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