Posted by Todd (216.199.5.38) on January 29, 2000 at 11:13:31:
In Reply to: Magnesium, Vitamin D, etc. posted by Phil on January 29, 2000 at 10:10:24:
Please note that this study involved intravenous infusions of MgSO4, not OTC health store supplements.
Treating migraine with magnesium
Magnesium (Mg) is the fourth most abundant cation in the body, after calcium (Ca), sodium (Na), and potassium (K). It is involved in more than 325 different enzymatic reactions, and plays a vital role in the activity of Ca and K; it regulates Ca balance by influencing parathyroid hormone, and it regulates K by acting as cofactor for Na-K-ATPase, the enzyme involved in maintaining the Na-K gradient (and thus the electrical potential) across cell membranes. Mg modifies at least three types of K channel and two types of Ca channel in cell membranes, and acts as a calcium antagonist in vascular, cardiac, and smooth muscle cells. (McLean RM. Am J Med. 1994;96:63-76. See also: Wilson L. MSB. 1994;16[9]:5-7.)
Mg (as a magnesium sulfate [MgSO4] infusion) is used therapeutically for conditions ranging from acute myocardial infarction and cardiac arrhythmias, to angina, alcohol withdrawal, seizure disorders (such as eclampsia), and asthma. Another condition that responds to MgSO4 treatment is severe headache. Mauskop et al (State University of New York Health Sciences Center in Brooklyn) recently reported the results of their study of intravenous MgSO4 for acute headaches. Study participants were 40 consecutive patients (11 men and 29 women) who presented with a moderate or severe headache of any kind; 16 had migraine without aura, 9 had cluster headaches, 4 had chronic tension-type headaches, and 11 had chronic migrainous headaches.
The results were amazing: Complete elimination of pain occurred in 80% of patients within 15 minutes of infusion of 1 gm MgSO4. No recurrence or worsening of pain was observed within 24 hours in 56% of patients. The investigators correlated clinical response with serum Mg and Ca levels. They found that all the patients had a deficit in the percentage of Mg that was ionized (Mg2+), regardless of whether or not the patient responded to the MgSO4 infusion. This deficit ranged from 11 to 18% below normal, and was significantly different than controls. All patients except tension headache patients had significantly reduced ionized Mg2+ levels. Patients who responded and had no return of headache or associated symptoms within 24 hours of IV MgSO4 infusion were those with the lowest baseline levels of ionized Mg2+, and patients with cluster headaches had the lowest basal ionized Mg2+ levels of all. Nonresponders had significantly elevated total Mg levels compared to responders.
In 1985, Altura first proposed that Mg may play a role in the etiology of migraine headache and may be an effective treatment. Mg deficiency is thought to make the brain more susceptible to spreading depression and spreading hypoperfusion. Cerebral blood vessels are more sensitive to Mg (either excess or deficiency) than any other type of vascular smooth muscle cell; deficiency potentiates vasoconstriction, excess potentiates vasodilation. Mg deficiency also makes the brain more susceptible to a particular type of seizure disorder: eclampsia of pregnancy. Interestingly, MgSO4 is effective for treating both eclamptic seizures and migraine, and divalproex sodium is effective for preventing both seizures and migraine, suggesting a common link between seizures and migraine. Also, patients with epilepsy are 2.4 times more likely to develop migraine than their relatives without epilepsy. (Lucas MJ, et al. N Engl J Med. 1995;333:201-205. Lipton RB et al. Neurology 1994;44:28-32, Ottman R, Lipton RB. Neurol.ogy 1994;44:2105-2110.)
MgSO4 is relatively safe, cheap, and simple to use, and it has a broad spectrum, short half-life, wide therapeutic range, and low propensity for drug interactions. The major side effect is transient facial flushing with rapid IV infusion. "Our findings indicate a potential role for ionized Mg2+ in the etiology and development of headaches," said Mauskop, "and they suggest a probable efficacy of intravenous MgSO4 in the acute treatment of many patients with a variety of headaches." (Mauskop A, et al. Headache. 1996;36:154-160.)