UMEM Educational Pearls

Title: IV Magnesium for Acute Migraine Headache

Category: Pharmacology & Therapeutics

Keywords: headache, migraine, metoclopramide, magnesium (PubMed Search)

Posted: 12/31/2014 by Bryan Hayes, PharmD (Updated: 1/3/2015)
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Does IV magnesium have a role in the management of acute migraine headache in the ED? A new study says yes. [1]

Intervention

35 patients received IV magnesium 1 gm over 15 minutes.
35 patients received IV dexamethasone 8 mg + IV metoclopramide 10 mg over 15 minutes.
Each group contained men and women.
Initial pain score 8.2 in dexamethasone/metoclopramide group vs. 8.0 in magnesium group.

What They Found

Magnesium sulfate was more effective in decreasing pain severity at 20-min (pain scale 5.2 vs. 7.4) and 1-h (2.3 vs. 6.0) and 2-h (1.3 vs. 2.5) intervals after treatment (p < 0.0001) compared to treatment with dexamethasone/metoclopramide.

Application to Clinical Practice

Two previous studies found mixed results using magnesium. [2, 3] This new study found that IV magnesium may be an additional option. The authors didn't compare magnesium to more common treatments such as prochlorperazine or metoclopramide 20 mg (+/- ketorolac and diphenhydramine), which may limit its generalizability. However, magnesium's pain lowering effect was good regardless of comparator group.

Another possible use for magnesium in the ED?

References

Shahrami A, et al. Comparison of therapeutic effects of magnesium sulfate vs. dexamethasone/metoclopramide on alleviating acute migraine headache. J Emerg Med 2015;48(1):69-76. [PMID 25278139]
Corbo J, et al. Randomized clinical trial of intravenous magnesium sulfate as an adjunctive medication for emergency department treatment of migraine headache. Ann Emerg Med 2001;38(6):621-7. [PMID 11719739]
Cete Y, et al. A randomized prospective placebo-controlled study of intravenous magnesium sulphate vs. metoclopramide in the management of acute migraine attacks in the Emergency Department. Cephalagia 2005;25(3):199-204. [PMID 15689195]

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