Hey Oxyrunner,

Good question...  If I were you...  I'd stay the course...  The risk:reward ratio is working in your favor if you have a better quality of life since starting this regimen...  And if the QoL isn't high enough...  you may need a higher dose of vitamin D3...

My wife takes 15,000 IU/day vitamin D3 and has done so for over a year.  She feels great, looks great and has more energy than I've seen in her in many years.  She's also kicked the heck out of 75 and turns 76 next week.  Her doctor told her to "keep doing whatever you're doing...  your labs look like their coming from a much younger woman."  That made my wife real happy...

When you see your doctor tell him you want to remain at the lowest dose of vitamin D3 that provides a therapeutic response to your CH (like mostly pain free) as long as your 25(OH)D level remains below the lower threshold for vitamin D3 intoxication at 500 nmol/L, (200 ng/mL).  If that dose is 14,000 IU/day...  Then that's the dose I'd take.

If your doctor is still having angst after hearing this...  Tell him you'll be happy to come in for another 25(OH)D lab in six months or if you appear to be having a reaction...

If you don't want to play Stump the Dummy with your doctor, go to the following link at the Vitamin D Council and get smart:

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I love their opening statement... and another further down the above page: "Can too much vitamin D be harmful? Yes, it certainly can - though anything can be toxic in excess, even water. As one of the safest substances known to man, vitamin D toxicity is very rare. In fact, people are at far greater risk of vitamin D deficiency than they are of vitamin D toxicity."

"Toxic doses

What exactly constitutes a toxic dose of vitamin D has yet to be determined, though it is possible this amount may vary with the individual.

Published cases of toxicity, for which serum levels and dose are known, all involve intake of ≥ 40000 IU (1000 mcg) per day.   Two different cases involved intake of over 2,000,000 IU per day - both men survived."

The whole issue over how much vitamin D3 to take and how high we should let our 25(OH)D go has unfortunately fallen into the hands of four big government, nanny-state bureaucrats on the Food and Nutrition Board at the Institute of Medicine and not in the hands of the thousands of physicians who treat patients with vitamin D3 deficiency on a daily basis over several years...

If you want to put this in perspective...  and there are several sides to this perspective depending on who/what you are...  i.e. CH'er, Big Government Bureaucrat, Physician, or Big Pharma...  let's take the use of verapamil as a CH preventative...

Until a couple years ago, neurologists just kept prescribing verapamil in higher doses... until we said "Ah", "Ugh" or fell on the floor clutching our chest...

Then in 2007, Goadsby et al. published a study on CH'ers taking verapamil as a preventative that found the following:

Results: Of three hundred sixty-nine patients with cluster headache, 217 outpatients (175 men) received verapamil, starting at 240 mg daily and increasing by 80 mg every 2 weeks with a check electrocardiogram (EKG), until the CH was suppressed, side effects intervened, or to a maximum daily dose of 960 mg. One patient had 1,200 mg/day. Eighty-nine patients (41%) had no EKGs. One hundred eight had EKGs in the hospital notes, and a further 20 had EKGs done elsewhere. Twenty-one of 108 patients (19%) had arrhythmias. Thirteen (12%) had first-degree heart block (PR > 0.2 s), at 240 to 960 mg/day, with one requiring a permanent pacemaker. Four patients had junctional rhythm, and one had second-degree heart block. Four patients had right bundle branch block. There was bradycardia (HR < 60 bpm) in 39 patients (36%), but verapamil was stopped in only 4 patients. In eight patients the PR interval was lengthened, but not to >0.2 s. The incidence of arrhythmias on verapamil in this patient group is 19%, and bradycardia 36%. Conclusion: We therefore strongly recommend EKG monitoring in all patients with cluster headache on verapamil, to observe for the potential development of atrioventricular block and symptomatic bradycardia.

Now...  How many of us received a prescription for verapamil prior to 2007 and were told to have an EKG to establish a baseline and to have a second EKG after reaching a therapeutic dose?   

My guess is the answer was zero... unless your cardiologist was treating your CH...

Let's try another analogy...  Which is bigger... a bread box or a house?

A house of course...  All Y'all got that right.

Now... which of the following two things we can take to prevent our CH has a bigger risk of death, Vitamin D3 or Verapamil?

If you said verapamil...  Good on you...  Now for the bonus question...

How much bigger?

You'll see what I mean if you take a look at the following link that provides statistics on adverse reactions and side effects attributed to verapamil as reported to the FDA.

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The links relating to death and verapamil are sobering:

Index of reports > Cases resulting in death (133)
         Completed Suicide (104),  Cardiac Arrest (12),  Drug Toxicity (10),  Poisoning (10),  Cardio-Respiratory Arrest (6),  Intentional Drug Misuse (5),  Poisoning Deliberate (5),  Medication Error (5),  Respiratory Arrest (5),  Intentional Overdose (4)

Kind of blows your mind a bit... doesn't it?  Now I'm not a doctor and you'll notice I didn't say "Don't take verapamil..."  It's a valuable medication when prescribed properly.  But when you compare the risk:reward ratios between verapamil and vitamin D3...  there's two reasonable options but really one good option...

Soooo...  in my book...  It all comes down to quality of life and the risk of keeping it high or at least acceptable so we can function like normal folks do...  If the risk is low in maintaining this level of QoL when preventing your CH...  it's a no brainer...  You decide then talk with your doctor...

Take care,

V/R, Batch