Hey Rookie,

Thanks for the feedback and kind words.  It's posts like yours that give the wallflowers dancing the cluster two-step on the side line the motivation to start the anti-inflammatory regimen and stop dancing the cluster two-step...

Take care and please keep us posted.

V/R, Batch

Hey RSI,

Welcome to CH.com and the anti-inflammatory regimen.  Thanks for the kind words and PM.  Hopefully we can discuss the contents of your PM in future posts here at CH.com following the Clusterbuster's Conference in Austin, TX next month.

For starters, it appears you're off to a good start with this regimen.  Off hand, as you're still experiencing CH, I'd suggest a higher maintenance dose of vitamin D3. 

I'd also suggest a week to 10 day course of oral Benadryl (Diphenhydramine HCL) at 25 mg in the am and another 25 mg in the evening.   Just be careful not to drive while taking Benadryl as is will make you drowsy.  If you need to drive during the day, taking 50 mg in the evening is just as effective...

The rationale for Diphenhydramine is you may have an allergic reaction cooking somewhere...  Some of these allergic reactions can be sub-clinical with no outward or obvious symptoms...  but they're still there.

The problem with allergic reactions is they cause a flood of histamine that triggers the release of CGRP from the trigeminal ganglia.  What's even worse is CGRP in turn triggers the release of more histamines.  This results in a self-sustaining perfect storm of CH until the chemical reactants are use up and this ends the CH attack...  During this perfect storm, CHers will be refractory to nearly all forms of CH prophylaxis... 

Fortunately a first-generation antihistamine like Benadryl (Diphenhydramine HCL) crosses the blood brain barrier to block H1 histamine receptors.  Blocking the H1 histamine receptors breaks the histamine-CGRP cycle, stops the histamine perfect storm and this enables vitamin D3 to prevent CH through genetic expression...

Regarding a reduction in the frequency of your CH following strenuous exercise...  I'm inclined to attribute this reduction in frequency to the vitamin D3.  That said, the real question is why does strenuous exercise trigger CH?

I'm of the opinion that arterial pH plays a major role in both the pathogenesis of CH and in the abort process with oxygen therapy at flow rates that support hyperventilation.

During my work in developing new methods of oxygen therapy as a CH abortive, I discovered an upward shift in arterial pH played a significant role in affecting the CH abort. 

The two methods I developed involved using oxygen flow rates that support hyperventilation (25 to 50 liters/minute) or hyperventilating with room air for 30 seconds at forced vital capacity tidal volumes then inhaling a lungful of 100% oxygen and holding it for 30 seconds. You keep repeating either method until the CH abort which averages 7 minutes across pain levels 3 though 9.

Both of these methods result in respiratory alkalosis as a result of intentional hyperventilation that pumps more CO2 from the lungs that normal.  As CO2 exists in the bloodstream as carbonic acid, removing more CO2 than normal reduces the concentration of carbonic acid and this in turn elevates arterial pH making it more alkaline...  hence respiratory alkalosis.

Here's where things get interesting...  The control mechanisms that maintain serum pH between 7.35 and 7.45 involve a process of increasing or decreasing the respiration rate, heart beat rate and constricting or dilating arteries, arteriols and capillaries. 

Almost everything in the human body needs to be maintained in a very narrow range for the many chemical processes within it to work properly. This is known as homeostasis. 

For reference, the body uses a number of homeostatic control mechanisms...  Ever wonder why the normal body temp is 98.6º?  The answer is homeostasis.  There's also calcium, sodium, phosphate, and magnesium homeostasis that maintains the serum concentration of these ions in a very narrow range.

The homeostatic processes that maintain arterial pH are controlled by a small cluster of chemoreceptors and baroreceptors in the carotid bodies located in the two carotid arteries and chemoreceptors in the periphery.

When these receptors detect the partial pressure of CO2 is too low or too high, they signal control centers in the hypothalamus which in turn regulate respiration, heart beat vasoconstriction and vasodilation.

In the case of oxygen therapy with hyperventilation where we've pumped out more CO2 than normal by intentionally hyperventilating, pH homeostasis signals a lower respiration rate, a lower heart beat and it signals the arteries, arterioles and capillaries to constrict. 

All this happens very rapidly as we can elevate our arterial pH from 7.35 to 7.45 and higher in a matter of 3 to 5 minutes as we continue intentionally hyperventilating.  The rapid vasoconstriction made possible with these two methods of oxygen therapy play a key role in the CH abort process.

The combined effect of these homeostatic control mechanisms during normal respiration, slows the loss of CO2 from the lungs allowing the arterial CO2 partial pressure to rise back to normal.

The exact opposite occurs if the partial pressure of CO2 is too high...  For CHers, this can be a trigger as excess CO2 triggers a very rapid vasodilation...  part of the CH pathogenesis... 

This also happens during deep sleep where the respiration rate is lowest allowing the partial pressure of CO2 to rise and the partial pressure oxygen to drop.  As CHers in cycle or near the tipping point... we get hit and wake up with the cluster beast jumping ugly...

Getting back to CH triggered by strenuous exercise...  A byproduct of strenuous exercise is lactic acid...  During normal physical activity, there is sufficient oxygen to metabolize glucose to CO2 and water.  This is called aerobic glycolysis.  However, during strenuous exercise muscles cannot get enough oxygen so breakdown glucose to lactic acid in what is called anaerobic glycolysis. 

For CHers near the tipping point for a CH, strenuous exercise can result in a perfect storm with excess CO2 and lactic acid, both of which trigger rapid vasodilation throughout the body... including the trigeminal ganglia...  a CH trigger.

Sorry about the long-winded explanation, but that's my take on why strenuous exercise can trigger CH.

Take care,

V/R, Batch