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

Published online by Cambridge University Press:  21 May 2015

Leonard R. Frank ,
Carin M. Olson ,
Klaus B. Shuler  and
Salma F. Gharib
Leonard R. Frank*
Affiliation:
Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Wash
Carin M. Olson
Affiliation:
Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Wash
Klaus B. Shuler
Affiliation:
University of Washington School of Medicine, Seattle, Wash
Salma F. Gharib
Affiliation:
University of Washington/Madigan Army Medical Center Affiliated Residency in Emergency Medicine, Seattle/Fort Lewis, Wash
*
Division of Emergency Medicine, Box 356123, University of Washington School of Medicine, Seattle WA 98195; 206 598-7941, lfrank@u.washington.edu

Abstract

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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.

Keywords

headachemigrainemagnesiumrandomized controlled trials
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 5 , September 2004 , pp. 327 - 332
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Welch, KMA.Current opinions in headache pathogenesis: introduction and synthesis. Curr Opin Neurol 1998;11:193–7.CrossRefGoogle ScholarPubMed
2.Mauskop, A, Altura, BM.Role of magnesium in the pathogenesis and treatment of migraines. Clin Neuro 1998;5:24–7.Google ScholarPubMed
3.Sarchielli, P, Coata, G, Firenze, C, Morucci, P, Abbritti, G, Gallai, V.Serum and salivary magnesium levels in migraine and tension-type headache. Results in a group of adult patients. Cephalgia 1992;12:21–7.CrossRefGoogle Scholar
4.Gallai, V, Sarchielli, P, Coata, G, Firenze, C, Morucci, P, Abbritti, G.Serum and salivary magnesium levels in migraine. Results in a group of juvenile patients. Headache 1992;32:132–5.CrossRefGoogle Scholar
5.Peikert, A, Wilimzig, C, Kohne-Volland, R.Prophylaxis of migraine with oral magnesium: results from a prospective, multicenter, placebo-controlled and double-blind randomized study. Cephalgia 1996;16(4):257–63.CrossRefGoogle ScholarPubMed
6.Pfaffenrath, V, Wessely, P, Meyer, C, Isler, HR, Evers, S, Grotemeyer, KH, et al. Magnesium in the prophylaxis of migraine — a double-blind placebo-controlled study. Cephalgia 1996;16(6): 436–40.CrossRefGoogle Scholar
7.Mauskop, A, Altura, BT, Cracco, RQ, Altura, BM.Intravenous magnesium sulfate rapidly alleviates headaches of various types. Headache 1996;36:154–60.Google Scholar
8.Vinson, DR, Hurtado, TR, Vandenberg, TJ, Banwart, L.Variations among emergency departments in the treatment of benign headache. Ann Emerg Med 2003;41(1):90–7.Google Scholar
9.Diamond, ML.Emergency department treatment of the headache patient. Headache Quart 1992;3(supp 1):28–33.Google Scholar
10.Thomas, SH, Stone, K.Emergency department treatment of migraine, tension, and mixed-type headache. J Emerg Med 1994;12:657–64.Google Scholar
11.Ellis, GLDelaney, J, DeHart, DA, Owens, A.The efficacy of metoclopramide in the treatment of migraine headache. Ann Emerg Med 1993;22:1991–5.Google Scholar
12.Seim, MB, March, JA, Dunn, KA.Intravenous ketorolac vs intravenous prochlorperazine for the treatment of migraine headaches. Acad Emerg Med 1998;5:573–6.Google Scholar
13.Duarte, C, Dunaway, F, Turner, L, Aldag, J, Frederick, R.Ketorolac vs. meperidine and hydroxyzine in the treatment of acute migraine headache: a randomized, prospective, double-blind trial. Ann Emerg Med 1992;21:1116–21.CrossRefGoogle Scholar
14.Saadah, HA.Abortive headache therapy with intramuscular dihydroergotamine. Headache 1992;32:18–20.Google Scholar
15.Cady, RK, Dexter, K, Sargent, JD.Treatment of acute migraine with subcutaneous sumatriptan. JAMA 1991;265:2831–5.CrossRefGoogle ScholarPubMed
16.Mauskop, A, Altura, BT, Cracco, RQ, Altura, BM.Intravenous magnesium sulfate relieves cluster headaches in patients with low serum ionized magnesium levels. Headache 1995;35:597–600.Google Scholar
17.Demirkaya, S, Vural, O, Dora, B, Topcuoglu, MA.Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache 2001;41(2):171–7.CrossRefGoogle ScholarPubMed
18.Bigal, ME, Bordini, CA, Tepper, SJ, Speciali, JG.Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized, double-blind, placebo-controlled study. Cephalagia 2002;22:345–53.CrossRefGoogle ScholarPubMed
19.Corbo, J, Esses, D, Bijur, PE, Iannaccone, R, Gallagher, EJ.Randomized clinical trial of intravenous magnesium sulfate as an adjunctive medication for emergency department treatment of migraine headache. Ann Emerg Med 2001;38:621–7.CrossRefGoogle ScholarPubMed
20.Ginder, S, Oatman, B, Pollack, M.A prospective study of i.v. magnesium and i.v. prochlorperazine in the treatment of headaches. J Emerg Med 2000;18:311–5.Google Scholar
21.Buyse, M.Interim analyses, stopping rules and data monitoring in clinical trials in Europe. Stat Med 1993;12:509–20.CrossRefGoogle ScholarPubMed
22.Todd, KH, Funk, JP, Funk, JG, Bonacci, R.Clinical significance of reported changes in pain severity. Ann Emerg Med 1996;27: 485–9.CrossRefGoogle ScholarPubMed
23.Lee, JS, Hobden, E, Stiell, IG, Wells, GA.Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med 2003;10:1128–30.Google Scholar
24.Cepeda, MS, Africano, JM, Polo, R, Alcala, R, Carr, DB.What decline in pain intensity is meaningful to patients with acute pain? Pain 2003;105:151–7.CrossRefGoogle ScholarPubMed
25.Harden, RN, Gracely, RH, Carter, T, Warner, G.Placebo effect in acute headache management: ketorolac, meperidine and saline in the emergency department. Headache 1996;36:352–6.Google Scholar
26.Marcus, DA.Migraine and tension-type headaches: the questionable validity of current classification systems. Clin J Pain 1992;8:28–36.Google Scholar
27.Cady, R, Schreiber, C, Farmer, K, Sheftall, F.Primary headaches: a convergence hypothesis. Headache 2002;42:204–16.CrossRefGoogle ScholarPubMed
28.Meyer, JS, Zetusky, W, Jonsdottir, M, Mortell, K.Cephalic hyperemia during migraine headaches. A prospective study. Headache 1986;26:388–97.Google Scholar
29.Nelson, CF.The tension headache, migraine headache continuum: a hypothesis. J Manipulative Physiol Ther 1994;17:156–67.Google Scholar