CNS Drugs

, Volume 9, Issue 3, pp 185–190 | Cite as

Magnesium for Migraine

Rationale for Use and Therapeutic Potential
  • Alexander Mauskop
  • Burton M. Altura
Leading Article

Summary

Magnesium deficiency can be assessed using serum ionised magnesium level, which appears to be a much more sensitive indicator of magnesium status than total serum or intracellular levels of this ion. In vitro and in vivo studies indicate that magnesium deficiency could play a contributing role in the pathogenesis of migraine in up to 50% of patients. In support of these findings, results from a single study indicate that intravenous infusion of magnesium sulfate can produce prompt and sustained relief of a migraine attack in half of patients. In this study, 85% of responders had low serum ionised magnesium levels, while 85% of non-responders had normal levels. Prophylactic oral magnesium supplementation has been shown to be effective in 2 double-blind trials, but ineffective in another. A possible reason for the lack of response reported in the latter study could be poor absorption of magnesium from the preparation used. Chelated magnesium diglycinate appears to be one of the better absorbed preparations.

Despite the absence of definitive large scale studies, we recommend magnesium supplementation (chelated magnesium diglycinate 600 mg/day) in patients who experience migraine. This recommendation is based on the excellent safety profile and low cost of the supplementation, and the large amount of experimental and clinical data that support the use of this therapy.

Keywords

Migraine Cluster Headache Migraine Attack Magnesium Sulfate Magnesium Level 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Altura BT, Altura BM. Magnesium in cardiovascular biology. Sci Am Sci Med 1995; 2(3): 28–37Google Scholar
  2. 2.
    Mathew R, Altura BM. The role of magnesium in lung diseases: asthma, allergy and pulmonary hypertension. Magnes Trace Elem 1992; 10: 220–8Google Scholar
  3. 3.
    Marcus JC, Valencia G, Altura BT, et al. Serum ionized magnesium in premature and full-term infants. Pediatr Neurol. In pressGoogle Scholar
  4. 4.
    Altura BT, Shirley T, Young CC, et al. A new method for the rapid determination of ionized Mg2+ in whole blood, serum and plasma. Methods Find Exp Clin Pharmacol 1992; 14(4): 297–304PubMedGoogle Scholar
  5. 5.
    Altura BT, Shirley TL, Young CC, et al. Characterization of a new ion selective electrode for ionized magnesium in whole blood, plasma, serum and aqueous samples. Scand J Clin Lab Invest 1994; 54Suppl. 217: 21–36CrossRefGoogle Scholar
  6. 6.
    Mauskop A, Altura BT, Cracco RQ, et al. Serum ionized magnesium levels in 500 patients with headaches. Proceedings of the 38th Annual Scientific Meeting of the American Association for the Study of Headache; 1996 May 31–Jun 2; San DiegoGoogle Scholar
  7. 7.
    Mauskop A, Altura BT, Cracco RQ, et al. Intravenous magnesium sulfate relieves migraine attacks in patients with low serum ionized magnesium levels: a pilot study. Clin Sci 1995; 89: 633–6PubMedGoogle Scholar
  8. 8.
    Mauskop A, Altura BT, Cracco RQ, et al. Chronic daily headache: one disease or two? Diagnostic role of serum ionized magnesium. Cephalalgia 1994; 14: 24–8PubMedCrossRefGoogle Scholar
  9. 9.
    Altura BM. Calcium antagonist properties of magnesium: implications for antimigraine actions. Magnesium 1985; 4: 169–75PubMedGoogle Scholar
  10. 10.
    Thomsen LL, Iversen HK, Lassen LH, et al. The role of nitric oxide in migraine pain: therapeutic implications. CNS Drugs 1994 Dec; 2(6): 417–22CrossRefGoogle Scholar
  11. 11.
    Palmer RMJ, Ashton RS, Moncada S. Vascular endothelial cells synthesize nitric oxide from L-arginine. Nature 1988; 333: 664–6PubMedCrossRefGoogle Scholar
  12. 12.
    Altura BT, Altura BM. Endothelium-dependent relaxation in coronary arteries requires magnesium ions. Br J Pharmacol 1987; 91: 449–51PubMedCrossRefGoogle Scholar
  13. 13.
    Moskowitz MA. The neurobiology of vascular head pain. Ann Neurol 1984; 16: 157–68PubMedCrossRefGoogle Scholar
  14. 14.
    Weglicki WB, Phillips TM. Pathobiology of magnesium deficiency: a cytokine/neurogenic inflammation hypothesis. Am J Physiol 1992; 263: R734–7PubMedGoogle Scholar
  15. 15.
    Altura BM, Turlapaty PDMV. Withdrawal of magnesium enhances coronary arterial spasms produced by vasoactive agents. Br J Pharmacol 1982; 77: 649–59PubMedCrossRefGoogle Scholar
  16. 16.
    Peters JA, Hales TG, Lambert JJ. Divalent cations modulate 5-HT3 receptor-induced currents in N1E-115 neuroblastoma cells. Eur J Pharmacol 1988; 151: 491–5PubMedCrossRefGoogle Scholar
  17. 17.
    Hanington E. The platelet and migraine. Headache 1986; 26: 411–5PubMedCrossRefGoogle Scholar
  18. 18.
    Ravn HB, Vissinger H, Kristensen SD, et al. et al. Magnesium inhibits platelet activity: an in vitro study. Thromb Haemost 1996; 76(1): 88–93PubMedGoogle Scholar
  19. 19.
    Turlapaty PDMV, Altura BM. Magnesium deficiency produces spasms of coronary arteries: relationship to etiology of sudden death ischemic heart disease. Science 1980; 208: 198–200PubMedCrossRefGoogle Scholar
  20. 20.
    Altura BM, Altura BT, Carella A, et al. Mg2+-Ca2+ interaction in contractility of vascular smooth muscle: Mg2+ versus organic calcium channel blockers on myogenic tone and agonist-induced responsiveness of blood vessels. Can J Physiol Pharmacol 1987; 65: 729–45PubMedCrossRefGoogle Scholar
  21. 21.
    Altura BT, Altura BM. Withdrawal of magnesium causes vaso- spasm while elevated magnesium produces relaxation of tone in cerebral arteries. Neurosci Lett 1980; 20: 323–7PubMedCrossRefGoogle Scholar
  22. 22.
    Foster AC, Fagg GE. Neurobiology. Taking apart NMDAreceptors. Nature 1987; 329: 395–6PubMedCrossRefGoogle Scholar
  23. 23.
    Huang QF, Gebrewold A, Zhang A, et al. Role of excitatory amino acids in regulation of rat pial microvasculature. Am J Physiol 1994; 266: R158–63PubMedGoogle Scholar
  24. 24.
    Bille B. Migraine in school children. Acta Paediatr 1962; 51Suppl. 136: 1–151Google Scholar
  25. 25.
    Joutel A, Bousser MG, Biousse V, et al. A gene for familial hemiplegic migraine maps to chromosome 19. Nat Genet 1993; 5: 40–5PubMedCrossRefGoogle Scholar
  26. 26.
    Henrotte JG. Genetic regulation of red blood cell magnesium content and major histocompatibility complex. Magnesium 1982; 1: 69–80Google Scholar
  27. 27.
    Schoenen J, Sianard-Gainko J, Lenaerts M. Blood magnesium levels in migraine. Cephalalgia 1991; 11: 97–9PubMedCrossRefGoogle Scholar
  28. 28.
    Facchinetti F, Sances G, Borella P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache 1991; 31: 298–301PubMedCrossRefGoogle Scholar
  29. 29.
    Sarchielli P, Coata G, Firenze C, et al. Serum and salivary magnesium levels in migraine and tension-type headache: results in a group of adult patients. Cephalalgia 1992; 12: 21–7PubMedCrossRefGoogle Scholar
  30. 30.
    Soriani S, Arnaldi C, De Carlo L, et al. Serum and red blood cell magnesium levels in juvenile migraine patients. Headache 1995; 35: 14–6PubMedCrossRefGoogle Scholar
  31. 31.
    Ramadan NM, Halvorson H, Vande-Linde A, et al. Low brain magnesium in migraine. Headache 1989; 29: 590–3PubMedCrossRefGoogle Scholar
  32. 32.
    Pfaffenrath V, Wessely P, Meyer C, et al. Magnesium in the prophylaxis of migraine: a double-blind, placebo-controlled study. Cephalalgia 1996; 16: 436–40PubMedCrossRefGoogle Scholar
  33. 33.
    Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16: 257–63PubMedCrossRefGoogle Scholar
  34. 34.
    Mauskop A, Altura BT, Cracco RQ, et al. Intravenous magnesium sulfate relieves cluster headaches in patients with low serum ionized magnesium levels. Headache 1995; 35: 597–600PubMedCrossRefGoogle Scholar
  35. 35.
    Mauskop A, Altura BT, Cracco RQ, et al. Intravenous magnesium sulfate rapidly alleviates headaches of various types. Headache 1996; 36: 154–60PubMedCrossRefGoogle Scholar
  36. 36.
    Schuette SA, Lashner BA, Janghorbani M. Bioavailability of magnesium diglycinate vs magnesium oxide in patients with ileal resection. JPEN J Parent Enterai Nutr 1994; 18(5): 430–5CrossRefGoogle Scholar
  37. 37.
    Altura BT, Wliemzig C, Trnovec P, et al. Comparative effects of a Mg-enriched diet and different orally administered magnesium oxide preparations on ionized Mg, Mg metabolism and electrolytes in serum of human volunteers. Am Coll Nutr 1994; 13: 447–54Google Scholar
  38. 38.
    White J, Massey L, Gales SK, et al. Blood and urinary magnesium kinetics after oral magnesium supplements. Clin Ther 1992; 14(5): 678–87PubMedGoogle Scholar
  39. 39.
    Mauskop A, Altura BT, Cracco RQ, et al. Intravenous magnesium for the prophylaxis of menstrual migraines [abstract]. Cephalalgia 1997; 17(3): 425Google Scholar
  40. 40.
    Seelig MS. Magnesium defeciency in the pathogenesis of disease. New York: Plenum, 1980Google Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • Alexander Mauskop
    • 1
  • Burton M. Altura
    • 2
  1. 1.New York Headache CenterNew YorkUSA
  2. 2.Departments of Physiology and MedicineState University of New York Health Science CenterBrooklynUSA

Personalised recommendations