Intravenous magnesium for acute benign headache in the emergency department: a randomized double-blind placebo-controlled trial

Abstract

Background: Magnesium deficiency may play a role in the pathogenesis of migraines and other headaches. Studies in outpatient clinics have found that magnesium administered intravenously (IV) reduces headache pain. We investigated the effectiveness of IV magnesium in patients with acute benign headache who presented to the emergency department (ED). Methods: This randomized double-blind placebo-controlled trial compared 2 g of IV magnesium versus placebo for the treatment of patients with acute benign headache who presented to the EDs of two teaching hospitals. Pre- and post-treatment pain scores were measured on a 100-mm visual analog pain scale. Results: Forty-two patients were randomized, 21 in each treatment group. Treatment groups had similar baseline characteristics. After treatment, placebo recipients reported an 8-mm median improvement in pain, and magnesium recipients had a 3-mm improvement (p = 0.63). We found no statistically significant difference between groups for any secondary outcomes; however, the patients who received magnesium had significantly (p = 0.03) more side effects than did those in the placebo group. Conclusions: We found no benefit to using IV magnesium to treat patients with acute benign headache who present to the ED.

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…The addition of caffeine to paracetamol, aspirin (Migliardi et al, 1994 Level I) or ibuprofen (Diamond et al, 2000 Level II) significantly improved analgesia and a paracetamol-aspirin-caffeine combination was more effective than placebo and all three component drugs alone, in terms of analgesia outcomes and time to effect (Diener et al, 2005 Level II). IV magnesium was ineffective in treating acute TTH in the emergency department (Frank et al, 2004 Level II).…”

Magnesium and headache after aneurysmal subarachnoid haemorrhage

“…Two small controlled but non-randomised studies have suggested that intravenous magnesium sulphate reduces headache in patients with acute migraine attacks13 and in patients with headache of any type, including migraine, cluster headache and chronic daily hedache 14. However, randomised controlled trials did not show any beneficial effect of intravenous magnesium on migraine15 16 or acute benign headache 17. In most of these studies, magnesium was administered as an intravenous bolus of 1–2 g 15–18.…”

Primary Headache Disorders in the Emergency Department

“…Magnesium deficiency has been presumed to contribute to the pathogenesis of primary headaches, particularly migraine (Frank, Olson, Shuler, & Gharib, 2004). Research has shown that patients who experience migraine have lower serum magnesium levels during headache exacerbation and during periods without headache (Frank et al, 2004).…”

“…Research has shown that patients who experience migraine have lower serum magnesium levels during headache exacerbation and during periods without headache (Frank et al, 2004). Resultantly, a treatment strategy for patients with headache has been the administration of magnesium (Frank et al, 2004). Frank et al (2004) evaluated the effectiveness of intravenous magnesium for pain relief among patients with primary headache presenting to the ED.…”

“…Resultantly, a treatment strategy for patients with headache has been the administration of magnesium (Frank et al, 2004). Frank et al (2004) evaluated the effectiveness of intravenous magnesium for pain relief among patients with primary headache presenting to the ED. Alarmingly, 83% of patients who received intravenous magnesium required additional treatment with rescue medications, such as sumatriptan, parenteral narcotics, or NSAIDs (Frank et al, 2004).…”