Emergency treatment of headaches with intravenous magnesium

Intravenous infusion of magnesium for the treatment of an acute migraine is receiving more attention and is mentioned in the recent issue of journal Headache. In the first of three articles Drs. Nancy Kelley and Deborah Tepper of the Cleveland Clinic describe the use of triptans (such as sumatriptan, or Imitrex), DHE (dihydroergotamine), and magnesium for the emergency treatment of migraines. In their article they included seven reports of the use of magnesium infusion, all with positive results. We published the very first article on the use of intravenous magnesium for migraines in 1995. In the same year we published our results of the use of this treatment for cluster headaches, also a first and since that time have been promoting the use of this safe and effective treatment in many articles, lectures, and symposia. We’ve found that 50% of patients with migraines and 40% of those with cluster headaches responded to magnesium infusion. Unfortunately, many patients seen in the emergency room still do not receive magnesium, but in the best case sumatriptan or ketorolac injection, in the worse, narcotic drugs. An infusion of magnesium should be always tried first. We actually discourage our patients from going to the emergency room during office hours – instead they come to our office and are given an infusion of magnesium. If it is ineffective, then we proceed with sumatriptan, ketorolac, dexamethasone, other drugs, and sometimes nerve blocks.
Oral magnesium is not suitable for the acute treatment of a severe headache because it is absorbed too slowly. However, Migralex, a drug containing magnesium and aspirin was developed to dissolve and absorb quickly, so it can deliver magnesium (along with aspirin) to the brain within 15 – 30 minutes. Another article in the same issue of Headache recommends the use of aspirin as the first line treatment for migraine and tension-type headaches, regardless of their severity. Many doctors use “stratified” approach, which means that they recommend aspirin for milder headaches and a prescription drug, such as sumatriptan, for more severe attacks. However, the authors reviewed results of studies involving thousands of patients and concluded that aspirin can be very effective for many patients with a severe headache and should be tried first. If it is ineffective, then the patient is advised to take the prescription drug.

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