Wow! Great posts and great questions... I'll try to address them in order...

Patti, as I indicated in the earlier post, I'm comfortable with a 25(OH)D serum concentration up to 200 ng/mL...  I've had it that high for a few weeks with no problems.  My serum calcium remained well within its normal reference range and my PTH was in the lower third of its normal reference range.  I'm a chronic CHer so have maintained an average 25(OH)D serum concentration at 140 ±50 ng/mL taking an average vitamin D3 dose of 20,000 IU/day for the last three years.  This gets me through the high pollen season with only a few days of Benadryl (Diphenhydramine HCL).  My PCP is ok with my 25(OH)D in this range as long as my calcium and PTH remain in the green.

Accordingly, I would work with my PCP to set up prescriptions for the before and after labs of serum 25(OH)D, calcium and PTH then start titrating the vitamin D3 dose up from the present maintenance dose by 5,000 IU every 3 days until completely pain free for 3 days then stay and that dose for at least 15 days before getting another set of labs.  It's also important to drink 2.5 liters of water a day if you're going to push your 25(OH)D above 120 ng/mL.  This helps flush excess calcium from the kidneys.

Yo Greg, Howzit in Idaho? Great question regarding the calcium supplement, which calcium salt works best and what I take...  Nearly all the vitamin D3 experts say calcium chloride works best primarily due to the low incidence of osmotic diarrhea.  In order after that come magnesium glycinate and magnesium oxide.  The consensus holds that magnesium citrate has the highest incidence of osmotic diarrhea. 

I should point out that I've tried all of the above or I wouldn't suggest them in the treatment protocol. I happen to take the Nature Made High Potency 400 mg liquid gelcaps containing magnesium oxide... I've not had any problems with them, but then I've a cast iron GI tract...  What I've found over the years is if I miss a dose of magnesium, I'll start getting hand/finger and leg cramps. Our bodies consume magnesium during the enzymatic reactions that hydroxylate vitamin D3 to 25(OH)D, and 25(OH)D to 1,25(OH)2D3.  Without magnesium supplements, we can easily end up with a calcium-magnesium imbalance and that leads to muscle cramps.  The cramps clear in a couple hours after taking the magnesium.

Hey JT, you're my kind of CHer... I've taken 100,000 IU of vitamin D3 in a single dose after one of my 25(OH)D burn down tests where I stopped taking vitamin D3 until I got hit... Just don't stay at 80,000 IU/day vitamin D3 for too long... and be sure to drink 2.5 liters of water a day...  A trip to your PCP for labs of your serum 25(OH)D, calcium and PTH is also in order after you've stabilized at a new maintenance dose for a couple weeks.

Have you completed the 3-month course of vitamin B 50 Complex?  This was a topic of interest with Dr. Stasha Gominak at the 20th Conference on Vitamin D3 last March in Orlando, FL.  She now suggests her headache patients stay on the vitamin B 50 complex year round.  If you're taking the Kirkland brand 50+ Mature Multi, you should be getting sufficient amounts of the B vitamins...  The Mature Multi formulation also contains chromium picolinate recommended by Dr Coimbra in his vitamin D3 regimen used by MS patients to prevent outbreaks.

Regarding the Benadryl (Diphenhydramine HCL)... Many allergic reactions are subclinical, i.e., no outward or obvious symptoms yet they're still there triggering mast cells to degranulate dumping histamine into your system... The histamine triggers neurons within the trigeminal ganglia to express calcitonin gene-related peptide (CGRP).  This is the nasty neuropeptide that stimulates neurogenic inflammation and the pain we know as CH... Accordingly a first-generation antihistamine like Benadryl (Diphenhydramine HCL) crosses the blood brain barrier to block histamine H1 receptors and this stems the release of CGRP.  25 mg of Benadryl (Diphenhydramine) every four hours during the day for a few days will tell you if an allergic reaction is part of your problem in going CH pain free.  Just be careful and not drive while taking this much Benadryl as it will make you drowsy...  If you need to drive during the day, take 50 mg when you get home for the day and another 50 mg at bed time... If there's no joy... i.e., favorable changes in your CH patterns after 3 to 4 days of Benadryl, discontinue...  I'd also start taking vitamin C at a 1000 mg every 4 hours throughout the day to see what happens. Vitamin C is a great antiviral, antibacterial and antifungal agent.

The other items on the check list include starting a good probiotic and a 1000 mg/day Turmeric (Curcumin).

Hope this answers the questions...

Take care and please keep us posted. 

V/R, Batch

Jenna,

I chose the Kirkland 50+ Mature Multi for this regimen as it only has 220 mg of calcium and most of the other vitamin D3 cofactors needed in Vitamin D3 pharmacokinetics and pharmacodynamics in one daily tablet.  I've taken it for nearly 7 years.

As far as the anti CGRP monoclonal antibodies (mAbs) like Ajovy (Femanezumab) and Aimovig (Erenumab) go in preventing migraines... My analysis of their RCT results and the alternative, vitamin D3, indicates $1.50/month worth of vitamin D3 is slightly more effective in reducing monthly migraine days than the $1,725 to $1,800/month mAbs...  You can do your own cost effectiveness analysis...

As far as Benadryl (Diphenhydramine HCL) goes, I would only take it if I hadn't responded to at least the first 5 to 7 days of the 12-Day vitamin D3 loading schedule. No response in that amount of time is a likely indication of an allergic reaction. 

An allergic reaction to CHers is like kryptonite to Super Man.  It makes nearly all forms of CH intervention ineffective.  If adding the Diphenhydramine does work to reduce the frequency of CH, start looking for the allergen causing the problem avoid exposure to it.

Take care and please keep us posted.

V/R, Batch

Hey JT,

Sorry the CH beast has been jumping ugly.  What you're experiencing happens from time to time to all of us taking the anti-inflammatory regimen.  It's likely due to an allergic reaction.  This time of year the culprit allergen is likely leaf mold spores but it could be due to dietary sources like wheat products.

The best course of action is to start a vitamin D3 loading schedule at 50,000 IU/day and continue at this dose until you experience a significant reduction in the frequency of your CH or a lasting pain free response for at least 48 hours.  At that point you can drop back to your usual maintenance dose of vitamin D3. Remember to double the magnesium dose to 800 mg/day split 40 mg with breakfast and 400 mg with the evening meal. while loading D3. 

30 days after starting this loading schedule, see your PCP/GP for labs of your serum 25(OH)D3, calcium and PTH.  As long as your serum calcium remains within its normal reference range, there is no vitamin D3 intoxication/toxicity.  It's best to have your PCP/GP write the lab orders for the nearest Quest Diagnostics.  They us the Liquid Chromatography Dual Mass Spectroscopy (LC-MS/MS) assay method.  It has a maximum reading of 512 ng/mL where the DiaSorin assay is only good to 117.4 ng/mL.

The Quest Diagnostic labs you want are:

25-Hydroxyvitamin D3 [25(OH)D3].  Quest Diagnostics Test Name: 92888 - QuestAssureD 25-OH Vitamin D (Total), LC/MS/MS CPT Code 82306.

Parathyroid Hormone (PTH) Intact and Total Calcium. CPT codes 83970, 82310.

Taking Benadryl (Diphenhydramine HCL) at 25 mg every four hours throughout the day for a max of 10 days might help.  Just be careful and not drive as this much Diphenhydramine will make you drowsy.  If you need to drive or be sharp as a tack duringu the day, wait until you're home then take 50 mg as you walk through the door and another 50 mg at bedtime.

It's essential to take all the supplements in this regimen within 10 to 20 minutes after finishing the largest meal of the day.  Stomach acid will be highest at this point and that helps ensure these supplements are properly broken down for absorption when the reach the small intestine. 

Diet and in particular sugar and wheat products (bread, pasta, crackers, cookies and pizza) should be avoided completely until you've been back CH pain free for at least a week or two.  Even then I'd avoid all sugars and limit wheat products.  I would also start a course of a good probiotic.

Take care and please keep us posted.

V/R, Batch

Hey JT,

Thanks for the feedback.  That your CH came back when you stopped the Benadryl (Diphenhydramine HCL) is actuall a good sign.  It tells us you're battling an allergic reaction to something in your environment or the food you're eating.

The solution that has worked best for CHers in your situation is to start loading vitamin D3 at 50,000 IU/day and continue loading until you've experienced at least 24 hours CH pain free.  If you haven't done so, many CHers have found switching to the Bio-Tech D3-50 water soluble 50,000 IU vitamin D3 capsules cut the time to CH pain free results.  The D3-50 capsules are faster acting with a higher bioequivalence in elevating serum 25(OH)D3 than the same dose of the oil-based liquid softgel vitamin D3 formulations.

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Be sure to double the magnesium intake from 400 mg/day to 800 mg/day split 400 mg with breakfast and 400 mg with the evening meal.  Take all the other vitamin D3 cofactors with the evening meal.

When you've been CH pain free for 24 hours, drop back to a maintenance dose of 10,000 IU/day if taking the liquid softgel form of vitamin D3.  If you're taking the Bio-Tech D3-50, drop back to a maintenance dose of one (1) D3-50 capsule a week.  It's a good idea to see your PCP/GP for lab tests of your serum 25(OH)D3, calcium and PTH 30 days after you've stopped loading vitamin D3.  As long as your serum calcium remains within itss normal reference range, there's no hypercalcemia, a.k.a., vitamin D3 intoxication/toxicity.

All the supplements in this treatment protocol should be taken within 10 minutes of finishing the largest meal of the day. The reason for doing this is simple.  Stomach acid content is highest at this point and that helps break down the food you've eaten as well as the supplements for better absorption. 

Depending on the meal size and fat content, the pancreas starts squirting pancreatic juices into the duodenum in as little as 30 to 40 minutes after eating.  These juices are high in bicarbonate (like Arm & Hammer Baking Soda) and this neutralizes the hydrochloric acid so it can pass into the small intestine.  Accordingly taking these supplements more than 30 minutes after eating may cause them to pass into the small and large intestines undissolved so will do little good.  The following X-Ray illustrates three days worth of two calcium tablets/day taken on an empty stomach.  As you can see all six tablets are still undissolved in the large intestine.

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Diet is also an important thing to change at this point as the allergen(s) causing your problems may be dietary.  Accordingly, it's best to cut out all sugars and fruit juices.  Avoiding all wheat products is also essential.  That means no bread, pasta, cookies, crackers or pizza starting now and lasting for at least a month after a 24 hour CH pain free response.

Take care and please keep us posted.

V/R, Batch

Hey JT,

Thanks for the update.  I've been in your shoes...  "Do I take more vitamin D3 or what?"  The first thing to remember about vitamin D3 therapy is it is not the dose that counts, but rather the 25(OH)D3 response and of course, a cessation of your CH attacks.

That's a not so subtle hint to see your PCP/GP for lab tests of your serum 25(OH)D3, calcium and PTH ASAP!  If your serum calcium is still within its normal reference range and even if it's up against the upper limit...  continue loading vitamin D3 at 50,000 IU/day then taper the dose to find how much you need to remain CH pain free then test again. 

Have your PCP/GP order your labs from the nearest Quest Diagnostics collection site.  You may as well have your PCP/GP write two sets of lab orders.  One now and the second 30 days later.  The orders should be written as follows:

• 25-Hydroxyvitamin D3 [25(OH)D3]. CPT Code 82306. Quest Diagnostics Test Name: 92888-QuestAssureD 25-OH Vitamin D (Total), LC/MS/MS.

• Parathyroid Hormone (PTH) Intact and Total Calcium. CPT codes 83970, 82310.

You can also pick up some 3 mg boron tabs and take one a day.  Boron down-regulates the expression of Vitamin D3 24-Hydroxylase (CYP24A1).  This is the enzyme that hydroxyates (Adds a hydroxyl [OH] group) to vitamin D3, 25(OH)D3 and 1,25(OH)2D3.  This starts their destruction and eventual elimination down the dumper so they become useless in preventing CH.  The net effect is lower serum and cellular concentrations of vitamin D3 and its metabolites 25(OH)D3 and 1,25(OH)2D3.  Without 1,25(OH)3D3 we have no effective CH prevention regardless of the vitamin D3 dose. 

Accordingly, taking 3 mg/day boron helps preserve oral vitamin D3 and its metabolites resulting in a higher serum vitamin D3 and 25(OH)D3 concentrations. This translates to higher cellular concentrations. The mechanism of action underlying vitamin D3 and its capacity to prevent CH involves vitamin D3 and 25(OH)D3 passing through the blood brain barrier and into neurons within the trigeminal ganglia.  Once there, they are further hydroxylated to 1,25(OH)2D3 the genetically active vitamin D3 metabolite that down-regulates the expression of CGRP, SP, VIP and PACAP preventing our CH.

As far as being in your shoes goes...  I got hit with a major allergic reaction to mold spores in June of 2018.  My 25(OH)D3 serum concentration was upwards of 140 ng/mL at the time to get through the spring pollen season, so was a little surprised, but I continued loading at 50,000 IU/day for over a week along with the Benadryl at 25 mg every four hours during the day until I experienced a CH pain free response.  Here's a chart of my labs for 25(OH)D3, Calcium and PTH over the past three years.

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I keep my PCP in the loop on all this so asked for labs every 90 days.  My PCP understands my need to take higher doses of vitamin D3 and has no problem with my 25(OH)D3 being as high as (188 ng/mL) as long as my serum calcium remains within its normal reference range... and it has.  It's also important to note that my serum PTH trace mirrors serum calcium. 

This is a classic indication of calcium homeostasis in action. As the serum calcium goes up, serum PTH goes down.  This results in less 25(OH)D3 being hydroxylated in the kidneys to 1,25(OH)2D3 and as this genetically active metabolite pulls calcium from the gut and bones, less calcium is pushed into the bloodstream to keep its serum concentration within its normal reference range. I also use MyQuest at the following link to review my lab results.  Open an account...  its free.  Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Bottom line... See your PCP/GP for lab tests of your serum 25(OH)D3, calcium and PTH.  If your serum calcium is still within its normal reference range, load away with 50,000 IU/day vitamin D3 and add 3 mg/day boron.  Test again once you've reached a CH pain free state and have found a lower vitamin D3 dos that keeps you there.

If you haven't eliminated all wheat products and sugars, now would be a good time to do so.

Hope all this makes sense.

Take care and please keep us posted.

V/R, Batch

Hey William,

Thanks for the update and kind words.  It's exchanges like this over the last 9 years that have enabled me to compile a working knowledge base of CHers taking the anti-inflammatory regimen including how it works, when it doesn't work, why and what to do when it doesn't work.

You took the words out of my mouth about ECHers staying on this regimen year round so I won't belabor that point.  What I will say is in the absence of vitamin D3 intake and no cutaneous vitamin D3, the average adult burns through 15 ±5 ng/mL of 25(OH)D3 per month. 

That means if your 25(OH)D3 serum concentration was 80 ng/mL while taking this regimen and the average 25(OH)D3 CH threshold is 60 ±10 ng/mL below which you get hammered, 2 months without vitamin D3 lowers your serum 25(OH)D3 to 50 ng/mL.  Accordingly if you're hit with an allergic reaction any time after that... the CH beast is going to jump real ugly in no time at all.

That your most recent CH was most likely due to an allergic reaction is a no-brainer...  What caused the allergic reaction is another story.  It could be your walk to a waterfall.  They have a habit of putting out mist and nano droplets loaded with lots of mold and moss spores from the moss and ferns growing around the falls.  It could be the Mexican food and it could be the two draft cervezas. 

Allergic reactions can be subclinical with no outward or obvious symptoms - unless you're a CHer in which case it's like Kryptonite to Superman triggering the CH beast to jump real ugly.

As this appears to be a one-off occurrence, I wouldn't worry about the cause and focus instead on the treatment.  The tried and true course of action in this case is to start loading vitamin D3 at 50,000 IU/day, double the magnesium to 800 mg/day split AM/PM along with all the cofactos take with meals (10 to 20 minutes after eating) and start a week to 10 day course of Benadryl (Diphenhydramine HCL) at 25 mg every 4 hours throughout the day. 

When you've been CH free for at least a week to 10 days, taper the vitamin D3 dose back down to your usual maintenance dose over a two week period.  This much vitamin D3 should elevate your serum 25(OH)D back up well above the 25(OH)D3 CH triggering threshold of 60 ±10 ng/mL.

30 days after you start loading vitamin D3, it's prudent to see your PCP/GP for lab tests of your serum 25(OH)D3, calcium and PTH.

Regarding the vitamin B complex...  The latest change to the anti-inflammatory regimen will include switching to the Bio-Tech D3-50 50,000 IU water soluble form of vitamin D3.  I and many other CHers have found it to be faster acting with a higher bioequivalence in elevating serum 25(OH)D3 than the same dose of the oil-based liquid softgel vitamin D3 formulations.

I'm also suggesting METHYL FOLATE + by One Elevated as it contains the B complex we need in the most bioactive forms.  30 days should be sufficient.  After that there's ample B Complex in the Kirkland brand Adult 50+ Mature Multi.

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Take care and please keep us posted.  Again it's the feedback that helps make this regimen and treatment protocol better for the next CH.

V/R, Batch