Hey Danny,

Great questions and good on you for switching to the Bio-Tech D3.  It's proving to be very effective for me.  Were you able to obtain the D3-5 (5,000 IU water soluble vitamin D3 capsules) there in the UK?

In response to your questions, a survey of 1134 CHers conducted by Dr. Todd Rozen in 2008 mostly from here at CH.com and Clusterbusters found the following on CH pain location:

Pain location
- 49.1% right-sided
- 44.1% left-sided
- 3.1% bilateral pain: CCH 8.3% vs ECH 1.5%.
- 30.5% stated that pain has changed sides since onset of CH
- 8% stated that pain shifted sides during an individual CH attack

At least two well constructed CH cohort studies did a meta-analysis of triggers and found a change in atmospheric pressure served as a CH trigger.

Have you started your brother on the anti-inflammatory regimen?

Take care and please keep us posted.

V/R, Batch

Hey Danny,

Your 25(OH)D serum concentration at 210 nmol/L is right in the sweet spot 200 - 250 nmol/L for CHers to prevent their CH.  That said, if I was still getting hit, I would try to elevate my 25(OH)D serum concentration to at least 250 nmol/L (100 ng/mL) to see if that reduced the frequency of my CH even more or completely.

Before doing that I would also see my PCP for labs of my serum calcium and PTH.  As long as my serum calcium remained within its normal reference range and was not at its upper limit, that tells me I can safely increase my vitamin D3 daily intake.

As you're likely been taking the Bio-Tech D3-50 at one 50,000 IU vitamin D3 capsule every five days for an average of 10,000 IU/day, I would decrease the dosing interval to one capsule every 4 days (an average of 12,500 IU/day) to see the effect on CH frequency.  If there's a reduction in CH frequency but they're not eliminated completely, I'd reduce the dosing interval to one capsule every three days (an average of 16,666 IU/day) to see what happens.

Data from the online survey of 257 CHers taking the anti-inflammatory regimen indicate that as the 25(OH)D serum concentration increases, a greater percentage of CHers experience a favorable response.  This makes perfect sense as there's also a wide variation among CHers in their 25(OH)D response to 10,000 IU/day vitamin D3.  This variation ranges from a low of 60 ng/mL to a high of 192 ng/mL.  Bottom line... as long as serum calcium remains within its normal reference range and the CHer is still experiencing CH, more vitamin D3 may be better.

The big spoiler in all of this is an allergic reaction.  Allergic reactions trigger the body's mast cells to release large quantities of histamine which in turn triggers neurons to release Calcitonin Gene-Related Peptide (CGRP), Substance P (SP) and Vasoactive Intestinal Peptide (VIP), all of which contribute to the neurogenic inflammation and pain we know as CH. 

It gets worse...  CGRP in turn triggers mast cells to release even more histamine in a circular chemical chain reaction.  This ultimately results in what I call a CGRP cascade that makes nearly every CH intervention ineffective.  This can happen even with 25(OH)D serum conentrations as high as 180 ng/mL.   The best course of action in this case is a first-generation antihistamine like Diphenhydramine or Mepyramine.  You'll need to see your local chemist/pharmacist to obtain them.

These first-generation antihistamines cross the blood brain barrier to block histamine H1 receptors at the genetic layer and this helps stop the circular chemical chain reaction and in the process, enables vitamin D3 to down-regulate the expression of CGRP, SP and VIP to prevent our CH.

Hope all this makes sense.  Take care and please keep us posted.

V/R, Batch

Hey Danny,

Thanks for the update.  Be sure you and your brother ask for labs of your serum 25(OH)D, calcium and PTH after 30 days on the Bio-Tech D3-50.  Even your NHS will approve these lab tests if you tell your PCP you've been taking vitamin D3 up to 50,000 IU/day.

Take care and thanks again.

V/R, Batch