have one of these viral infections or even a bacterial infection, our immune system gobbles up 25(OH)D at a much higher rate...  That means a maintenance dose of 10,000 IU/day vitamin D3 may not be sufficient to prevent our CH...  so we need to add 5,000 to 10,000 IU/day vitamin D3 to the existing maintenance dose.

The third category of reasons why some CH'ers don't respond to this regimen is still not clear and there are few answers.  Here is what we know so far:

• It's characterized by no change in CH patterns even with a 25(OH)D serum concentration in the green zone.

• Some CH'ers in this category are taking vitamin A at RDA and have tried tuning their magnesium and calcium intake

• Nearly all the CHe'rs in this category are forced to use abortives like imitrex, and wide range of preventatives

• Many CH'ers in this category have either suffered a previous head injury or had neurosurgery.  They also have difficulty making oxygen therapy work effectively

We'll need more information to get our arms around the reasons why CH'ers in this category don't have a favorable response.

In closing, I urge CH'ers who have been on this regimen for at least a month to take the Anti-Inflammatory Regimen Survey if they've not already done so. 

I've had several physicians look at the raw data from this survey and they all commented this is exactly the type of information needed to get the ball rolling on an RCT and to attract the required funding.  See the following link for instructions on this survey.

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Take care,

V/R, Batch