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Migraine and Magnesium

Timothy C. Hain, MD Page last modified: May 18, 2016 See also -- many pages on migraine on this site

Main points:

Migraines are an immensely common human problem, affecting about 15% of the entire population (mainly women). A little known aspect of migraine is that they are more likely when magnesium blood levels are low, and some migraines can be aborted by large amounts of magnesium, usually given in the emergency room (Sun-edelstein et al, 2009). The evidence for prophylaxis in adults is reasonable, but the evidence for use in children as well as an abortive is weak.

Magnesium absorption is reduced by some stomach medications for reflux, called proton pump inhibitors. Some of them are over the counter -- e.g. prilosec. This means that it is especially important to take magnesium supplements for migraine prevention, if you take a PPI.

Evidence for magnesium supplements as prophylaxis:

Evidence for magnesium working as a migraine abortive:

Proton pump inhibitors (PPI) and magnesium.

Proton pump inhibitors approved in the US include:

  1. omeprazole (Prilosec),
  2. lansoprazole (Prevacid),
  3. rabeprazole (Aciphex),
  4. pantoprazole (Protonix),
  5. esomeprazole (Nexium), and
  6. Zegarid, a rapid release form of omeprazole.

Recent papers showing an association between PPI use and low magnesium include:

One would think that use of PPI would be correlated with more migraines. This does appear to be true in large studies (e.g. Liang et al, 2014). H2 blockers, such as Ranitidine ("Zantac"), might beless likely to cause headache. So far, there has not been a comparison trial (between PPI and H2 blockers).

Recommendations:

Overall, we agree with the conclusion of Pardutz et al (2012) : "The data available suggest that magnesium has a potential role in the prophylaxis, but the results in acute therapy are far less convincing."

We suggest that most patients with migraine should be taking magnesium 500 mg/day.

References:

 

Copyright August 3, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on August 3, 2016