Intravenous Magnesium Sulphate in the Acute Treatment of Migraine Without Aura and Migraine with Aura. A Randomized, Double-Blind, Placebo-Controlled Study

Abstract

Magnesium sulphate has been used in the acute treatment of migraines; some studies found it to be a highly effective medication in the acute control of migraine pain and associated symptoms. This randomized, double-blind, placebo-controlled study assesses the effect of magnesium sulphate on the pain and associated symptoms in patients with migraine without aura and migraine with aura. Sixty patients in each group were assigned at random to receive magnesium sulphate, 1000 mg intravenously, or 0.9% physiological saline, 10 ml. We used seven parameters of analgesic evaluation and an analogue scale to assess nausea, photophobia and phonophobia. In the migraine without aura group there was no statistically significant difference in the patients who received magnesium sulphate vs. placebo in pain relief. The analgesic therapeutic gain was 17% and number needed to treat was 5.98 at 1 h. There was also no statistical difference in relief of nausea. We did observe a significant lower intensity of photophobia and phonophobia in patients who received magnesium sulphate. In the migraine with aura group patients receiving magnesium sulphate presented a statistically significant improvement of pain and of all associated symptoms compared with controls. The analgesic therapeutic gain was 36.7% at 1 h. A smaller number of patients continued to have aura in the magnesium sulphate group compared with placebo 1 h after the administration of medication. Our data support the idea that magnesium sulphate can be used for the treatment of all symptoms in migraine with aura, or as an adjuvant therapy for associated symptoms in patients with migraine without aura.

Current and prospective pharmacological targets in relation to antimigraine action

“…Decreased Mg 2+ concentrations also can activate NMDA receptors and, thus, can increase neuronal excitability. In agreement with this hypothesis, the infusion of Mg 2+ provided sustained headache relief (Bigal et al 2002), and oral Mg 2+ has been demonstrated to be an effective prophylactic in menstrual migraine (Facchinetti et al 1991). Thus, glutamate receptor modulators seem to be of benefit in migraine treatment; indeed, the NMDA receptor antagonist memantine and the NR2B subunit containing antagonist, CP-101,606, decreased spreading depression (Peeters et al 2007), a potentially important factor in migraine pathophysiology.…”

The power of negative thinking

“…[8][9][10] One double-blinded randomized, placebo-controlled trial also showed impressive benefits of IV magnesium in a subgroup of 30 patients suffering migraine with aura. 11 Only one study that failed to show benefit of IV magnesium has been published, although magnesium was used in addition to metoclopramide in this study. 12 So an uncritical review of the prior literature would suggest that IV magnesium is beneficial in migraine and other benign headaches.…”

Safety of opioid patch initiation in Australian residential aged care

“…Magnesium sulphate was effective in a small placebo-controlled trial (Demirkaya et al, 2001 Level II), with another trial demonstrating a reduction in all of the symptoms of migraine with aura (including headache), but only in photo/phonophobia in migraine without aura (Bigal, Bordini, Tepper et al, 2002 Level II). However, other studies showed that a combination of magnesium and metoclopramide was less effective than metoclopramide plus placebo (Corbo et al, 2001 Level II) and there was no significant difference between magnesium, metoclopramide or placebo (Cete et al, 2005 Level II).…”