Hey Angelic,

Your serum concentration of 25(OH)D3 is just fine.  I exchange survey data with Dr. Gominak on a regular basis and have incorporated the 3-month course of vitamin B50 in the anti-inflammatory regimen at her suggestion.

Your problem at this point is likely another comorbid condition that's sucking up vitamin D3 and its metabolites at a high rate leaving too little remaining to prevent your CH through genetic expression.

The most common comorbid condition is an allergic reaction.  Allergic reactions are frequently sub-clinical, i.e., no outward or obvious symptoms... but it is still there.  Allergic reactions release a flood of histamine that triggers the release of CGRP from the trigeminal ganglia. CGRP stimulates neurogenic inflammation and CH pain.  The CGRP also stimulates the release of even more histamine...  In a sense, this ends up in a perfect storm that continues until the chemical reactants are used up... and this ends the CH attack... for now...

Fortunately there's a simple solution if the problem is an allergy.  Benadryl (Diphenhydramine HCL) is a first-generation antihistamine that crosses the blood brain barrier to block H1 histamine receptors on neurons throughout the brain including the trigeminal ganglia. This stops the hystamin - CGRP cycle and that allows vitamin D3 to prevent CH through genetic expression.

I've found that a 25 mg tablet of Diphenhydramine in the morning and another 25 mg tablet in the evening after dinner works wonders.  Don't drive if you're taking Diphenhydramine as it will make you drowsy.  If you need to drive during the day, taking 50 mg in the evening is just as effective.

The other possible problem is a low grade viral infection that triggers the immune system into action.  This also consumes vitamin D3 and its metabolites at higher rates leaving too little to prevent CH.  A solution here is to take a 1000 mg tablet of vitamin C every two hours throughout the day for a total of 5 to 6 tablets.

Finally, a 25(OH)D serum concentration of 91 ng/mL may not be high enough to prevent your CH.  There are several CHers who maintain a 25(OH)D serum concentration around 150 ng/mL under a physician's supervision with frequent labs.

Accordingly, the solution here is to bump the maintenance dose of vitamin D3 from 10,000 IU/day to 15,000 IU/day for a few weeks to a month.  This will result in a 25(OH)D response up around 120 ng/mL.  This is not a problem as long as your serum total calcium remains within its normal reference rang.

If you need to do this, work with your PCP to schedule regular labs for serum 25(OH)D, total calcium, and parathyroid hormone (PTH) as long as your 25(OH)D is over 100 ng/mL. 

For reference, my wife has taken 15,000 IU/day vitamin D3 for the last 5 years to prevent her migraine headaches.  Her 25(OH)D averages 125 to 135 ng/mL and her serum total calcium remains within its normal reference range.

I hope this helps...

Take care and please keep us posted.

V/R, Batch