Title: Role of Magnesium in Prophylaxis of Migraine

Authors: Sagia Afrose, Nazmul Hoque Msunna, Md. Ismail Khan, Elisa Omar Eva

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i10.135

Abstract

Background:  Circumstantial evidence points to be possible role of magnesium (Mg+2) deficiency in the pathogenesis of migraine and has raised questions about the clinical utility of magnesium as a therapeutic regimen in migraine. This was a prospective, randomized, double blind, placebo controlled trial comparing the efficacy and tolerability of 400mg magnesium hydroxide once daily (23 patients), 10 mg Propranolol 3 times daily (22 patients), 200 mg Na-valproate twice daily (20 patients), and placebo (22 patients) in the prophylaxis of migraine diagnosed according to the criteria of the International Headache Society. Patients were evaluated for attack frequency, severity, drug side effects monthly for 3 months. Magnesium, Propranolol and Na-valproate were all superior to placebo (p<0.001) in reducing both attack frequency and severity after the first month. There was no significant difference between the three active drugs in reduction of attack frequency and severity. No serious side effects were observed and the frequency of side effects were not significantly different in all treatment groups. Our results show that oral magnesium is an effective and well tolerated drug in the prophylaxis of migraine and compares well to established drugs like Propranolol and Na-valproate both in effectiveness and occurrence of side effects. Magnesium may be an alternative drug in migraine prophylaxis, but more larger comparative trials are needed to confirm this results.

Aim: To find out the role of magnesium in migraine prophylaxis and compare it with two established drug Propranolol and Na-valproate on some diagnosed case of migraine.

Method: This was a prospective, randomized, double blind, placebo controlled trial conducted in the outpatient department of Neurology, Dhaka medical college & Hospital from July 2015 to June 2016. Sample size was 87.

Result: There was no statistically significant difference between the Magnesium, Propranolol and Na-valproate in reduction of migraine attack frequency and severity with ( P- value >0.05; which is not significant). Our result shows that magnesium significantly reduced the frequency of migraine attack and severity with no serious side effects compares well to established drugs like Propranolol and Na-valproate.

Conclusion: The study was conducted to find out the role of magnesium in migraine prophylaxis. The present study found that magnesium significantly lowers the frequency of attack & severity of migraine. So magnesium can be used as an alternative agent for migraine prophylaxis for its effectiveness, well tolerability and less side effects.

Keywords: Migraine prophylaxis, Propranolol, Na-valproate , Magnesium.

References

  1. Rasmussen BK (1995) Epidemiology of headache. Chephalalgia 15:45-68
  2. Bank J (1994) A comparative study of amitriptyline & fluvoxamine in migraine prophylaxis. Headache 34:476-478
  3. Tfelt-Hansen P, Standnes B, Kangasneimi P, Hakkarainen H, Olesen J (1984) Timolol vs propranolol vs placebo in common migraine prophylaxis : a double blind multicenter study. Acta Neurol Scand 69:1-8
  4. Verspeelt J, De Lochcht P, Amery WK (1996) Post-marketing cohort study comparing the safety and efficacy of flunarizine & propranolol in the prophylaxis of migraine. Cephalalgia 16:328-336
  5. Gomersall JD, Stuart A (1973) amitriptyline in migraine prophylaxis. J neurol Neurosurg Psychiatry 36:684-690
  6. Ziegler DK, Huewitz A, Preskorn S, Hassanein R, Seim J (1993) propranolol & amitriptyline in the prophylaxis of migraine. Arch Neurol 50:825-830
  7. Couch JR, Hassanein RS (1979) Amitriptyline in migraine prophylaxis. Arch Neurol 36:695-699
  8. Ramadan NM, Schuitz LL, Gilkey SJ (1997) Migraine prophylactic drugs: proof of efficacy, utilization and cost. Cephalalgia 17:73-80
  9. Sorensen PS, Hansen K, olesen J (1986) A placebo-controlled, double blind, cross over trial of flunarizine in common migraine. Cephalalgia 6:7-14
  10. Louis P (1981) A double blind placebo controlled placebo prophylactic study of flunarizine in migraine. Headache 21:235-239
  11. Frenken CWGM (1984) Flunarizine, a new preventive approach to migraine. A double blind comparison with placebo. Clin Neurol Neurosurg 86:17-20
  12. Mendenopoulou G, Manafi T, Logothesis I, Bostantjopoulou S (1985) flunarizine in the prevention of classic migraine: a placebo-controlled evaluation. Cephalalgia 5:31-37
  13. Louis P, Spierings ELH (1982) aA comparison of flunarizine & pizotifen in the treatment of migraine. A double blind study. Cephalalgia 2:197-203
  14. Centonze V, Magrone D, Vino M et al (1990) flunarizine in migraine prophylaxis : efficacy & tolerability of 5 mg & 10 mg dose levels. Cephalalgia 10:17-24
  15. Ziegler DK, Hurwitz A, Hassanein RS, Kodanaz HA, Prekorn SH, Mason J (1987) Migraine prophylaxis: a comparison of propranolol & amitriptyline. Arch Neurol 44:486-489
  16. Altura BM (1985) calcium antagonist properties of magnesium : Implication of antimigraine actions. Magnesium 4:169-175
  17. Mauskop A, Altura BT, Cracco RQ, Altura BM (1993) Deficiency in serum ionized magnesium but not total magnesium in patients with migraine. Possible role of Ica+2/IMg+2 ratio. Headache 33:135-138
  18. Ramadan NM, Halvorson H, Vende Linde A et al (1989) low brain magnesium in migraine. Headache 29 : 590-593
  19. Taubert K (1994) Magnesium bei Migraine. Fortschr Med 112 : 328-330
  20. Pfaffenrath V, Wessely P, Meyer C, Isler HR, Evers S, Grotemeye KH, Taneri Z, Soyka D, Gobel H, Fischer M (1996) magnesium in the prophylaxis of migraine- a double blind, placebo controlled study. Cephalalgia 16 : 436-440
  21. Peikert A, Wilimzig C, Kohne-Volland (1996) prophylaxis of migraine with oral magnesium : result for a prospective, multicenter, placebo controlled and double blind randomized study. Cephalalgia 16 : 257-263
  22. Facchinetti F, Sances G, Borella P, Genazzani AR, Nappi G (1991) magnesium prophylaxis of menstrual migraine. Effects of intracellular magnesium. Headache 31 : 298-301
  23. Headache classification committee of the International Headache Society (1998) Classification & diagnostic criteria for headache disorders, cranial neuralgias & facial pain. Cephalalgia 8 [Suppl 7] : 1-96
  24. Sorensen PS, Larsen BH, Rasmussen MJK et al (1991) flunarizine versus metoprolol in migraine prophylaxis : a double blind, randomized parallel group study of efficacy & tolerability. Headache : 31 : 650-657
  25. Toda N, Tfelt-Hansen P (1993) Calcium antagonist. In : Olesen J, Tfelt-Hansen P, Welch KMA (eds) The headaches. Raven, New York, pp 383-391
  26. Marrannes R, Willems R, Prins E, Wauquier A (1988) Evidence for a role of the N-methyl-D-aspartate (NMDA) receptor in cortical spreading depression in the rat. Brain Res 457 : 226-240
  27. Ferrari MD (1992) Biochemistry of migraine. Path Biol 40 : 287-289
  28. Mody I, Lambert JDL, Heineman V (1987) Low extracellular magnesium induces epileptiform activity & spreading depression in rat hippocampal slices. J Neurophysiol 57: 869-888
  29. Altura BM, Altura BT (1978) Magnesium & vascular tone & reactivity. Blood vessel 15: 5-16
  30. Iseri LT, French JH (1984) Magnesium : nature’s physiologic calcium blocker . Am Heart J 108 : 188-193
  31. Norman AB, Battaglia G, Creese I (1985) [3H]WB4101 labels the 5-HT1A serotonin receptor subtype in rat brain. Mol Pharmacol 28 : 278-294
  32. Turlapaty PD,Altura BM (1980) Magnesium deficiency produces spasms of coronary arteries : relationship to etiology of sudden death ischemic heart disease. Science 208 : 198-200
  33. Goldstein S, Zsoter TT (1978) The effect of magnesium on the response of smooth muscle to 5-hydroxytryptamine. Br J Pharmacol 62 : 507-514
  34. Weglicki WB, Phillips TM (1992) Pathology of magnesium deficiency : a cytokine/neurogenic inflammation hypo-thesis. Am J Physiol 263 : R734-R737
  35. [Moskowitz MA (1984) The neurobiology of vascular head pain. Ann Neurol 16 : 157-168
  36. Gallai V, Sarchielli p, Coata G et al (19920 serum and salivary magnesium levels in migraine. Result in a group juvenile patients. Headache 32 : 132-135
  37. Soriani S, Arnaldi C, De Carlo L et al (1995) Serum & red blood cell magnesium levels in juvenile migraine patients. Headache 35 : 14-16
  38. Schoenen J, Sianord-Gainko J, Lenaert M (1991) Blood magnesium levels in migraine. Cephalalgia 11 : 97-99
  39. Gallai V, Morucci P, Abbritti G (1993) Red blood cell magnesium levels in migraine patients. Cephalalgia 13 : 74-81
  40. Mazzotta G, Sarchielli P, Alberti A, Gallai V (1999) Intracellular magnesium concentration & electromyographical ischemic test in juvenile headache. Cephalalgia 19 : 802-809
  41. Gallai V, Sarchielli P, Morucci P, Abbritti G (1994) Magnesium content of mononuclear blood cells in migraine patients. Headache 34 : 160-165
  42. Durlach J (1976) Neurological menifestations of magnesium imbalance. Handbook Clin Neurol 28 : 545-579
  43. Demirkaya S, Vural O, Ozdag F et al (1999) Efficiency of intravenous magnesium sulphate treatment in acute migraine attacks. Presentation [P03.054] at the AAN 51st Annual Meeting, Toronto, Ontario, Canada (abstract)     
  44. Mauskop A, Altura BT, Cracco RQ, Altura BM (1996) Intravenous magnesium sulfate rapidly alleviates headache of various types. Headache 36 : 154-160
  45. Neilson JP (1995) Magnesium sulphate : the drug of choice in eclampsia. BMJ 16(7007) : 702-703.

Corresponding Author

Sagia Afrose

Contact number: 01914121309, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.