A detailed explanation because you deserve detailsSince a lot of responders seem to be skeptical about the Vimovo/D3/melatonin approach, I decided to explain how I arrived at it in the first place, and to provide additional details about it.
BlackLab, I completely understand that there will be people who can't take Vimovo (Naproxen+Esomeprazole Magnesium). My comment about Verapamil is based on personal experience, as well as my own neurologist's opinion. The fact that I had to get regular blood pressure tests just to be allowed to start and continue taking it should give you some idea of how potentially dangerous it is. My GP was very concerned about me trying Verapamil, and by contrast, she didn't bat an eyelash at me taking Vimovo. Verapamil wasn't very effective for me anyhow. I had to take it at the maximum dosage of 960mg (very nearly the maximum permitted dosage of 1,000mg) in order to see any changes in my CH frequency at all, and at that dosage, I was starting to have trouble concentrating and physically exerting myself. Even climbing a small staircase was wearing me out. I considered that unacceptable, as I'm a relatively fit 46 year old. In the end, Verapamil didn't even completely stop the CHs, so what was the point? Vimovo, by contrast, does not cloud your brain or make you tired/unable to exert yourself. You are entirely yourself, physically and mentally. It has had no more noticeable effect on me than taking an Advil: basically zero. In addition, the naproxen in Vimovo is considered much less associated with cardiac effects than other NSAIDs, and for me, the esomeprazole magnesium negating the potential of naproxen to cause stomach bleeding potential renders it safe enough for me, and clinched the deal as a potential treatment, at least for the short and medium term. I am still on the lookout for something that can do what it does with fewer potential long-term side-effects, but I would point out that even straight naproxen was responsible for fewer fatalities in 2014 than Ibuprofen, the main ingredient in Advil, so I hardly consider it to be a 'dangerous' substance.
Obviously, if you have any of the medical conditions or risk factors mentioned by the manufacturer of Vimovo, you will need to speak with your doctor before considering it. Now that I'm CH-free, I am going to look around for possible alternatives to Vimovo. But I felt it was my civic duty to report what led a chronic sufferer to a CH-free experience with Vimovo to other CH sufferers.
Just a note to those nattering at me about Vimovo: If you're not chronic, you have the luxury of knowing the cycle you're in will probably end. When you're chronic like I was for over a year, the possible side-effects of taking Vimovo seem piffling, as your quality of life is in the toilet. You want the pain to stop, and you'll do whatever it takes to make it stop. What I'm offering is advice on possibly the least dangerous way to do this there currently is, so please bear this in mind when sniping. The idea is not to stay on Vimovo for the rest of my life, but to use it as a 'big gun' to just make the damned CHs stop and stop for an extended period of time. On this count, it has, in combination with the rest of my routine, been 100% effective. Note that I said '100%' and not some lower figure. I have had NOT ONE (not even a little, tiny level 1 CH--even that sensation which preceded a CH and lingered after the pain left, or shadowing, is now absent) in 3 months on this routine.I do think the Batch D3 regimen is on the right track--the anti-inflammatory track--it just wasn't quite effective enough on its own for me, and that's why I'm posting this supplemental anti-inflammatory treatment in this thread. I don't know if Vimovo 500/20s would stop CHs by themselves, as I haven't tested that, but as a major component of an over-all anti-inflammatory routine, including a rigorous attention to regulating my sleep patterns with strong (10mg) melatonin tablets, I'm merely reporting that I'm CH-free, and I wasn't CH-free on just the D3 regimen after over two months of meticulously following it.
The story
So, after a month and a half of taking the full Batch D3 regimen, and finding that it was not stopping my CHs, I felt I had to resort to some kind of anti-inflammatory supplementation. I based my research on the basic premise behind Batch's regimen, which is that CHs are caused by an inflammation response in our bodies. After all, many people had reported success with the Batch D3 regimen, it just hadn't been as effective for me, and several others in that thread have also reported less than stellar efficacy.
What actually causes inflammation?
Since many had reported success using Batch's anti-inflammatory D3 regimen, I believed the essential approach was sound, but perhaps, just not potent enough: that CHs are caused by inflammation, and specifically, inflammation of the tissues surrounding the trigeminal nerve. I believe that during a cluster attack, the tissues around the trigeminal are swelling, constricting the the nerve in much the same way that a boa constrictor crushes its prey. The immediate question for me as a victim of this torture was simply, what is the proximate cause of this inflammation? What makes your tissues around your trigeminal nerve swell? My reading indicated that prostagladins are responsible for tissue swelling, and that there are two things in your body that produce prostaglandins:
COX-1: responsible for "baseline levels of prostaglandin", and
COX-2, which produces additional prostaglandins through "stimulation". (Multimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
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Bingo! COX-2 is produced on demand by your body in response to tissue stress. In other words, put simply, it's COX-2 that makes your thumb swell if you bang it with a hammer, and my reasoning is that somehow, in CH sufferers like us, SOMETHING is causing the production of too much COX-2, likely on a circadian cycle (or a messed-up circadian cycle) of some kind, and over-production of COX-2, and consequent over-synthesis of prostagladin is causing inflammation in the tissues surrounding our trigeminal nerve.
An arthritis asideIn my case, I also 'lucked out' (if you can call arthritis of any kind 'lucky') in noticing that my right hand joints were starting to get arthritic joint pain around the time that I went from episodic to chronic back in August of 2014. For me, this was another clue that Batch was on the right track with an anti-inflammatory approach. After all, arthritis of the type my doctor says I have is caused by inflammation of the joints. Hmmm. Inflammation! COX-2!
Reducing your COX-2 level is the keySo the issue for me quickly became, if my body is over-producing COX-2, and that's causing excessive prostaglandin production which is now giving me arthritis and CHs, what will inhibit that? Since the vitamin D3 regimen (D3 helps to inhibit COX-2's catalysation of arachidonic acid into prostaglandin) was not eliminating my CHs; (at best, they were somewhat milder, and almost as frequent) I decided it needed some help.
If even extremely high doses of D3 were still not sufficient to stop my CHs, perhaps I simply had far too much COX-2 in my system to begin with. I am chronic after all. So I decided I had to find something that would reduce the amount of COX-2 in my body in the first place: to look for a 'big gun' that would work in partnership with the D3, to help push down my inflammation levels even more and keep them down: a knock-out blow, so to speak, and NSAIDs are that 'big gun'.
NSAIDs are known, effective inhibitors of COX-2. As I've already mentioned, just as a test for my theory that inhibiting COX-2 should halt CHs, I experimented on myself by taking two extra strength Advils (Ibuprofen) every 4-6 hours continuously for 5 days. In the past, and even at the very beginning of my CH odessey back in 2007, I had tried taking Advils to deal with the headaches, but of course, as I quickly discovered for myself, and as my specialist subsequently confirmed, orally-administered Advils don't kick in quickly enough to prevent the onset of a CH (although they did seem to help once they did start to take effect--but of course, I was never really certain it was the Advil that curtailed the duration of a CH, or if the damned thing had just ended on its own), so like all of you, I had long-since abandoned Advil as an effective treatment for a CH onset.
However, what I wanted to find out for this experiment was, would taking Advil on a continuous basis, ie BEFORE I even get the sense of a CH onset PREVENT the CH from happening. So I timed the Advils to approximately an hour before I expected the next CH. This started pushing the CHs around in terms of timing, but didn't stop them altogether, so I decided to go all-out and just take them every 4-6 hours (maximum dosage, though hospitals regularly administer much higher doses of ibuprofen for certain conditions) continuously, for a set period of 5 days. I've always had a cast-iron stomach, so I knew this would not be an issue. Note that immediately preceding this experiment, I was getting at least 1 CH each and every day (often two or even three in a 24 hour period) for over a year, with only the occasional exception, and even then, I never enjoyed more than one skipped CH in a row. The round-the-clock, maximum dose Advil experiment worked like a charm! I did not get a single CH for those 5 days! Could be fluke, I thought. I had been let down many times with different treatment approaches, but I decided to pursue the notion that it HAD worked, just in case.
Round the clock Advil works, but what is a more sustainable NSAID?
So it was then that I decided to find the most sustainable form of NSAID that would do what the Ibuprofen was doing, and based on my own evaluation of the risks, and the fact that Vimovo was both naproxen accompanied by a protein pump inhibitor, esomeprazole magnesium, and was designed as a slow-release, coated formula, I chose to try Vimovo. An interesting coincidence, is that Vimovo is normally prescribed as an arthritis treatment! So I made an appointment with my neurologist and told him my idea. He said that, as he did not have anything known to be effective as a treatment for chronic CHs, he was willing to write me a prescription for Vimovo. I went out and filled it that same afternoon, and started taking the maximum dosage of 2x500/20mg Vimovo every day on Oct. 15th, while also continuing to take 10,000iu Vitamin D3, a Centrum multi-vitamin, 10mg melatonin each night after sundown, and making myself go to bed between 9-12am, even if I had to also take a sleeping pill (Trazadone in my case.) My symptom diary says I had 9 CHs from Oct. 15th to Nov. 2nd, and then nothing. I have not had a single CH since Nov. 2nd of 2015 (I am not exaggerating--I mean not a single, solitary CH, not even the sense of a strong shadow, although I've noticed a couple of very minor shadows when I have tried going for more than 4-5 days without any Vimovo).
Do I think this is the magic cure for CH, and no further work needs to be done? Of course not. Is it a substitute for the D3 regimen? No. But if you can take it (ask your doctor/PHP) and especially if you are chronic, this may be the only thing that gives you your life back, as it has done for me.
Role of regular sleep
As part of a comprehensive, all-out assault on anything that could cause inflammation in my body, in addition to the Vimovo, I also decided to get very serious about regulating my sleep schedule. Ever since I was a teenager, I have had trouble falling asleep consistently at a set bedtime (I've had enough experience since my first definite CHs in 2007 to know that staying up late almost guaranteed CHs/stronger CHs). So I decided, in addition to taking the Batch D3 regimen, and the Vimovo, to get something that would knock me out to sleep, if necessary (trazadone), and something that would keep me asleep if I didn't take a trazadone (melatonin). To further guarantee sleep success, I even got a prescription for Tramadol in order to eliminate the possibility that a CH might wake me up an hour into sleep. I only took 2-3 of these over the course of the preliminary period Oct. 15th-Nov. 2nd. They are an opioid, so not recommended for any sustained use, but the sure as hell kept me asleep when a CH might well have woken me up!).I had found that the 1mg or 1.5mg melatonins were not strong enough to keep me asleep, so I found 10mg melatonin tablets at Costco (Nature's Path 10mg). These do an admirable job of this.
So my approach from Oct. 15th of last year can be summarized as:
1) Daily use of Batch D3 regimen (10,000iu of Vitamin D3 if nothing else).
2) 2 Vimovo 500/20mg per day, always with meals, while trying to break the chronic cycle, then 1 Vimovo 500/20 (or less) for maintenance. (I am still experimenting with how many days I can go without the Vimovo, just taking the D3/melatonin--I can now go several days at a time before sensing any shadows; that I should take a Vimovo).
3) Sleep regulation, using 10mg melatonin, and occasionally, using trazadone to make me unconscious if necessary. (I even got a prescription for Tramadol in order to help me sleep--only took 2-3 of these over the course of the preliminary period Oct. 15th-Nov. 2nd, to keep me asleep in the event of a CH). This involves going to bed around the same time and getting up whenever you need to, but sleeping in is absolutely recommended whenever possible. You can never get 'too much sleep'. That is a myth. Your body will never sleep longer than it needs to! This is important!
It took about 18 days to completely stop the CHs, but after Nov. 2, not a single CH. I scaled back the Vimovo to 1 500/20mg tablet per day, and have tried 2 or 3 times cutting out the Vimovo, and just taking the D3+multivitamin and the sleep regulation routine. So far, no CHs, but I have resumed the once daily Vimovo whenever I have sensed a shadow, which is also often accompanied by additional arthritic soreness in my right hand. I am now experimenting with taking only 1 Vimovo whenever I have the vague sense of a shadow, and then going more days to see how long I can go before the next vague sense of a shadow. Note that these are not full-on shadows, like I would get before an actual attack. These are even less intense that those. They're more like a hint of a shadow, which is more than enough!
All I know is that this Vimovo/D3/melatonin routine has worked flawlessly for me for over three months now. Not a single CH. I don't know how much of a role the various parts of my routine play in the cessation of my CHs, but probably, all of them are needed. It's possible there is a synergy between the D3 and the Vimovo. I have not tried stopping the D3, so I don't know.
Believe me, as a fellow CH sufferer, I would not lie about my results to fellow sufferers. What would be the point? I promise that if anything changes, and the treatment routine I'm following suddenly proves itself ineffective, I will update everybody.
I don't know how helpful this will be for episodic sufferers, though I'd venture to guess that it will work for you, too. But if you are a chronic CH sufferer and you can do what I'm doing: if you can get approval from your doctor for Vimovo 500/20mg, and you can take 10,000iu of D3 and get yourself to sleep on a regular sleep schedule, using melatonin and/or something even stronger whenever necessary, to make yourself sleep, you owe it to yourself to try this for at least a couple of weeks. I promise it will not be a waste of your time.