Craigo

@dhuddly and to all reading. After a sleep I feel I overstepped with my comments above so I wanted to offer an apology and make clear that's my stuff, not his and I should have chosen my words better. Sorry Dhuddly, hope you may be able to accept my apology.

I can work with truck driver vocabulary and your grammar isn't that bad. Books and written to be read and videos to be watched, I'd love to check them out, please feel free to drop links here or send me a DM so I can go check them out. I just read The Headache, Tom Zeller Jr, episodic cluster sufferer and it was an absolutely amazing read. Welcome again to the community @dhuddly, if that's what you were after then certainly you are in the right place, there are some phenomenally good people in the cluster headache community, of that I can say for sure - and the reason I reckon I will be back in Chicago come October for this years conference!

Hi @CHfather and @dhuddly. Sorry you find yourself in our company there dhuddly, I haven't been on past couple weeks with some life changes I alluded to above and a number of projects on the go. I would appreciate links to studies you've read, always keen to expand my knowledge of the vitamin D3 literature. Here are the studies and their findings relating to the dopaminergic system in CH published last year for your reading and interest. What I would say above and beyond these studies, the work that has come out over the past number of years in CH space makes it fairly clear that between the active bout periods in episodic CH, the patient does not return to a normal baseline, the attacks may stop but there are perturbations that extend into the interictal periods that give me some level of assurance that I am doing the right thing for myself in terms of staying on the anti-inflammatory regimen 365 days of the year. I also hope that in doing so, I am providing an additional level of protection against developing other disease. I have more recently revisited Dr. Gominak's work (a contributor in part to the regimens inclusion of the B-Vitamins) and believe another reason for the regimens efficacy relates to vitamin D3's influence on the composition of the gut microbiota and the maintenance of epithelial tight junctions. Given nearly every cell expresses the VDR and the lack of formal studies in CH, it would be impossible for us to confirm Pete Batcheller's original hypothesis as to its precise mechanism of action (and as you mention, partial or non-response) but I think he is on the money with the umbrella thinking that it's underlying mechanism is the up and down regulation of genetic products which have the VDR sequence in their promoter / enhancer or silencer regions on DNA. Dysfunctional mesocorticolimbic circuitry in cluster headache. Ferraro et al. (2025) This fMRI study used a "Monetary Incentive Delay" task to probe the mesocorticolimbic dopaminergic pathways. Chronic CH (cCH): Patients exhibited blunted activity in the Ventral Tegmental Area (VTA) - a central dopaminergic hub - during reward anticipation. They also showed an imbalance in the pathway between the VTA and the medial prefrontal cortex (mPFC). Episodic CH (eCH): Patients showed intact VTA responses but abnormal mPFC activity, which the authors suggest may be an early sign of emerging dysfunction in the VTA-mPFC dopaminergic pathway. Conclusion: The study suggests an abnormal dopaminergic state in chronic patients that is distinct from affective disorders (depression/anxiety). Uncovering the neurological substrates underlying restlessness in cluster headache - A functional MRI study Chen et al. (2025) This study investigated the neural correlates of restlessness/agitation, a core clinical feature of CH. Substantia Nigra (SNpc): Patients experiencing restlessness showed increased functional connectivity between the Substantia Nigra pars compacta (SNpc) - a dopamine-producing nucleus - on the pain side and the Locus Coeruleus (noradrenergic) on the non-pain side. Frontal Inhibition: The study found decreased connectivity between the pain-side SNpc and the superior frontal gyrus, suggesting a disruption in top-down inhibitory control contributes to motor restlessness. Neurotransmitter Imbalance in Cluster Headache: A Systematic Review of Mechanisms and Therapeutic Targets Pellesi et al. (2025) This review aggregates data from multiple biochemical studies regarding dopamine levels in CH. Platelet Levels: Citing D'Andrea et al. (2006), the review notes that platelet dopamine levels were significantly higher in patients with episodic CH during both active bouts and remission compared to healthy controls. Plasma Levels: Citing D'Andrea et al. (2017), the review reports that patients with chronic CH exhibited higher plasma levels of dopamine compared to controls. Cerebrospinal Fluid (CSF): Citing Strittmatter et al. (1996), the review notes that CSF levels of dopamine were not significantly different between CH patients and controls, though norepinephrine was reduced. Autonomic dysfunction in patients with episodic cluster headache during remission period López-Bravo et al. (2025), This study summarizes previous biochemical findings in CH. It cites D'Andrea et al. (2017) regarding Abnormal Tyrosine Metabolism: Chronic CH patients show increased levels of dopamine and its precursor tyrosine in plasma. The authors interpret this anomaly in tyrosine metabolism as a potential predisposing factor for the chronification of episodic CH. Thesis: Felicia Jennysdotter Olofsgård (2025) Jennysdotter Olofsgård (Thesis) Genetics: A meta-GWAS identified WNT2 as a new risk locus for Cluster Headache. The author notes that WNT2 is known to be involved in dopaminergic neuronal development. What is seldom discussed in our community is the psychological and personality dimension of CH and how that relates to this topic. Kudrow and Graham were notably candid in the 1970s. I hesitate to be quite so direct, yet many of the personality characteristics they described feel uncomfortably familiar, as though my name might as well have been written beside them. If I may delicately say @dhuddly, from your posts and your manner of written expression, you come across as highly intelligent, thoughtful and kind. You have also mentioned being a full stack developer (I saw that response on a possible CB app - thank-you!), someone your friends describe as operating at extraordinary speed. I want to be clear that I am not attempting to analyse or explain you, rather, those observed qualities deeply resonate with me and provide a useful reference point for describing how I have come to interpret similar tendencies in my own life, over-achievement, high intelligence, tendency to work at a million miles an hour to name but a few. So... here's my story and my take on those qualities in the context of my life journey and CH. My father died before I was born. Throughout childhood I struggled to understand, let alone regulate, the emotions associated with that absence. In adolescence this unresolved grief drifted into substance abuse. Later, the same undercurrent appeared to transform into an intense drive for achievement, knowledge, and ultimately explanation. A life organised around such a pursuit rarely tolerates stillness. Pausing to enjoy simple pleasures can mean confronting emotions one has never properly learned to process. I am still learning how to do that. My sense, shaped by both experience and reading, is that unprocessed anger, grief, and guilt can sustain a chronic autonomic bias toward fight or flight, with downstream effects across our physiology. Viewed through that lens, it is perhaps unsurprising that my nervous system, which has otherwise been remarkably resilient, shows points of vulnerability. I cannot claim definitive evidence that CH, or another unique and uncommon disorder I am afflicted with - vocal cord dysfunction, arises from such experiences. This remains an interpretation, not a conclusion. The closest conceptual framework I have encountered is found in the work of Dr Allan Abbass, particularly his writing on overcoming emotional resistance through Intensive Short Term Psychodynamic Therapy. I feel his work and this topic deserves more discussion, as confronting as these topics can be. Link. Anyway, I pray I have not overstepped and I welcome you here with open arms. I am glad to connect. Craig.

See you there

Faraidoon is the headache researcher whom is leading the Psilocybin Efficacy and Acceptability on Cluster headache Episodes (PEACE) Trial.

Patient perspectives on research gaps in cluster headache Faraidoon Haghdoost, Dilara Bahceci, Candice Delcourt, Tissa Wijeratne, Rigmor H Jensen, Carl Cincinnato, Susan Tomlinson, Bob Wold, Vince Polito, Cheryl Carcel, Usman Ashraf, Bronwyn Jenkins, Anja Sofie Petersen, Jason C Ray, Emmanuelle A D Schindler, Benjamin Tsang, Chris Gianacas, Anthony Rodgers Published in Headache on January 21, 2026 Link: https://doi.org/10.1111/head.70031 Abstract: Objective: This study was undertaken to identify gaps in cluster headache management, highlight patient-prioritized research needs, and assess patient interest in, and preferences for, clinical trial participation.

Most of these studies were posted here on the forum, study by study over the course of 2025. For those wanting to look at some of the studies mentioned they are in my 2025 CH Research Notebook.

2025 Highlights in cluster headache Roemer B. Brandt, Rolf Fronczek Published in Cephalalgia on January 2026 Link: https://doi.org/10.1177/03331024251411870 Abstract: Cluster headache remains enigmatic with a significant unmet treatment need, especially in the chronic form. The steps made in 2025 have taken us further along the road to a true understanding of the still unknown pathophysiology, hopefully leading to a causal treatment.

This is a pretty epic study and I have a lot of questions. I am not even sure I fully understand all of it yet, so I want to check that I am interpreting it correctly. Anyone else have any thoughts, please share. In their bidirectional Mendelian randomization analysis, are they essentially saying that they identified 11 cerebrospinal fluid metabolites that are associated with increased risk of cluster headache, and that among those, three showed the strongest associations, and these key metabolites are involved in pathways linked to mitochondrial energy metabolism and ATP production? Rather than mitochondria in cluster headache fail to produce enough ATP, it appears they are suggesting that ATP production is inefficient and metabolically costly. Do these findings help explain the small ketogenic diet study from 2018, where 11 of 18 refractory chronic cluster headache patients became pain free? There is often discussion about ketone bodies being a more efficient fuel source than glucose metabolism. In the context of this paper, could ketosis be improving ATP yield per unit of oxygen or reducing oxidative and redox burden on already stressed mitochondria, thereby raising the threshold for attack generation? What do these results suggest about the role of the “Full Monty” supplements that are recommended for non-responders to the base Vitamin D regimen? Many of those supplements have antioxidant or reactive oxygen species scavenging properties. Does this metabolite profile support the idea that reducing oxidative stress and the ATP cost of redox maintenance could improve mitochondrial efficiency and help explain why some non-responders improve when these additional supplements are introduced? The paper also references the glutathione cycle. Does the signal around 5-oxoproline and glutathione metabolism suggest that supplementing glutathione might be beneficial in this context? Or is the implication more that excessive glutathione turnover reflects an upstream oxidative burden that needs to be addressed rather than simply supplying more? What do these findings imply about the role of melatonin? Melatonin is synthesized within mitochondria and is known to improve mitochondrial efficiency, reduce oxidative stress, and support electron transport chain function. Could impaired or mistimed melatonin signaling be one of the factors that lowers energetic resilience during vulnerable circadian windows in cluster headache? Finally, do these findings offer any insight into a potential abortive mechanism for DMT? Anyone have any insight in this regard?

NotebookLM Audio Summary. Cluster_Headache_s_Metabolic_Root_Cause_Found.m4a Or just check out the Notebook for yourself. https://notebooklm.google.com/notebook/27364f47-4518-433b-86d9-d3aad07c9f0e?authuser=1

Bidirectional Mendelian Randomization Analysis of 338 Cerebrospinal-Fluid Metabolites and Cluster-Headache Risk Danhua Yu, Xuewei Yang, Jinli Zhou, Weiwei Chen, Jinhui Song, Weifei Yu & Shaokang Huang Published in Journal of Pain Research on January 8, 2026 Link: https://doi.org/10.2147/JPR.S550160 Abstract: Cluster headache (CH) is a rare but highly disabling primary headache disorder characterized by severe unilateral attacks and autonomic symptoms. The metabolic mechanisms underlying CH remain poorly understood. To investigate the potential causal effects of cerebrospinal fluid (CSF) metabolite levels on CH risk, and to explore possible reverse causal effects of CH on CSF metabolites, using a bidirectional Mendelian randomization (MR) approach. We performed a bidirectional two-sample Mendelian randomization (MR) analysis integrating genome-wide association study (GWAS) data for 338 cerebrospinal fluid (CSF) metabolites and CH (1,833 cases and 498,515 controls from FinnGen release 12). Genetic instruments were selected at P < 1×10−5 (LD r2 < 0.01). The primary causal estimates were derived using the inverse-variance weighted (IVW) method under a random-effects model, complemented by MR-Egger, weighted median, and MR-PRESSO sensitivity tests. Multiple testing correction was performed using both Bonferroni and false discovery rate (FDR) approaches. In the forward MR analysis, 11 CSF metabolites were significantly associated with CH risk (P<0.05). The strongest associations were observed for orotate (β = 0.53, 95% CI: 0.23–0.82, P = 0.0006), betaine (β = 0.47, 95% CI: 0.16–0.79, P = 0.0035), and 5-oxoproline (β = 0.57, 95% CI: 0.17–0.97, P = 0.0053). In the reverse MR analysis, eight metabolites, including lysine (β = 0.015, P = 0.029) and kynurenine (β = 0.025, P = 0.020), were nominally associated with genetic liability to CH. Sensitivity analyses showed no evidence of directional pleiotropy or heterogeneity (all P > 0.05). This bidirectional MR study provides the first genetic evidence linking central metabolic alterations to CH susceptibility. While these results highlight potential metabolic biomarkers and mechanistic pathways, the findings remain preliminary due to modest statistical power and should be replicated in larger and ethnically diverse cohorts.

Your post hits me in the feels. It really does. I would say it is changing lives. I have had one of those days, your post is timely and let me be as real as I can with you on what is a topic that lies close to my heart. At least once, more often several times a week, I receive an email from someone who found www.vitamindregimen.com, come across Clusterbusters, a social site or watched one of the interviews with Pete Batcheller on YouTube. They rolled the dice on the regimen and got pain free. They write to say it changed their life. Even one of those emails is enough to justify every hour of advocacy. It’s worth it. I have spent over a decade now reading obsessively on this topic, not just to understand why and how the regimen may work, but to also understand why a percentage of people do not get fully pain free when applying it. Along the way I have interviewed some of the most amazing people in the vitamin D3 research space and with every interview, every study read, every question asked, I feel like I have moved a little closer to an answer and built upon my knowledge of the subject. I am so grateful Pete opened that door for me. That man is a global treasure. It’s also perplexing because this week alone I have seen cluster headache social media channels suggest ginger, purple cabbage, and today, chewing on a lime. I should have become a fruiterer! I understand the premise behind criticism of the regimen or pushing it to the side as a bunch of simple pills. From the outside, a handful of vitamins can look just as batshit crazy as cabbage when stacked against the sheer terror of CH. I get it. That is the real challenge. How do you communicate the regimen in a way that reaches more people, without overclaiming, without slipping into evangelism and without being lumped into the bucket of folk remedies? How do you communicate something that sits uncomfortably between patient-led discovery and clinical blind spots? I may have an opportunity to do more having just resigned my job today with no intention of continuing on the same path / career. 43, soon to be jobless - very tempting to study and see what further value I may add to this important body of work. Never too old right? Absolutely agree with you, happy for you to have found success with it and pleased to see you here on the CB forums!

Dang, darn and I'm sorry you are getting hit despite the comprehensive approach you've got going on there. Quercetin and resveratrol were two of the primary anti-histamine full monty supplements in the regimen that come to mind, I didn't see that you had incorporated. It also suggests to increase the fish oil dosage. Just listing the items from the QSG below along with the suggested dosages. Primary Antihistamine Supplements A. 1 to 2 Grams/day Turmeric (Curcumin) with Piperine B. 1 to 2 Grams/day Quercetin C. 1 to 2 Grams/day Resveratrol D. 8 Grams/day vitamin C Optional As Needed E. 2 Grams/day Omega-3 Fish Oil (EPA and DHA) F. 250 mcg/day Selenium G. 1000 mg/day N-Acetyl Cysteine (NAC) H. 5 to 10 mg/day Melatonin (Taken at bedtime) I. 200 to 500 mg/day CoQ10 J. 50 mg Zinc Picolinate* K. Diamine Oxidase (DO)** 4 mg 2 to 3 times/day with meals Have you considered putting yourself into nutritional ketosis? In terms of a dietary measure that has some reports in chronic CH albeit was a small cohort 11 of 15 got pain free, the regimen quick start guide recommends it. I take it you have the quick start guide handy, if not it is here. There may be some relevant information there (page 12 onwards describes falling from remission / non-response to regimen). Other reports of nutraceuticals include thiamine which I had seen a few reports recently on Reddit threads of people reporting success but only a single case report in literature using 750mg (tapered). There is busting... a topic well covered on the forums, if an option for you? You probably already know you've got some medication options but just putting it out there, perhaps a short steroid course would be enough to disrupt the cycle and for it not to return after the taper? This was my go to for the first couple of years with the regimen (having not stayed on maintenance thereafter all year round). Or another poster pointed out a monoclonal antibody, there's also verapamil etc. Nothing it seems works for everyone but while you are throwing everything but the kitchen sink at it already I could only but list the options... I've only been in your position once before and at a baseline 100ng/mL and getting hit with attacks. I did another 600,000iu loading dose, all of the full monty supplements (less the melatonin), did NOT do keto and found myself pain free 4 days later - I realize I am lucky. I finished the load and dropped to 20,000iu maintenance for remainder cycle, level increased to 180ng/mL, calcium was okay - understandably becomes a bit nerve racking at these levels. Pete's labs in the guide show he has been higher than this previously - obviously none of us can flat out recommend you do that. Good luck I am sorry again you find yourself in that spot. XXX isn't too frequent here these days, if you DM me I am happy to share his email address should you want to drop him a line - hint, it's also listed on the bottom of the full reference guide.

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.