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I initially thought the same, but I was wrong, very wrong with my attempt to supplement estrogen. As with you, soon after starting I was under attack. I added progesterone into the mix but no improvement. As I had mentioned in my previous post, zero attacks during pregnancy for me. I even once said I might just stay pregnant forever so that I don't have Headache but life didnt play out that way. During pregnancy there are 6 main hormones in play. Estrogen, progesterone and prolactin increase and stay at higher levels until birth, hcg increases then slowly decreases, oxytocin jumps in at the end, but relaxin jumps up then levels out and gradually reduces again until birth. Now relaxin relaxes blood vessels to increase blood flow. Relaxin also increases prior to menstation to start preparing the uterus for pregnancy. Relaxin kicks in about day 14 and peaks at day 21, then drops down quickly. Now interestingly, my HA cycle always started day 22-23 and lasted two weeks which coincidentally lines up with the increase and decrease in relaxin hormone.. might be onto something here

And that was a goodie.. Post attack eye attached

Hi, I've had PH for 38 years, I've lost count of how many times I've requested oxygen. It is always denied. Up until about 3 or so years ago, there were clear pain free periods between attacks and between cycles. Now I have constant pain, always around a 2-3 level between attacks with attacks several times a day (sporadic) anything from 6-10 level and now there is no cycles, it's all the time. Example today, 1am woken with level 6, took naproxen lasted 20 minutes, went back to sleep, woken again at 3am with a 7 lasted 20 minutes, woke at 5am with another 7, took naproxen lasted about 30 minutes then no point going back to sleep as alarm went off to get up for work at 5.30am. Got to work at 7am, 8am, level 8, off to hide in the bathroom, for 15 minutes, had tried to ride it out at my desk but couldn't. 11.30am another 8, 2pm, another 7, got home at 4.30pm, 5pm rolls around and hit with a 9, more naproxen, ice pack out, off to hide in my bedroom. All the while I have a lingering low level pain between attacks. Today is the worst I've been in a while. Going to hit the indomethicin tonight at bed time. Have had verapamil in the past, did nothing. Very difficult to get anything here in New Zealand. I was misdiagnosed with CH in my teens, was only a few years back of doing my own research that I heard about indo and managed to convince my doctor to let me try it, it worked and from there rediagnosed with PH. Episodic PH has become chronic HC I'd rather try natural solutions, all these medications just make me feel rubbish on top of headaches. I like to be able to function. I've had some success with keto in the past. I only started keto again on 1st January so I'm wondering if this rough patch is just my body working out what I'm doing to it and it will settle down after a course of indo I did have a bit of a carb binge over the Christmas period so that won't have helped. 7pm and another coming on now, off to get ice and go hide out.

@Nikkk I'll echo Craigs kudos for offering your time and skills!! I've lived long enough to become the elder statesman of the forum having been here since our go live date 16 years ago and counting!! That was Oct of 2009 and at that time the only online support sites were OUCH, clusterheadaches dot com which i think DJ launched in 1998.....and DJ was instrumental on getting us online as a yabb powered sister site. Although I've become the senior member, the jeebster AKA @Bejeeber and @CHfather got here in short order! I think Im safe in saying for all 3 of us that those years of the forum before Facebook were vastly different than they are today!! I've made several appeals at past conferences for folks that I personally know and who were once active members to take a little time and comeback and be a part of this community to no avail!! Although we transitioned to the current forum software probably 10 years ago, it is still a "static" type of board vs the "dynamics" of Facebook. As a result the forum has become just a few active members who support the few clusterheads who happen to find us before they find the many support groups on the "Book"! I was able to have a conversation with our fearless leader Bob at our Conference in Dallas this past September regarding the future of the forum.......I walked away from that conversation not anticipating any upgrades!! However, I can't speak for Bob and will definitely bring this thread to his attention!! The real tragedy is that this is the only place that you get reliable, time proven advice on the "clusterbusters protocol" while in the Facebook groups the term "busting" has become so bastardized that the information and advice is often worthless!! I used to keep my eye on those groups but eventually got tired of sounding like a broken record as I tried to offer correct information when I saw bullshit advice being given and finally just gave up posting there!! As to an app, although I've never used one, I know that there are several out there in use......in fact we had a member here several years ago that developed an app called "Nobism" if I'm remembering correctly......but I haven't heard anything about it either here or Facebook in at least a couple years! Once again, kudos and welcome to the community!!

@Ange72, it might be worth trying oxygen, because sometimes it works or at least helps, but as I'm sure you know, that's rare with hemicranias. Similarly, triptans rarely work, but they could be worth trying. We've had some people here with hemicranias mention getting some relief from oxygen and/or triptan injections. Busting sometimes provides some temporary relief (a day or maybe two). Your experience with indo side effects is sadly typical. Other possible treatments for PH that are typically listed are other NSAIDs (aspirin, naproxen and diclofenac); COX-2 inhibitors (celecoxib and rofecoxib); and calcium channel blockers (verapamil and flunarizine). I have read lately that vagus nerve stimulation is helping with hemocranias: one such device is the GammaCore. But really hoping the keto, and D regimen, will make a difference for you. You mention in your post that the headaches are "constant." Did you mean that you have some kind of background pain all day, with eruptions of greater pain, or did you just mean by "constant" that you have many of them every day? (I realize that I might sound here like I might be a doctor or some kind of expert. I'm just reporting what I've seen here and read.)

No I don't need to wait but results shouldn't take too long hopefully. I've never been able to get hold of oxygen unfortunately. I only have indomethicin which I only use when headaches become unbearable as it is horrible stuff. The side effects are not pleasant. In my HC the attacks only usually last 20-30 minutes with the worst of the attack being about 10-15 minutes in the middle. For that I use my icepack, pressure on certain spots on my head and deep slow breathing to relax and just breath my way through it. I've tried various different methods of aborting over the years, but nothing really reacts quickly enough. Most attacks are through the night and I'm usually slow to respond. I try to just go back to sleep hoping it won't actually come to anything. Not usually how it works out though.

Note: This trial is only for people who live near the Netherlands and speak Dutch. Please share it to groups and individuals who may qualify. Deelnemers gezocht: LICIT-onderzoek Kan LSD helpen tegen chronische clusterhoofdpijn? Op dit moment wordt dit onderzocht in het LICIT-onderzoek, dat plaatsvindt in het LUMC in Leiden en in het CWZ in Nijmegen! Waarom LSD? Mensen met clusterhoofdpijn geven vaak aan dat hun klachten minder heftig zijn wanneer ze een lage dosis LSD gebruiken. Dit komt ook naar voren in vragenlijst-onderzoek. Daarnaast werkt LSD op dezelfde soort receptoren in de hersenen als medicijnen zoals sumatriptan en methysergide (Deseril). Er is daarom voldoende reden om te denken dat LSD goed kan helpen tegen clusterhoofdpijn. Maar LSD is nog geen geregistreerd medicijn, daarvoor is meer onderzoek nodig. Daarom wordt onderzocht of een lage dosering LSD effectief en veilig is als behandeling tegen clusterhoofdpijn. LSD is een psychedelische stof die in hoge dosering een "trip" kan veroorzaken, maar bij deze lage dosering gaan deelnemers niet ‘trippen’. Hoe werkt het LICIT-onderzoek? We vergelijken LSD met een placebo. Een placebo is een middel zonder werkzame stof, een ‘nepmiddel’. Deelnemers worden willekeurig ingedeeld. Groep 1: Krijgt 3 weken lang elke 3 dagen een lage dosis LSD (25 microgram) Groep 2: Krijgt 3 weken lang elke 3 dagen een placebo Deelnemen? Heb jij chronische clusterhoofdpijn en wil je deelnemen aan dit onderzoek of heb je vragen hierover? Neem dan contact op: Voor deelname in het LUMC (Leiden): LICIT@lumc.nl Voor deelname in het CWZ (Nijmegen): LICIT@cwz.nl Wat zijn het LUMC en het CWZ? Het LUMC (Leids Universitair Medisch Centrum) en het CWZ (Canisius Wilhelmina Ziekenhuis) zijn ziekenhuizen die gespecialiseerd zijn clusterhoofdpijn. Arts-onderzoekers in deze ziekenhuizen werken veel samen in het onderzoek naar clusterhoofdpijn om zo de zorg rondom clusterhoofdpijn te verbeteren. Zo hebben het LUMC en het CWZ (samen met andere ziekenhuizen) een aantal jaar geleden samengewerkt aan de ICON-trial, dit was een groot onderzoek naar de effectiviteit van ONS (occipitale zenuwstimulatie) bij clusterhoofdpijn. Naar aanleiding van dit onderzoek is ONS toen beschikbaar geworden in Nederland als behandeling van medicamenteus onbehandelbare chronische clusterhoofdpijn.

I don't think you need to wait for the results before starting the Vit D. You can get started now and adjust when you find out what your levels are. I would be willing to put money on that you have low D levels. What do you use for aborting your attacks? Oxygen available?

I have paraxsysmal hemicrania directly linked to hormones. Started age 15, two weeks in cycle, two weeks out. This continued until age 24 when I fell pregnant. I had zero attacks during pregnancy. Exactly 1 week after I had given birth, attacks started again, opposite side, moved from right to left. Attacks for about a year following the birth of my son became sporadic but the attacks were way more intense than I had previously experienced. I went on the depo injection, I found this stopped cycles until about a week before my next injection was due, then once I'd had my next injection the cycle would come to an end. Repeat this cycle until age 43 when GP told me I wasn't allowed depo any longer. Enter perimenopause and for the last 10 years, frequency has gradually increased to now chronic for the last 3 years or so, however attack intensity has reduced. Now post menopause and still constant but less intense attacks. I started on mht estrogen and progesterone November 2024. I had to stop after about 6 weeks as the headache intensity became severe again. Now just battling on. I have had some success with keto previously, not 100% but it definitely helped, I've just started back on keto again so we will see what happens. I have also just had my vitamin d tested, awaiting results, as I intend to start the vit d regimen to see what impact that has.

The whole article can be read here. It's darn fascinating, although the authors are clear that practical applications are likely pretty far off. Advancements-in-Intranasal-Delivery-of-Drugs-for-Cluster-Headache-Treatment-using-Cubosome-Based-Nanocarriers-A-Review.pdf There are a lot more articles about the same technology but different, non-CH, applications here: Advancements in Intranasal Delivery of Drugs for... - Google Scholar Seems to be very much an India-based thing, judging by the various authors of the papers.

Advancements in Intranasal Delivery of Drugs for Cluster Headache Treatment using Cubosome-Based Nanocarriers: A Review Preeti Chaudhary, Kirtan Vimal Shah, Darshan Rajendra Bodas, Sanjana Prasad Deshmukh, Akash Milind Solanki Published in Research Journal of Pharmacy and Technology on December 1, 2025 Link: https://doi.org/10.52711/0974-360X.2025.00887 Abstract: Cluster headaches (CH) represent a debilitating neurological disorder characterized by severe, recurrent attacks of pain, often leading to significant impairment in quality of life. Traditional treatments often face issues like delayed onset of action, systemic side effects, and challenges in achieving optimal drug concentrations at the target site. Intranasal drug delivery has emerged as a promising alternative for the management of cluster headaches due to its potential for rapid absorption and direct access to the central nervous system. Among the novel strategies under investigation, cubosome-based nanocarriers have gained significant attention due to their unique structural properties, biocompatibility, and ability to encapsulate a wide range of therapeutic agents. This review highlights recent advancements in intranasal delivery systems, focusing on cubosome-based nanocarriers for the treatment of cluster headaches. It explores the physicochemical characteristics of cubosomes that make them ideal for intranasal administration, including their high surface area, mucoadhesive properties, and ability to enhance drug stability and bioavailability. The review also examines the potential of cubosome-encapsulated verapamil, a calcium channel blocker, as a promising candidate for rapid and effective cluster headache relief. Furthermore, it addresses the challenges and future perspectives in the development and clinical translation of cubosome-based intranasal therapies. By synthesizing current research findings, this review aims to provide insights into the potential of cubosome-based nanocarriers as a transformative approach in the treatment of cluster headaches, paving the way for more effective, patient-friendly therapeutic options.

HNY and right on Jon, exactly - CH is pretty much a stress-test for Helsinki and CIOMS. I can only imagine the complexities of designing CH studies that advance knowledge but always place the well-being of the study participant first, let alone sitting on the ethics committees that have to review and approve them. Check out the below, part 33. World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects https://jamanetwork.com/journals/jama/fullarticle/1760318 And the Council for International Organizations of Medical Sciences, guideline 5. https://www.ncbi.nlm.nih.gov/books/NBK614415/ I saw a few posts on socials in recent weeks venting that there isn't enough research on CH and I get it but I also want to acknowledge that like the lead author of this study, we have some amazing researchers in our corner and I am so thankful for that as well as excited to see what happens in 2026. I feel we saw some real advancement in our understanding in 2025. Thank-you for bringing up this very relevant point.

...at one point (cannot enumerate) there was a reluctance(?) official or non by researchers to placebo arm studies with active HA patients. understandable, but obviously limiting. any thoughts? was this just an understanding or are there study protocols (besides life or death) concerning pain or perhaps intractable pain that have been superseded/modified?

Thank-you to the researchers. The study was exploratory and only had 18 participants split into three groups so the lack of statistical power is the likely reason for the discrepancy where the single-dose group showed a large effect size against placebo yet the primary outcome for the trial failed to reach statistical significance. And the single dose group reported greater improvement than the two dose group... could be just simply random variability again due to the small sample. Diphenhydramine was used to mimic the effects of psilocybin yet they found it only "partially substituted" for them, do they mean the participants may have been able to distinguish the active from placebo and potentially biased the self-reported headache diary results? i.e. expectation bias. Given the placebo performed unexpectedly well, should we be asking if diphenhydramine has therapeutic potential for migraine? Batch has previously said the neuropeptides involved in migraine and CH such as CGRP, PACAP, SP etc can trigger mast cell degranulation, histamine release and a self-sustaining feedback loop hence the early recommendation to take Benadryl (diphenhydramine) or more recently the full monty supplements with the D3 regimen for CH. Looking forward to larger trials. Welcome to read the study at link above or interact with it in NotebookLM (AI) below. https://notebooklm.google.com/notebook/94236d69-1463-4b24-93a4-a3870f7e9701?authuser=1

Comparing single- and repeat-dose psilocybin with active placebo for migraine prevention in an exploratory randomized controlled clinical trial Emmanuelle A D Schindler, Christopher H Gottschalk, Brian P Pittman, Deepak C D'Souza Published in Headache on December 29, 2025 Link: https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.70024 Abstract: Objective: The goals of this study were to examine the therapeutic effects and safety of psilocybin given as a pulsed regimen for the prevention of migraine and to consider the blinding integrity of an active control agent. Background: The administration of a single low dose of psilocybin was observed to have lasting therapeutic effects in one small pilot trial in migraine, although the ability of a pulse dose regimen, as practiced by patients with cluster headache, to potentially improve magnitude and/or duration of transitional preventive effects has not been studied. Furthermore, comparison to an active placebo agent that adequately mimics the acute subjective effects of psilocybin is required to improve blinding integrity and measure placebo effects. Methods: In an exploratory randomized, double-blind, placebo-controlled, parallel group study, adults with migraine having at least two weekly migraine days at baseline (n = 18) participated in two drug administration sessions separated by 7 days during which they received zero, one, or two doses of psilocybin (10 mg; psi). Whenever participants did not receive psilocybin, they received diphenhydramine (25 mg; diph). Participant recruitment took place between September 2021 and August 2023. The primary outcome measure was a change in migraine frequency using headache diary data collected starting 2 weeks before and continuing through 8 weeks after the second drug session. Results: In the 2 weeks after completion of the two drug administration sessions, the change from baseline in migraine days/week was not significantly different among groups [diph-diph: -0.7 (95% confidence interval, -1.5 to 0.2); diph-psi: -2.0 (-3.0 to -1.0); psi-psi: -1.7 (-4.1 to 0.7); Χ2 (2) = 4.56, p = 0.102], despite large effect sizes against the placebo group in the those receiving one (diph-psi; d = 1.66) or two (psi-psi; d = 0.69) doses of psilocybin. Similar reductions in migraine frequency approximating 50% were seen in all groups over the 8 weeks measured. The difference in 50% response rate among groups over 2 weeks, however, approached significance (diph-diph: 17%; diph-psi: 80%; psi-psi: 80%; p = 0.087). Drug confidence ratings (i.e., blinding integrity) suggested that diphenhydramine partially substituted for the acute effects of psilocybin. No correlations were observed between changes in migraine frequency after psilocybin and drug confidence, acute general drug effects, or acute psychedelic effects. No serious or unexpected adverse events occurred. Conclusion: This exploratory study found similar reductions in migraine frequency with single-dose psilocybin, a two-dose pulse of psilocybin, or diphenhydramine placebo. Whereas blinding was incomplete in this study, this important topic is highlighted in the study design and findings. The potential for psilocybin to serve as a transitional treatment in migraine remains but will require careful planning in future studies to separate drug and non-drug effects. Furthermore, the inclusion of headache specialists in the design and execution of these future studies is necessary to preserve the viability of psilocybin treatment in headache medicine.

Wishing everyone a happy new year and pain free wishes to all.

Just to wish you all a happy new year, and as I always tell myself: Yesterday, the weather always will be acceptable. <3

As I said in my other post, I’m pleased to have you here - whilst sorry you are in a bout, you have a good vibe that I resonate with. Yes! I have thought more than once about most of your suggestions and I love it - whether there is an out of the box solution or something custom, there is an old world charm about the forums here that I really do appreciate but understand if it was a little more in line with the times like integrated into an app it might be able to add more value, whether support, social connections, helping more people, fellowship etc. Someone from the awesome admin team might be able to give an update on any behind the scenes improvements that are in the pipeline. I’m sure I read somewhere there were some website things in the works. Good on you for offering your skills man, that’s what I just love about this community, people are too good.

Ok so this is a few suggestions ideas, and i'm not sure exactly where this post belong so mods feel free to move it anywhere you feel fits. I am a product designer and I work also as graphic UX designer sometimes, and while using the website here I started to get a few ideas, so here it comes: - That one is an easy one: Can we implement a dark mode toggle for the website? I feel like all of us clusterheads would appreciate it greatly:) -The other idea is a tad more complex but i'm sure that there are other members that could team up with me to achieve this: a clusterbusters app! It could include different parts but basically would be a comprehensive toolbox: -one repository of treatments and resources available at hand, it could be parametric so you can basically tick your journey in treatments and whenever they match other users treatments create a node, refer to forum chats on that topic etc. -a logging app, like cluster uck, where you log and keep track of your cycles, attacks and medication protocols, the logs and time stamps can be automatically link to location in order to log atmospheric pressure, pollution, etc -the forum, an inbox, etc Its just an in between attacks idea, but please let me know if you think this is potentially interesting, I am so thankful for this community, I would love to give back to it with whatever skills and time I have. Happy holidays everyone <3

@Craigo thank you for the laughs:) I can definitely use those atm! I don't touch hákarl ever tbh! it stinks more than it taste but unless it would abort CH I don't think I would eat it. And yeah somehow CH have a sneaky way of teaching you about the fragile balance within our bodies hey. Ok now I thought my mycology knowledge was rather advanced but I've never seen that NZ mushroom before! How funky! tbf i'm not too educated on non western fungi except for a few celebrities ofc. Here I pick mainly psilocybe semilanceata, it is potent indeed and quite consistent which is an advantage but definitely not as exotic as your alien testicles:) cheers mate, hear you next year!

Do you guys say this as you slurp another piece of fermented shark from the tin? Hehe. I really love that saying though, I will remember that! Sorry to hear about your bout with pneumonia, glad you are on the mend from that - hopefully the steroids and I suspect antibiotics didn't mess you around too much. A couple of years ago I had a real bad run with a recurrent bacterial infection that used 5 rounds of antibiotics before my doctor presented a biologic which I had said absolutely not in a million years - saw a functional doc, got it under control but low and behold that was the one year I fell from cluster free remission whilst maintaining the target vitamin D3 range - opened my eyes to a few different topics including microbiome - sorry to say I don't know that the fermented shark packs a probiotic punch like kim chi though. You also mentioned in another post about foraging up there in Iceland for medicine, I suspect your varieties would be quite different to what's found in more warmer climates. It's the same in New Zealand, we have mystical magical varieties down under, one example being Psilocybe weraroa, they look like little blue testicles and pack a heck of a punch. Happy to see you here on the forums - I recently landed here earlier in the year, good bunch of folk here and we all seem to love cats. I feel like this is the more appropriate place to share recent research. So... I sign off by saying Happy new year and thank-you for the old one!

@Craigo thank you! this is reassuring news:) And yes i'm taking quite small dose of calcium blockers anyways, for the blood pressure, which indeed keeping my blood pressure in check has shown to work well as prophylactic measure. I'm currently (hopefully) on the verge of successfully bust a surprise cycle triggered by weaning off steroids that were prescribed for a pneumonia.. it has been messy since it was a surprise cycle I somehow panicked and started using sumatriptan spray to abort and I quickly realized that it made things worse so I dropped and went back to my dear fungi But since it has been such a roller coaster I started to dive back in the CH treatments and research rabbit hole.. and wanted to make sure i'm not doing anything stupid again out of panic! Thank you again and happy holidays, and as we say in Iceland: Happy new year and thank you for the old one! <3

Another review in pediatric migraine just published. Here we start to see an intervention with probiotics to modulate the microbiome. Let's see what happens in 2026 with this evolving area of research. Targeting the microbiome in pediatric migraine: gastrointestinal manifestations and the therapeutic role of Bifidobacterium longum Pi-Chuan Fan, Huey-Huey Chua, Chia-Ray Lin, Tzu-Hsuan Lai, Lih-Chu Chiou, Wang-Tso Lee Gut Microbes on December 27, 2025 https://doi.org/10.1080/19490976.2025.2606487 Abstract: Migraine is a disabling neurological disorder that often begins in childhood or adolescence and is frequently accompanied by gastrointestinal (GI) symptoms. However, the microbiota signatures and gut–brain interactions underlying pediatric migraine, particularly in the presence of GI disorder, remain poorly defined. This study aimed to explore the clinical and microbial features of pediatric migraine, as well as the therapeutic potential of probiotics. We prospectively enrolled 126 pediatric migraine patients (ages 6–19) with or without GI disorder and 50 age-matched healthy controls. Fecal microbiota was profiled using 16S rRNA sequencing. Patients with migraine were stratified based on Rome IV-defined GI disorders and evaluated for headache characteristics, PedMIDAS scores (disability assessment), plasma calcitonin gene related peptide (CGRP, thought as a key biomarker of migraine), cytokines, and fecal calprotectin. Probiotic effects were tested in both young (3–4 weeks) and adult capsaicin-induced migraine rat models, and an exploratory pilot study involving 23 pediatric migraine patients. Compared to controls, migraine patients exhibited distinct gut microbiota with reduced Bifidobacterium longum. and elevated Bacteroides. GI disorders were present in 46.8% of migraine patients and were associated with significantly higher rates of abdominal pain (50% vs. 13%, p <0.001), greater migraine-related disability (PedMIDAS: 60 ± 13.2 vs. 29 ± 7.0, p = 0.042), elevated fecal calprotectin, and enrichment of Streptococcus gallolyticus. In contrast, Faecalibacterium prausnitzii, positively correlated with B. longum, was linked to milder symptoms and shorter disease duration in migraine patients without GI disorder. In animal models, B. longum attenuated trigeminal activation in both young and adult rats. An exploratory pilot study showed B. longum supplementation led to reductions in headache days, intensity, and frequency. These findings reveal distinct gut microbial signatures in pediatric migraine, and identify B. longum as a promising microbiota-targeted therapeutic strategy. Our work highlights the therapeutic potential of modifying the gut–brain axis in childhood migraine.

Thanks CHfather – I don’t recall Batch’s earlier advice either, likely before my time. We’re talking roughly 200–500mg calcium in a multi vitamin and most probably consume at least that daily through a standard diet. Check out this ask the Doctor post from Havard, although the patient was taking a different class of calcium channel blocker I suspect the answer would be the same. While high doses of intravenous calcium are sometimes used to reverse an overdose of a calcium-channel blocker, the 600 milligrams of calcium in your daily supplement isn't enough to interfere with the drug's ability to lower blood pressure. In fact, oral calcium supplementation has been shown to lower blood pressure slightly in some people. So you can continue to take both without risking your bones or raising your blood pressure. https://www.health.harvard.edu/blood-pressure/do-calcium-supplements-interfere-with-calcium-channel-blockers As for vitamin D3, this study by Holick and colleagues looked at supplementation with 10,000iu D3 (amongst other doses) and found no change in serum calcium (albeit an increase in 25(OH)D and decrease in PTH). You could see an increase in calcium labs maintaining 80-120ng/mL however if maintained within normal reference my understanding is that you are good. https://www.nature.com/articles/s41598-019-53864-1 You could jump on one of the Facebook or Reddit groups and ask the question there, I know a couple of chronic warriors that take both verapamil and the regimen together and are doing well. One comment about verapamil that stuck with me was that many warriors find the immediate release vs the sustained release works better for CH prophylaxis - why I am not sure but thought to add. Happy holidays all.