Meds & Supplements, Treatment

Magnesium & Migraine

By Christina Peterson, MD

Should You Be Taking Magnesium?
Two doubleblind studies have shown that magnesium supplementation may reduce the frequency of migraine. In research studies, we have found that magnesium levels affect serotonin receptors, and also have an effect on nitric oxide synthesis and release, as well as on NMDA receptors—all brain structures and chemicals suspected to be important in migraine. In small studies, both migraine and cluster headache patients have responded acutely to intravenous magnesium. In a larger double-blind controlled study, the treatment group, receiving 600mg of magnesium for a 12 week period, experienced a 41.6% reduction in headaches as compared to only 15.8% reduction in migraine headaches in the placebo group.

What Does Magnesium Do?
It is responsible for over 300 essential metabolic reactions in the body. It is required for synthesizing proteins in the mitochondria, and for generating energy in most of the body’s basic cellular reactions. It is necessary for several steps in the synthesis of DNA and RNA. Magnesium is also present in a number of other important enzymes. As important as it is intracellularly, 60% of the body’s magnesium is present in bone, and 27% in muscle.

Magnesium Supplements
If you decide to take supplemental magnesium, start at 400-500 mg/day in divided doses. The limiting factor for most people is diarrhea. If you are on a migraine preventative medication that is constipating, like amitriptyline or verapamil, this might be a plus.

WARNING: If you have heart disease or kidney disease, or are prone to kidney stones, talk to your doctor before starting on calcium and/or magnesium.

To be metabolized effectively, magnesium must be taken with calcium. The amount of calcium should be no more than double the amount of magnesium— this is the ratio commonly recommended for women. Men may require less calcium, and sometimes take a ratio of calcium-magnesium that is equivalent mg/mg.

Many people take in only 60-70% of the recommended daily allowance in the first place, and then things like stress and caffeine can deplete that further throughout the day. Migraine sufferers have been found to have a relative magnesium deficiency in their bloodstream between migraine attacks, and intracellular magnesium levels drop even further during a migraine attack.

Magnesium oxide, magnesium citrate, and magnesium sulfate are bioavailable — look for mixed salts of these forms, or magnesium gluconate, which is ionized, and is biologically active; if you develop diarrhea from those forms of magnesium, look for chelated magnesium.

Magnesium carbonate dissolved in CO2- rich water is 30% more bioavailable than magnesium found in foods or in pill-format.

Foods Rich in Magnesium

  • Peanuts*
  • Almonds*
  • Brown rice
  • Hazel nuts*
  • Blackstrap molasses
  • Bananas*
  • Beans
  • Tofu*
  • Soy beans*
  • Avocado*
  • Broccoli
  • Spinach
  • Swiss chard
  • Tomato paste
  • Sweet potato
  • Pumpkin seeds
  • Peanut butter*
  • Chocolate*
  • Cocoa powder*
  • Succotash
  • Cooked artichoke
  • Black-eyed peas
  • Whole-grain cereals
  • Cooked okra
  • Beet greens
  • Acorn squash
  • Chickpeas
  • Split peas
  • Lentils
  • Kiwi fruit*
  • Apricots
  • Baked potato
  • Raisins
  • Yogurt*
  • Milk

*these can be migraine triggers for some people

Magnesium-Drug Interactions

  • Digoxin – Decreased absorption due to magnesium
  • Nitrofurantoin – Decreased absorption due to magnesium
  • Anti-malarials – Decreased absorption due to magnesium
  • May interfere with quinolone or tetracycline antibiotics
  • May interfere with anticoagulants
  • Diuretics such as furosemide (Lasix) or hydrochlorothiazide can result in magnesium depletion
  • Iron supplements may interfere with magnesium supplement absorption

This article appeared in the April/May 2006 of the Headquarters Migraine Management newsletter, Dr. Peterson’s bimonthly newsletter on migraine awareness and education. If you’re not signed up to receive this electronic newsletter, you’re missing out!

News & Research, Resources

What Are Clinical Trials All About?

WebMD recently published lots of information on clinical trials. There’s more here than one person can possibly retain, so take small bites!

Is a Clinical Trial Right For You?
Clinical trials are experiments. As such, they may involve risks, often serious ones. You have no guarantee how the trial will turn out if you choose to enroll. You also may undergo discomfort, inconvenience, and expense that you would not have had otherwise. Only you can decide whether joining a clinical trial is worthwhile or not, based on how you value the possible benefits and risks.

What to Expect in a Clinical Trial
Every clinical trial is a bit different so there is no typical trial.
Still, you may want to see an example of what a clinical trial really involves before joining. Here, we’ve created a fictional clinical trial designed to last one year. The description below resembles the “procedures section” you would find in the trial’s informed consent document.

Clinical Trials: Benefits and Risks
People participate in a clinical trial for many reasons. Healthy people may join clinical trials to contribute to medical science and improve medical knowledge and care for others. If you have a specific illness, clinical trials offer access to new approaches that are often not available otherwise. You should understand that clinical trials are still experiments. They
involve risks. Here are some of the risks the NIH urges you to consider before joining a clinical trial.

Clinical Trials: Your Rights and Informed Consent
Informed consent is a crucial aspect of clinical trials. Informed consent is the process of giving you all of the information that you need to make an informed decision about a research experiment.

Clinical Trials: 10 Questions to Ask
Before joining a clinical trial, you should feel comfortable and fully informed. The National Library of Medicine suggests a series of questions to ask before you enroll in a clinical trial, which we’ve adapted below. You should know the answers to all of these questions before you enroll.

Concerns for Women, Children and Genetic Privacy in Clinical Trials
The focus of clinical trials has changed in recent years. For decades, researchers mostly enrolled adult men and older women in clinical trials, but the number of studies devoted to children has grown enormously since 1997. Clinical trials that include genetic tests have also become increasingly common. These new developments have changed who enters clinical trials and the potential risks you may experience if you choose to enroll.

12 Answers to Common Questions About Clinical Trials

Glossary of Terms Used in Clinical Trials

If you’ve participated in a trial, I’d love to know what you thought and how it went. Please leave a comment or e-mail me.

News & Research

Current Clinical Trials for Headache, Migraine & Cluster Headache

NIH’s clinical trials database is brimming with clinical trials for headache disorders. There are currently 110 headache, 65 migraine and five cluster headache studies either actively recruiting or will do so soon.

Topics include:

And there are many, many more. Many are for drugs, but others have minimal risks.You can search by which phase trails are in, I, II and III. The website breaks down how the trials differ:

  • In Phase I clinical trials, researchers test a new drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
  • In Phase II clinical trials, the study drug or treatment is given to a larger group of people (100-300) to see if it is effective and to further evaluate its safety.
  • In Phase III studies, the study drug or treatment is given to large groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.

To learn more about clinical trials and for definitions, stay tuned for tomorrow’s post.

Reader Stories

Live in Seattle and Have Migraine or Chronic Daily Headache?

If you live in Seattle or its suburbs, have migraine and/or chronic daily headache, and would like to help me with a story for the writing class I’m taking, let me know!

I don’t have details yet, but my aim is to tell the story of another headache sufferer. I want to get to know you, how you live and the place that headache has in your life. It will involve some talking (translated: me asking you questions) and some general hanging out time (translated: me following you around while you go about your life).

If you’re interested in knowing more or would just like to get together sometime and talk about coping with headache disorders, please e-mail me. We’ll talk about particulars and you can tell me if you want to go through with it or not. There’s no pressure.

I know my story inside and out and, while our experiences are similar, they are also very different. Each one of you has a story worth telling. This is my first step in learning how to help you tell those stories.

Patient Education, Reader Stories

Chiari Malformation & Headache

One of the uncommon causes of headache is called Chiari malformation. Also referred to as Arnold-Chiari, it’s a condition where brain tissue protrudes into the spinal canal. It happens when part of the skull is extra small or misshapen and presses on the brain, forcing it downward.

As with much of the scary stuff I write about, very few people’s headaches are caused by this malformation. So don’t panic! Chiari is detected by an MRI and headache is only one of the many possible symptoms.

Anna Roberts, a medical student in the UK, was recently diagnosed with and had surgery to correct her Chiari malformation. She describes having brain surgery while a medical student — a situation where she has enough information to be scared, but not enough to know what’s really happening.

Mayo Clinic has an easy-to-read explanation of Chiari, it’s symptoms and treatments. You can also learn more from NIH‘s Chiari fact sheet.

[via Kevin MD]