From the March 2000 Issue of Nutrition Science News
by Richard N. Podell, M.D.
About 18 million women and some 5 million men in the United States suffer from migraine headaches. Only about a third are satisfied with their treatments, which can range from over-the-counter headache remedies to serotonin receptor antagonists, beta-blockers and calcium antagonists. Many of these prescription drugs come with an array of side effects. But what if a mineral could make a difference for migraine sufferers?
Magnesium's role in the origins of migraine headaches has been demonstrated in a number of studies. It seems magnesium concentration affects serotonin receptors, nitric oxide synthesis and release, as well as other migraine-related receptors and neurotransmitters. In fact, evidence suggests some 50 percent of patients have low levels of ionized magnesium (IMg++) during an acute migraine attack. 
Alexander Mauskop, M.D., and colleagues from the State University of New York Health Science Center at Brooklyn set out to evaluate intravenous magnesium to treat headaches, to correlate clinical responses to baseline serum magnesium levels, and to see if patients with certain headache types had low serum ionized magnesium vs. total serum magnesium. (For more on the causes of low magnesium levels, see sidebar.) Traditional blood magnesium tests measure total magnesium, but Mauskop believes the ionized fraction (IMg++) is more relevant to the migraine problem, so he developed a test to measure IMg++ and used it in the study.
The researchers recruited 40 people (11 men and 29 women) who suffered from any type of moderate or severe headaches. Of these patients, 36 had some diagnosed form of migraine. Patients with renal, cardiac, diabetic or other medical problems were excluded. Age-matched healthy volunteers served as controls. When subjects had an acute headache, researchers measured their ionized magnesium, then gave them a 1 g intravenous infusion of magnesium.
The results of this study were impressive. Only eight patients had no response to the magnesium, while 32 of the 40 patients (80 percent) had complete elimination of their headache pain within 15 minutes. However, as with other anti-migraine maneuvers, symptoms returned within hours in 14 of the 32 patients (43 percent). Still, with just this one magnesium treatment, 18 of the 32 subjects were free of symptoms for 24 hours or more. (One patient's remission lasted more than five months.) Almost all patients reported a flushed feeling after the magnesium injection, but that was the only side effect.
Interestingly, researchers found those without pain for 24 hours or more after treatment were mainly the patients whose initial ionized magnesium levels were low, below 0.55 mmol/L. In all, there was a correlation between the clinical response to intravenous magnesium and low serum magnesium levels in 75 percent of the patients. 
The conclusions from this study: A substantial proportion of migraine patients probably have low IMg++. For those patients with low magnesium levels, acute migraine pain can likely be stopped with a single intravenous magnesium treatment. The researchers summarize: "Magnesium deficiency could be involved in both the vascular and neurological aspects (e.g., migraine aura, pain, nausea, etc.) of the development of migraine. Our results support a role for magnesium deficiency in the development of headache."
Although migraine research is abundant, no one has yet tried to reproduce the findings detailed here. Nor has anyone explored whether higher intravenous magnesium doses would be more effective for acute headaches or whether periodic repeated doses would effectively prevent recurring migraines. Oral magnesium is not absorbed as well as intravenous magnesium and has no effect on acute headaches. Evidence is conflicting regarding whether it can prevent chronic migraines. Perhaps interest will grow as magnesium testing becomes easier and more available.
The Missing Mineral
Richard N. Podell, M.D., M.P.H., is director of the Podell Medical Center in New Providence, N.J.
Mauskop A, Altura BM.
Role of magnesium in the pathogenesis and treatment of migraines.
Clin Neurosci 1998;5(1):24-7.
Mauskop A, et al.
Intravenous magnesium sulfate rapidly alleviates headaches of various types.
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