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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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