What is the Role of Magnesium in Migraine?
Two double-blind studies have shown that magnesium supplementation may reduce the frequency of migraine.1,2 Research studies reveal 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 during headache attacks to intravenous magnesium. In a larger double-blind controlled study looking at prevention, the treatment group receiving 600 mg 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.2 Another controlled trial at a dose of 485 mg did not show benefit.3
What magnesium does in your body
It is responsible for over 300 essential metabolic reactions in the body. It is required for synthesizing proteins in the mitochondria, the metabolic powerhouses of your cells, 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, the recommended starting dose is 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. It’s always wise to check with your doctor before starting on magnesium, especially if you are on medication. Warning: If you have heart disease or kidney disease, or are prone to kidney stones, be sure to talk to your doctor before starting on magnesium or a calcium magnesium supplement.
To be metabolized effectively, magnesium must be taken with calcium, or with adequate calcium in the diet. 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. There is emerging evidence to suggest that dietary intake of calcium may be preferable to calcium supplements in women and men who are middle-aged or elderly.
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 or magnesium glycinate, which are ionized, and 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.
Magnesium–drug interactions
Some medications may not be completely absorbed if taken at the same time as magnesium. Digoxin absorption, for example, may be decreased due to magnesium. Nitrofurantoin and anti-malarials may also be decreased in absorption due to magnesium. Magnesium may interfere with quinolone or tetracycline antibiotics, and can interfere with anticoagulants. Diuretics such as furosemide (Lasix®) or hydrochlorothiazide can result in magnesium depletion. Iron supplements may interfere with magnesium supplement absorption. It is best not to take magnesium at the same time as medications. If you have concerns about whether or not you should be taking magnesium, or about the timing of magnesium and your medications, your pharmacist may be of help in advising you.
Foods rich in magnesium:
Potential headache triggers: Not usually headache triggers:
| peanuts | brown rice |
| almonds | blackstrap molasses |
| hazel nuts | kiwi fruit |
| bananas | broccoli |
| tofu | spinach |
| soy beans | swiss chard |
| avocado | tomato paste |
| peanut butter | sweet potato |
| chocolate | pumpkin seeds |
| cocoa powder | succotash |
| black-eyed peas | cooked artichoke |
| whole grain cereals | cooked okra |
| chick peas | beet greens |
| split peas | acorn squash |
| lentils | baked potato |
| beans | fresh apricots |
| dried apricots | raisins |
| yogurt | milk |
Note: not all suspect trigger foods are triggers in all headache sufferers.
References:
1. Mauskop A, Altura BM. Role of magnesium in the pathogenesis and treatment of migraines. Clin Neurosci. 1998;5(1):24-27
2. Peikert A, Wilimzig C, Kohne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia. 1996;16(4):257-263
3. Pfaffenrath V, Wessely P, Meyer C, et al. Magnesium in the prophylaxis of migraine–a double-blind placebo-controlled study. Cephalalgia. 1996;16(6):436-440
by Christina Peterson, M.D.
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