Migraine Treatment: IV Magnesium Sulfate

When Migraine has gone on too long, or is too painful to bear and other medications and treatments have failed, patients often think “It’s time to bring out the big guns” and opt for powerful painkillers instead of other more helpful treatments less likely to cause Medication Overuse Headache.  When visiting the emergency department, patients are often offered drugs that might help short-term with the pain, but do nothing for the attack itself.  If we can stop an attack in progress, the pain will go away, and this is the approach Migraine specialists take, often utilizing a very simple approach that can work quickly and extremely effectively.

Magnesium sulfate is a drug/nutrient we’ve talked about here before.  It is used in a hospital setting for serious conditions in addition to Migraine, including:

  • Life threatening asthma attacks
  • A heart rhythm problem called torsades de pointes which can result in heart attack
  • Pre-eclampsia
  • To delay labor in preterm situations

Magnesium sulfate also reduces inflammation, relaxes muscles and blood vessels as well as modulates calcium ion channels within our cells which trigger the release of neurotransmitters.

Migraine patients were found to be more likely than non-Migraineurs to be magnesium deficient when their blood is tested.  However, even this doesn’t show the magnitude of the problem, because magnesium levels are difficult to maintain in tissue, especially the brain.  Labs which check only our blood levels may appear normal in the presence of a deficiency in our central nervous system.


Many hospitals have a protocol they use for Migraineurs which utilizes magnesium sulfate first, before pain meds are offered.  Sometimes mag sulfate is given in addition to pain medication.

My headache specialist has a protocol she likes her patients to try.  She gives patients a sheet with the protocol listed so if an emergency department visit becomes necessary, they have specific information to give to the ED staff.

My doctor’s protocol for administration of mag sulfate is:

  1. 1 gram magnesium sulfate given intravenously, unless otherwise specified.
  2. Dilute the magnesium sulfate 1 gram with 0.9% sodium chloride for a total volume of 10cc. Solution should not be used if discolored or if it contains precipitate.
  3. Magnesium is to be administered IV push over 3-5 minutes
  4. Vital signs (BP and pulse) should be obtained at baseline, and after administration.

I have had mag sulfate used under the direction of other physicians as well.  In those cases, instead of IV push using a syringe, my mag sulfate was put into a saline IV bag and given over the period of 30 minutes.  This is often done because magnesium can be irritating to veins.

Possible side effects of mag sulfate include:

  • Facial flushing
  • Hypotension
  • Lightheadedness
  • Diarrhea

Hypermagnesemia may develop if administered chronically (repeatedly in a relatively short period of time).  Symptoms of hypermagnesemia include:

  • Nausea
  • Sedation
  • Hypoventilation
  • Muscle weakness
  • Decreased heart rate

As advocates we try to remind patients that the emergency room is often not our friend and should be utilized only when necessary or in the case of an emergency situation.

If what we’re experiencing is a worse than normal Migraine, but otherwise the symptoms are the same as our usual attacks, doctors will often not be happy to see us in their department.  When Migraineurs then ask for narcotic pain relief, this can raise red flags for staff, calling into question the reason for the request for addictive drugs.

Knowing about and utilizing magnesium first can often show staff that a patient is not only educated about their disease, but also willing to try something other than narcotics to help themselves.  This can go a long way if the magnesium fails, when doctors who are now more willing to trust you are subsequently asked for pain relief.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (6)
  • blueagain
    5 years ago

    Ellen, can you please address my comment/question below if you read this. I’m new on this site and don’t know how to contact directly.

  • blueagain
    5 years ago

    I have received IV magnesium for years and it has been helpful to abort a migraine. Since I’ve had chronic migraine for over ten years, my memory doesn’t serve me as well as it used to. My question is-can IV magnesium be used preventatively as well? Can my doctor order it before, say, a long trip where I know I’ll get one to prevent me from getting one or is it for intervention only? And if it can be used preventatively, does anyone know of any sources stating that. I would love that to be true especially since I can’t get my new insurance to understand when ordered I need it right away instead of two weeks later.

  • Michelle
    6 years ago

    Ellen, I hate to be critical or nitpicky. I have never thought about having IV Magnesium for an acute onset of a migraine. Although I do take it orally every day. Here is where I am going to correct you though. To the best of my knowledge (because I am not an expert) you are partially right about Mag being used in a hospital setting for certain heart conditions. However, it is used for frequent Premature Ventricular Contractions or as PVC’s. When a patient is having many PVC’s, especially in a row at a fast pace, it is called V-Tach. One of the first things a Dr. orders is labs to see if they are low on Mag or in some cases they give Mag. But actually Torsade’s De Points is a very serious and life endangering form of V-Tach. In fact the majority of people do not survive when in this rhythm.

    Like I said I am not an expert, nor am I a doctor. I have been a cardiac monitor tech for over 16 years. I have actually seen patients go into Torsade’s and of those patients I have never seen them survive.

    I’m sorry if I sound nitpicky, just wanted to clarify some of your data.

  • Ellen Schnakenberg author
    6 years ago

    Hi Michelle,

    I am always open to constructive criticism and am always learning. 🙂 However in this case, I’ve had a lot of conversation with my doctors throughout the years I’ve received this treatment. I’ve also had it used on me personally for more than one reason.

    Mag sulfate has many uses, and one actually is for the correction of Torsades de Pointes. A quick look-up gives you this PubMed paper: http://www.ncbi.nlm.nih.gov/pubmed/3338130 This doctor http://www.patient.co.uk/doctor/Torsades-de-Pointes.htm calls mag sulfate the treatment of choice for the condition, saying “Intravenous magnesium is the drug of choice for torsades de pointes. Magnesium is effective even in patients with normal magnesium levels.”

    That said, I certainly didn’t intend this short list to be all-inclusive, but just to give a few examples of ways mag sulfate may be used in other conditions. 🙂

    I think you’re also very correct – from what I’ve learned of Torsade’s, it is often fatal.

  • slhart
    6 years ago

    Thank you for this information.

  • Ellen Schnakenberg author
    6 years ago

    slhart – You’re welcome – and thank you for taking the time to comment 😀

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