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Debilitating Nausea Caused By High(ish) Magnesium Dose

white capsulesWoo hoo! I feel human again and it’s all because I stopped taking magnesium. Yep, magnesium, the wonder supplement that helps so many people with migraine and chronic daily headache. I don’t think magnesium itself is to blame, but that the dose was too high. Since I can’t even take a multivitamin without nausea, I was hyper-aware as I increased from my starting dose of 100 mg. Or so I thought.

At 333 mg per day, it was within the normal dose range for treating headaches of 200-500 mg per day. It was also within the recommended daily allowance of 350 mg. I’ve discovered that allowances and ranges are like speed limits: A guideline you’re not supposed to exceed, but that you don’t have to meet.

Practically every health care provider I’ve seen has recommended magnesium to me. I’ve taken it on and off over the last five years, although this is the first time I’ve taken it consistently for more than a few weeks. Because I’ve read so much about it and had it prescribed before, I thought I could adjust the dose myself just fine. I figured I’d be fine if I stayed at or under the RDA. I unwittingly fell for the myth that medications, vitamins and supplements sold over-the-counter are harmless.

The good and frustrating news: My overall head pain was less and I had fewer migraines during the time I was horribly nauseated. I’m guessing that means the magnesium helped some. I think once my system flushes the current round of magnesium, I’ll have my different vitamin and mineral levels tested. I’ll also make myself keep a diary of my symptoms and doses. I wouldn’t want to go through these last six weeks again. I felt horrible and was so scared of what might be wrong with me.

I haven’t had any blood tests, so I’m not positive the nausea was caused by excessive magnesium. But when debilitating nausea that began about the time I increased my dose goes away when I stop taking the pills, the evidence is strong enough for me.

What is your experience been with magnesium? Please leave a comment below or chime in on the online support group and forum.

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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!

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Cautiously Optimistic

Eliminating triggers, particularly food triggers, is the main headache treatment that all the naturopaths I’ve seen use. While effective for some, only about 25% of people with migraine have food triggers. In recent years, certain supplements — magnesium, riboflavin, coenzyme Q10 and feverfew — have also been added to the naturopaths’ arsenal.

To my immense relief, the naturopath I saw yesterday wanted to move beyond the obvious (and mostly ineffective for me) treatments. The first step is to equalize my elimination pathways. That’s all I’m going to tell you about my bowels, but I think you get the picture.

While I’m glad she wants to treat different pathways (a word she used at least 20 times), I am a little skeptical about her knowledge of and beliefs about migraine. She always referred to a problem, like toxicity in the body or postural alignment, as causing headaches. The cause of headaches is a neurological malfunction, everything else is a trigger.

Foods, stress, weather, toxic blood can all trigger a particular headache, but they are not the underlying cause of the headaches. If they were, it follows that anyone with one of these issues would have headache, particularly migraine in this case. But only people with a neurological predisposition to headaches will actually have them.

But since she’s working on other areas, I’m not too concerned about this. I’m also more lenient because the friend who recommended her will only see excellent health care providers. And this friend’s recommendations, from acupuncturist to general practitioner to restaurants, are always spot on.

Before I tell you about my treatment, a disclaimer is required. I’m not recommending that you take any particular product, nor do I work for any of these companies. Infomercials and the like are evil and do nothing to persuade me. The more hyped up a claim is, the more skeptical I am of it. But I’m willing to try anything that doesn’t harm my body.

My treatment includes a “greens drink,” which are said to “contain grasses, sprouted grains and green vegetables which infuse your body with easily absorbed vitamins, minerals and amino acids.” The website of the drink I’m using, Greens First, claims that “one serving of Greens First contains more phytonutrients (health promoting chemicals in plants) than ten servings of fruits and vegetables and much more!” In any case, it tastes good and doesn’t appear to be harmful so I’m trying it.

Next I’m taking a probiotic called “Fortefy.” The best description I can find of it is on a website selling the stuff: “. . . contains elite strains of friendly Lactobacillus and bifidobacterium. . . . Proprietary blend of 20 billion organisms: lactobacillus acidophillus, bifidobacterium bifidum, lactobacillus salivarius.” Funny how the description doesn’t explain the product.

The other two things are ones that I’ve taken off and on before, magnesium and fish oil. If you’re interested, I recommend Pharmax fish oil with orange essential oils. It is good mixed in a smoothie and doesn’t make you burp fish oil. Sorry to break my promises by recommending a specific product and also mentioning digestive functions, but the orange makes this oil far superior to any others I’ve tried.

These are on top of Migratrol and Gentiana Complex, which my acupuncturist (who is also a licensed Chinese herbal medicine practitioner) prescribed on Monday. Migratrol is self-explanatory, the connection between gentiana and headache is more complicated. The quick explanation is that a blockage of chi (energy) at the liver contributes to headaches.

The naturopath also recommended having my posture checked and having craniosacral therapy. I’ll probably check these out in the future, but I’m going to focus on acupuncture for now. If I’m shelling out lots of money for all this bodywork, I want to be able to figure out which ones are worth the cost.

I’ve gotten to the point that I know so much about headache and it’s characterization in western medicine that it’s easy for me to understand it in those terms. Even if I don’t understand something I know how to learn about it and which resources are accurate. With “alternative” medicine, I’ve been plunged into the deep end without knowing how to swim. Where are my water wings?