MAGraine: Magnesium compared to conventional therapy for tre
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A migraine is a chronic neurologic disease characterized by attacks of throbbing, often unilateral headache associated with photophobia, phonophobia, nausea, vomiting, and cutaneous allodynia. Several classes of medications have been studied for the treatment of migraine. Magnesium is an intracellular cation that has been associated with both the function of serotonin and regulation of vascular tone, which are both mechanisms that implicate its role in the treatment of migraine.

This was a prospective, randomized, double-blind trial. Adults who presented to the ED with a diagnosis of migraine from August of 2019 to March of 2020 were included. Pregnant patients, or with renal impairment were excluded. Patients were randomized to receive intravenous magnesium, prochlorperazine, or metoclopramide. The primary outcome was change in pain from baseline on a numeric rating scale (NRS) evaluated at 30 min after initiation of infusion of study drug. Secondary outcomes included NRS at 60 and 120 min, ED length of stay, necessity for rescue analgesia, and adverse effects.

A total of 157 patients were analyzed in this study. 61 patients received magnesium, 52 received prochlorperazine, and 44 received metoclopramide. Most patients were white females, and the median age was 36 years. Hypertension and migraines were the most common comorbidities, with a third of the patients reporting an aura. There was a median decrease in NRS at 30 min of three points across all three treatment arms. The median decrease in NRS (IQR) at 60 min was -4 in the magnesium group, -3 in the metoclopramide group, and -4.5 in the prochlorperazine group. There were no statistically significant differences in ED length of stay, rescue analgesia, or adverse effects. Reported adverse effects were dizziness, anxiety, and akathisia. No significant difference was observed in NRS at 30 min between magnesium, metoclopramide and prochlorperazine.

IV magnesium may be used as an adjunctive agent for the treatment of migraines, or may serve as a safe alternative when agents such as prochloperazine or metoclopramide are not appropriate.

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