Magnesium and Migraines

Table of Contents

  1. How does magnesium work for migraines ?
  2. Where do I go for magnesium testing and what type of test should I have?
  3. Why is my serum magnesium level normal but I have symptoms of hypomagnesemia?
  4. Who is at risk for hypomagnesemia?
  5. When is magnesium not good to take?

How does magnesium work for migraines?

Magnesium is a dietary mineral that helps regulate blood vessel size, serotonin function, and nerve activity in the brain, among other functions. Magnesium deficiency is thought to be at least one important factor in migraine attacks. Many studies suggest that magnesium might be a common denominator in both the vascular and the neural theories of migraine. In support of the vascular theory, magnesium deficiency results in blood vessel constriction and adding magnesium to the diet leads to the opening (dilation) of blood vessels. In support of the neural theory, magnesium deficiency has been linked with the production and release of substance P12-a biochemical that contributes to the inflammation of nerves and headache pain.

In a recent study conducted by Dr Alexander Mauskop and his colleagues, they reported an 85% success rate in treating migraines with an intravenous injection of magnesium. In the study 85% of the magnesium deficient men and women in the middle of a migraine attack experienced rapid and dramatic relief of symptoms when they received magnesium. Within minutes individuals felt relief of migraine pain. They also felt relief from nausea and from sensitivity to light and noise. Aside from a very few patients who had short-term light headedness during the infusion, there were no side effects. In the study people who were not deficient in magnesium at the outset did not experience relief. This indicates that improvement was not due to a placebo effect.

Recent studies indicate that magnesium depletion, that is, having lower than normal levels of the mineral magnesium, can influence serotonin and nitric oxide release, blood vessel size, and inflammation. It’s also thought that people with mitral valve prolapse have lower than normal levels of magnesium.

Several studies have shown that magnesium depletion plays a critical role in blood vessel size. It seems not only to cause blood vessel constriction but to make blood vessels more sensitive to other chemicals that cause constriction and less sensitive to substances that cause blood vessels to dilate.

Studies have also shown that magnesium depletion seems to help release serotonin from its storage sites. It also helps make blood vessels in the brain more receptive to serotonin and thus clears the way for serotonin to cause constriction of blood vessels.

Replacing magnesium has been shown to have a very positive effect on migraine symptoms in some people.
Reference 1. The Headache Alternative, Dr Alexander Mauskop, Dell Books
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Where do I go for testing and what type of tests should I have ?

Any physician, lab or hospital can do the basic serum magnesium levels. There are special more accurate means of testing that are listed below. You will have to ask the specific place you go to whether or not they do the type of test you would like to have done.

Serum Magnesium Levels

Since magnesium is mainly an intracellular ion, measurement of serum total magnesium is an inaccurate index of intracellular or total magnesium stores. Hypomagnesemia (<1.7meq/L) is found in 7% of routine screenings, but is far more prevalent in patients with diabetes (20% to 50%) and in patients in the intensive care unit (20% to 65%).

Total Red Cell Magnesium

Atomic absorption spectroscopy measures of total red blood cell magnesium levels are less variable than serum measurements, but also do not adequately reflect total body magnesium status in health and disease.

Serum Ionized Magnesium

The use of magnesium-specific, ion-selective electrodes to more accurately assess extracellular free magnesium levels is a promising new technology. This technique correlates well with intracellular free magnesium levels in conditions such as diabetes, chronic renal failure, and pregnancy.

Intracellular free magnesium

P-nuclear magnetic resonance (NMR)spectroscopy is the most definitive and noninvasive measure of the active magnesium ion in blood cells or tissues in situ. Lack of routine availability of NMR has limited its clinical use so far.

Sublingual magnesium assay

A test that uses sublingually obtained mucosal cells smeared on carbon films and evaluated by energy dispersive x-ray analysis is a means of direct determination of cellular magnesium that correlates with cardiac tissue obtained during cardiac surgery. Its clinical applicability in arrhythmias and hypertension is under study. IntraCellular Diagnostics, Inc. ( ICD) is a biomedical diagnostics firm dedicated to the non-invasive and accurate testing of vital minerals and electrolytes at the cellular level with the sublingual test Exatest. Exatest is a safe non-invasive test that accurately measures the minerals inside the cells. Your doctor painlessly collects a sample from under your tongue and affixes it to a slide. The slide is then sent to IntraCellular Diagnostics, Inc. for analysis. Exatest is widely used in major hospitals and medical practices throughout the United States, Europe and South America. Click here to visit the Exatest Website

Magnesium Load Test

This test measures urinary magnesium excretion in response to a loading dose of magnesium. Although inconvenient to perform, this test has successfully identified individuals with even mild degrees of magnesium deficiency. It is only accurate with normal renal function and without renal magnesium wasting.

Reference
The Magnesium Report – First Quarter 200
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Why is my serum magnesium normal but I have symptoms of hypomagnesemia ?

Approximately 55% of the total body magnesium is in the skeleton and the remainder is intracellular (inside the cell), where it is the second most prevalent cation.

Extracellular (Outside the cell) magnesium accounts for about 1% of the total body magnesium content. When your doctor does a serum magnesium level this is what they are checking (The extracellular level). Which is why we say you can still be hypomagnesemic (Low magnesium) despite a normal serum magnesium level. They are only checking 1% of your total magnesium content in your body when they do a serum magnesium level.

One test that can be easily done is a red blood cell magnesium level (RBCMg). This will tell your doctor what is happening inside the cell where the majority of your magnesium is stored. This test also does not adequately reflect total body magnesium status in health and disease.

Another test that can be done is a Magnesium Load Test. This test is done if your physician thinks you may be losing the magnesium through the kidneys. The kidneys filter and absorb magnesium and other minerals. If your kidneys are not absorbing the magnesium you will lose it in your urine. The magnesium load test involves giving you a specific dose of magnesium continuously through IM or IV route and doing a 24 hour urine sample during this “load”. If there is excessive magnesium in the urine despite a low serum or RBCMg then this is Renal Wasting.

P-nuclear magnetic resonance (NMR) spectroscopy is the most definitive and noninvasive measure of the active magnesium ion in blood cells or tissues in situ. Lack of routine availability of NMR has limited its clinical use thus far.

Chemical compositions of intracellular and extracellular fluids

Extracellular Fluid

Intracellular fluid

Na+ 142meq/L

Na+ 10meq/L

K+ 4meq/L

K+ 140meq/L

Ca+ 2.4meq/L

Ca+ 0.0001meq/L

Mg+ 1.2meq/L

Mg+ 58meq/L

Cl+ 103meq/L

Cl+ 4meq/L

HCO3 28meq/L

HCO3 10meq/L

Phosphates 4meq/L

Phosphates 75meq/L

SO4 1meq/L

SO4 2meq/L

Glucose 90mg/dL

Glucose 0-20mg/dL

Amino Acids 30mg/dL

Amino Acids 200/dL ?

PCO2 46 mm Hg

PCO2 50 mm Hg?

PO2 35 mm Hg

PO2 20 mm Hg?

pH 7.4

pH 7.0

Cholesterol
Phospholipids 0.5gm/dL
Neutral Fat

Cholesterol
Phospholipids 2-95gm/dL
Neutral Fat

References

Fluid and Electrolyte Balance Nursing Considerations, Norma M. Metheny, 4th edition, JB Lippincott Co, Philadelphia

Fundamentals of Clinical Chemistry, 4th edition, Burtis and Ashwood, WB Sauders Co.
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Who is at risk for hypomagnesemia?

Causes of Hypomagnesemia and Magnesium Deficiency

Diminished Intake

Malnutrition-starvation
Mg? free parenteral feedings
Dieting

Gastrointestinal reduced absorption and increased losses

prolonged gastric suction
Laxative abuse
Small bowel resection or bypass
Malabsorption syndromes
Chronic diarrhea
Specific Mg? transport defects

Renal Wasting

Diuretics
Diuretic phase of acute tubule necrosis
Hyperaldosteronism
Bartter syndrome
Congenital renal tubule transport defect
Gitelman syndrome
Asthma Medications
Catecholamines (Adrenaline)
Steroids

Acquired Tubule Defects

Cisplatin
cyclosporine
Aminoglycosides
Pentamidine
Foscarnet

Redistribution

hungry Bones syndrome
Hyperadrenergic states
Insulin Therapy

Multiple Mechanisms

Alcoholism
Diabetes Mellitius
Major Burns
Pancreatitis

Miscellaneous

Hypercalcemia
Hyperparathyroidism
Hypophosphatemia
Volume Expansion
Excessive Lactation

References
Sutton and Dirks – Disturbances in control of body fluid volume and composition
Herbert C Mansmann Jr – Magnesium Supplementation Recommendations
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When is it not good to take magnesium?

People who have renal failure or kidney problems should not take magnesium without direct supervision of their physician.

Pregnant woman should consult their obstetrician before taking any supplements.

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