Leaderboard

Amon10, There's likely a good reason why 89-90% of CH attacks hit while sleeping if you're an ECHer in cycle or a CCHer... even if you're working swing or graveyard shifts. For starters, I've found several studies indicating the CH syndrome is pH sensitive. More on this later... Secondly, during sleep, our respiration rate, lung tidal volume and alveolar ventilation drop to their lowest levels while still on the good side of the air-grass barrier... Basic respiratory physiology tells us that under these conditions, our blood chemistry changes as follows: The arterial partial presser of carbon dioxide (PaCO2) elevates significantly and at the same time our arterial partial pressure of oxygen (PaO2) drops significantly. This combination represents a perfect storm for CHers. The high PaCO2, termed hypercapnea, translates to a drop in arterial blood pH below the normal range (7.32 to 7.42), making it more acidic in the chemical reaction where carbon dioxide, the byproduct of normal metabolism, combines chemically with water in the blood essentially creating carbonic acid as illustrated in the following chemical equation, CO2 + H20 <-> HCO3 + H. Blood gas chemoreceptors in the medulla oblongata (brain stem) sense the elevated PaCO2 content and lower arterial pH then signal control centers in the medulla and pons to adjust the respiration rate, increasing it slightly, the heart beat to increase slightly and vasculature to dilate in order to increase the loss of CO2 from the lungs. These are some of the basic and more rapid homeostatic mechanisms the body uses to maintain pH in the normal range. The following chart illustrates the four phases/stages of sleep we go through on a cyclic bases during a typical eight hours of sleep. While we're awake in a resting state, we have an average minute volume of lung ventilation with inspired air of 7.66 liters/minute. During steady state Non-Rapid Eye Movement (NREM) sleep, our breathing is regular, both in amplitude and frequency. Steady NREM sleep has the lowest indices of variability of all sleep stages. The minute volume of lung ventilation decreases by 13% in steady stage II sleep and by 15% in steady slow wave sleep (Stage III and Stage IV sleep). At Stages III and IV, the average minute volume of lung ventilation of inspired air drops to 7.18 liters/minute. That's enough drop in the minute volume to increase PaCO2 by 3-7mmHg, shift PaO2 lower by 3-9mmHg and SaO2 drops by ≤ 2%. The increase in PaCO2 translates to a drop in arterial pH to 7.32 and lower. While that may not seem like much, it translates to a much lower pH in tissues throughout the periphery and in particular the nervous system. That spells trouble for CHers with a hypersensitive trigeminovascular system as it sets the stage for the CH beast to jump ugly at the slightest provocation. Where CHers get into more trouble is during REM sleep. This is where respiration rates become Irregular, breathing with sudden changes in both amplitude and frequency at times interrupted by apneas (stopped breathing) lasting 10–30 seconds. The overall net affect is a drop in the minute volume of lung ventilation to an average of 6.46 liters/minute, 15% lower than the 7.66 liters/minute of air inspired while awake in a resting state. This drives arterial pH even lower below 7.32 increasing blood acidity to the point it can easily trigger the CH beast to jump ugly. Getting back to CH being sensitive to pH... Several studies have found a lower than normal pH triggers the release of vasoactive intestinal peptide (VIP) from the gut and the release of calcitonin gene-related peptide (CGRP) from the dorsal ganglia. Under normal conditions, for otherwise healthy people, this results in vasodilation to help increase the flow of CO2 to the lungs. For ECHers in cycle and CCHers, it's a different story. This is where VIP and CGRP trigger neruogenic inflammation and the CH beast to jump ugly giving us pain we know as cluster headache. If you look at the sleep stage chart, you'll see this happens between an hour and two hours after falling asleep. This same sleep stage pattern occurs three more times during the remainder of an 8 hour sleep cycle... Sound familiar? That was a long-winded explanation why and when we get hit during sleep... One of the better solutions to this problem for an ECHer in cycle and all CCHers, is to sleep in a recliner chair when the CH frequency is high, so the head is elevated 8-10 inches above the heart. This causes the heart to work harder pumping blood up to the brain. The increased work load translates to a slightly higher respiration rate keeping the PaCO2 and arterial pH closer to normal. This lowers the potential for the CH beast to jump ugly while sleeping. When you do get hit, jump on oxygen therapy at flow rates that support hyperventilation, i.e., an oxygen flow rate of 15 to 25 liters/minute. An oxygen flow rate of 40 liters/minute results in even faster aborts. Alternatively, you can try the latest oxygen therapy procedure where you hyperventilate with room air for 30 seconds at forced vital capacity tidal volumes then inhale a lung full of 100% oxygen and hold it for 30 seconds. Four to seven cycles like this are usually sufficient to abort a CH. This procedure also consumes a lot less oxygen from 280 liters at a flow rate of 40 liters/minute down to 28 liters... If you think about it... this method of oxygen therapy triggers the reverse in blood gas chemistry of what occurs during sleep. Intentionally hyperventilating blows off CO2 from the lungs faster than it's generated through normal metabolism. This causes PaCO2 to drop elevating arterial pH to 7.42 and above making it more alkaline. The elevated pH causes blood hemoglobin to have a greater affinity for oxygen which elevates PaO2 even further and in the process, super-oxygenates the flow of blood to the brain. This results in vasoconstriction and rapid oxidation of CGRP, the wonderful combination that aborts CH more rapidly and reliably than sucking oxygen from a non-rebreathing oxygen mask at 7 to 12 liters/minute. An even better solution is to start the anti-inflammatory regimen CH preventative treatment protocol. You can download a copy at the following VitaminDWiki link: http://www.vitamindwiki.com/tiki-download_wiki_attachment.php?attId=7708 To date, readers of this VitaminDWiki website have downloaded 3,939 copies of this treatment protocol since 21 January of this year. Take care and please keep us posted. V/R, Batch

Batch's whole document is here: https://www.vitamindwiki.com/tiki-download_wiki_attachment.php?attId=7708. At the bottom of page 2 is the table showing the ingredients, which I can't/don't know how to insert here, but is a lot easier to read. Of course, you should read the whole document. I'm going to quote some core things from pages 2, 5, and 6, but I'm not saying I'm not leaving out anything important! These quoted sections do not include the "loading" process to quickly ramp up D levels, which is described beginning at the bottom of page 7. Page 2: Anti-Inflammatory Regimen. The suggested nutrients and their doses used in the Anti-Inflammatory Regimen for adults are shown in Table 1 and Figure 2 below. Children with CH should receive a vitamin D3 dose of 50 IU per pound of body weight. The other nutrients and supplements should be taken at RDA for the appropriate age group. > Vitamin D3 (Cholecalciferol) 10,000 IU/day (Adjust as needed to keep serum 25(OH)D near 80 ng/mL) > Omega 3 Fish Oil 1000 to 2400 mg/day (Minimum of EPA 360 mg/day, DHA 240 mg/day) > Calcium * 220 to 500 mg/day > Magnesium 400 - 800 mg/day (magnesium chloride, glycinate or oxide) > Vitamin K2 (MK-4 & MK-7) MK-4 1000 mcg/day, MK-7 200 mcg/day (MK-7 preferred due to half-life) > Vitamin A (Retinol) * 900 mcg (3,000 IU) for men, 700 mcg (2,333 IU) for women (Maximum Dose) > Vitamin B 50 ** 3 month course, after that, the 7 B vitamins in the Mature Multi will be sufficient > Zinc * 10 mg/day > Boron * 1 mg/day minimum, 3 mg/day optimum * Included in the Kirkland brand Mature Multi in sufficient quantity ** Vitamin B 50 is a single pill formulated with the seven B vitamins plus 400 mcg of folic acid. Dr. Stasha Gominak, MD, a neurologist at ETMC, Tyler, TX, suggests a 3-month course of vitamin B 50 to address any deficiencies among the seven B vitamins. The anti-inflammatory regimen can be used by itself or as an adjuvant therapy along with the Standards of Care recommended treatments for CH Page 5. Order the following lab tests to establish a baseline before starting the anti-inflammatory regimen: o 25-Hydroxyvitamin D3 [25(OH)D3]. CPT Code 82306. Quest Diagnostics Test Name: 92888- QuestAssureD 25-OH Vitamin D (Total), LC/MS/MS. 95% of CHers with active bouts of cluster headache will have a 25(OH)D serum concentration ≤ 47 ng/mL, (117.2 nmol/L). Any 25(OH)D serum concentration < 50 ng/mL, (125 nmol/L) is grounds for starting this regimen. o Vitamin B12 (Cobalamin). CPT Code 82607 o Parathyroid Hormone (PTH) Intact and Total Calcium. CPT codes 83970, 82310. Establish baseline. o CBC (w/ Differential and Platelets). CPT Code 85025. (Abs) Eos >350 indicates possible allergy o Eosinophil Count, Nasal. CPT Code 89190 o Lab results for Erythrocyte Sedimentation Rate (ESR) CPT Code 85652, C-Reactive Protein (CRP) CPT Code 86140 and plasma viscosity may prove useful if inflammation is suspected Page 6. 50 mg/day (25 mg twice a day or 50 mg at bed time) Benadryl plus additional vitamin D3 up to 50,000 IU/day may be required to maintain a CH pain free response during periods of high pollen count resulting in an allergic reaction. Caution patient that Benadryl (Diphenhydramine hydrochloride) can and will cause drowsiness and not to drive when taking it if at all possible. Some CHers have reported that 12.5 mg Children’s Allergy Relief Liquid Benadryl taken twice a day is also very effective with less drowsiness.

Hey J, Off hand, I'd say you're doing great and it appears the vitamin D3 loading schedule worked as advertised. The average gain in 25(OH)D serum concentration during the vitamin D3 loading schedule is 10 to 12 ng/mL for every 100,000 IU of vitamin D3 when starting around 30 ng/mL. Using that formula, you gained roughly 78 ng/mL. Adding that to your starting 25(OH)D serum concentration, we'll assume to be 29 ng/mL we get 107 ng/mL as your new total... That's close enough. At the end of this loading schedule, we drop back to an initial maintenance dose of 10,000 IU/day. 30 days after start of regimen schedule another set of labs with your PCP. You'll need labs for your serum 25(OH)D, total calcium and PTH (Parathyroid hormone). If you're CH pain free at that point taking 10,000 IU/day and your 25(OH)D is 80 to 110 ng/mL, I wouldn't change a thing. Regarding your 25(OH)D being above 100 ng/mL, it's no big deal. The normal reference range for 25(OH)D uses an overly conservative upper limit of 100 ng/mL. As 25(OH)D is a poor biomarker for vitamin D3 toxicity, going above 100 ng/mL to even 150 ng/mL or higher is NOT an indication of vitamin D3 inoxication/toxicity. If there was such a relationship, it would likely be well above 200 ng/mL. There are a number RCTs concluding this to be the case. For reference, I've maintained a 25(OH)D serum concentration over the last three years of 140 ±50 ng/mL. My PCP just looks at my lab results and smiles saying... "Your vitamin D3 is elevated... as usual... but your total calcium is normal and PTH is low so I guess you know what you're doing controlling your CH this way." Accordingly, (for peace of mind if you're still concerned), what I would do is see my PCP for lab tests of serum total calcium and PTH. As long as the serum total calcium is within its normal reference range of 8.5 to 10.5 mg/dL, and PTH is in the lower third of its reference range, there's no vitamin D3 toxicity. Otherwise, I'd wait for 30 days after start of regimen for these lab tests. Prednisone has a slight negative effect on vitamin D3 metabolism. Once you've completed the taper, the shadows should diminish. Good move staying on the Benadryl at 25 mg every 4 hours during the day and 50 mg at bed time. I would do this for at least another week... 3 times a day was not enough for me. I've also taken 12.5 mg of the Children's Liquid Benadryl (Diphenhydramine HCL) allergy medicine and found it just as effective if taken every 4 hours as the tablet form. It also worked great in aborting shadows if you hold the liquid in your mouth and not swallow for 3 to 4 minutes as a buccal (between lower lip and gums) or sublingual (under the tongue) application. That's easy to say as the liquid form is terribly sweet and you'll be tempted to swallow it. You'll know when to taper off the Benadryl when you reach the 5 hour mark between doses and there are no shadows. At that point I extend the dosing interval to every 6 hours for a day or two, then every 8 hours, then 12 hours, then none... As long as there are no shadows at the new dosing interval, press on to the next longer dosing interval. If you remain CH pain free (that includes no shadows) for >24 hours after the last dose of Bendadryl (Diphenhydramine HCL), you'll know that it's the vitamin D3 that's preventing your CH. Again, I think you're doing great! Take care and please keep us posted. V/R, Batch .'