Magnesium IV and Orally for Migraine Headaches, Headaches, and Pain Syndromes An Interview with Neurologist and Pain Specialist Alexander Mauskop, MD

Migraines, Headaches and Pain…The Beneficial Effects of IV and Oral Magnesium. A Neurologist’s 30 years of Clinical Experience.

“…1 gram of MSo4 given in 10 cc normal saline by IV push over 5-10 minutes may have a better clinical effect than diluting the magnesium and giving it slower in an IV drip…”

“Clinical Uses of Magnesium Intravenously and Orally in the Treatment of
Migraine Headaches, Headaches and Pain”
an Interview with Neurologist and Pain Specialist Alexander Mauskop, MD

Alexander Mauskop, M.D.
New York Headache Center
30 East 76th Street
New York, NY 10021 USA
(212) 794-3550 / (212) 794-0591 (FAX)
drmauskop@nyheadache.com
www.nyheadache.com

The Science Behind Magnesium and Headaches (video); and The End of Migraines: 150 Ways to Stop Your Pain (book); Migraine Headaches and Magnesium, 1996 Expert Interview with Kirk Hamilton PA-C (click on link – control F – search “Mauskop” to find 1996 interview)

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“Clinical Pearls” by Kirk Hamilton PA-C from neurologist Dr. Alexander Mauskop’s “Staying Healthy Today Interview”…

  • Dr. Mauskop went to medical school in Ukraine right out of high school into a 6 year program. He did his four years of neurology residency in the United States at State University of New York (SUNY, 1979) and two years of pain fellowship at Sloan Kettering. He is a board certified neurologist and pain specialist. He has been treating headaches and pain syndromes for more than 30 years.

  • Dr. Burton Altura (professor of physiology) at State University of New York exposed him in the early 1990s to the concept of using magnesium in the treatment of migraine headaches and the importance of ionizable magnesium as the most accurate measurement of magnesium (98% of magnesium is intracellular). 50% of patients during an acute migraine attack had lowered levels of ionized magnesium. 1) 2) 3) 4)

  • The ones that responded to the IV magnesium and had headache symptoms reduced were magnesium deficient/insufficient. (RBC magnesium <5 mg/dl)

  • Those who respond to intravenous magnesium are generally deficient. Magnesium therapy generally doesn’t work for migraines if the patient is adequate in magnesium (RBC 5-6.4 mg/dl).

  • Magnesium is routinely given IV (MgSo4 – easily available, cost effective, and has been used in pre-eclampsia in much higher doses 5-6 gms so it is safe) 1-2 gm in 10 mls of normal saline over 5-10 minutes.

  • Giving it over 5-10 minutes IV push versus a slower drip diluted in more fluid appears clinically to have a better effect (tapering speed to patient flush, warmth, sleepiness, light headedness, etc. if administered too fast). The possible explanation is a higher tissue level with the IV push driving magnesium into the cell versus during a slower IV drip the magnesium may be excreted through the urine. Always administer to patient laying down.

  • People who are really deficient feel euphoric sometimes and they feel warm but comfortably so.

  • This 1 gram IV push (in some patients 2 grams) can be done monthly prophylactically or for an acute headache. Always give IV magnesium with the patient lying down.

  • Oral magnesium can be used prophylatically and the best assessment for the average clinician is RBC magnesium, not serum. Also the general range of RBC magnesium is 4.0-6.4 mg/dl. You want to get to 5 or above to reduce the likelihood of insufficiency.

  • He usually gives IV magnesium either in subjects with an acute headache and those that come in monthly IV for their shot.

  • There are many types of oral magnesium products (i.e glycinates, citrates, gluconates, taurates, oxides, aspartates, chelates, threonate, chloride, etc.). Whatever a patient chooses for oral intake should be followed by a RBC magnesium test trying to get a level greater than 5. The only real side effect from oral intake is diarrhea. Oral intake is reasonable between 350-450 mg/d with no GI upset or loose stools.

  • Take the magnesium at night can help them sleep.

  • The best time for a monthly injection is premenstrual for women. The magnesium can prevent a headache and reduce menstrual cramps.

  • Other pain syndromes that may benefit from IV magnesium are the pain of fibromyalgia, IBS, low back pain, shingles, neck pain…conditions that have low or low normal RBC magnesium of less than 5 mg/dl (optimal 5.0-6.4).

  • Magnesium is a predominantly an intracellular ion and acts as a natural “calcium channel blocker”. It effects over 300 enzyme systems in the body. It may work in migraine by 1) dilation and relaxation of blood vessels inhibiting or reversing blood vessel spasm 2) The magnesium ion “sits” inside the NMDA receptor blocking calcium’s entry and therefore blocking the transmission of pain. 3) Magnesium has an anti-inflammatory effect.

  • Magnesium deficiency may play a role in migraines by promoting cortical spreading depression, alteration of neurotransmitter release and the hyperaggregation of platelets.

  • Other nutrients that may benefit migraines: Vitamin B12 (> 500 pg/ml, closer to a 1000 may be more optimal); CoQ10 with levels > 1 mg/L, vitamin D > 50 ng/ml; vitamin B2; omega fatty acids (omega check ~ 5); ginger; alpha lipoic acid.

  • Food intolerance can play a role. He states the most common cause is sugar. When people consume sugar they may have a low blood sugar response and subsequent headache. Sometimes he will use metformin. Other commonly mentioned foods are: caffeine too much and withdrawal; sweets, chocolate, foods that are smoked, pickled, cured, have preservatives, sulfites, nitrates; cheese, dairy products, gluten. Any food can if particular to that individual.

  • Dr. Mauskop is a licensed acupuncturist and recommends 3-4 treatments to see if the patient will respond (works for 60% of people). People who really “enjoy” the initial treatment are generally the best responders.

  • Biofeedback, electrical stimulation may be of benefit.

  • Meditation is recommended.

  • There are so many options for headache sufferers. There is always one more thing to try. Check out Dr. Alexander Mauskop’s book The End of Migraines: 150 Ways to Stop Your Pain.

Alexander Mauskop’s MD Partial Publication List:

Serum ionized magnesium levels and serum ionized calcium/ionized magnesium ratios in women with menstrual migraine
Complementary and alternative approaches to the treatment of tension-type headache
Role of magnesium in the pathogenesis and treatment of migraine
Foods and supplements in the management of migraine headaches
Assessment: symptomatic treatment for muscle cramps (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
Magnesium in headache
Alternative headache treatments: nutraceuticals, behavioral and physical treatments
Why all migraine patients should be treated with magnesium
Nonmedication, alternative, and complementary treatments for migraine
Complementary and alternative approaches to the treatment of tension-type headache
Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society
Nutraceuticals in Acute and Prophylactic Treatment of Migraine
Stem Cells in the Treatment of Refractory Chronic Migraines
Intravenous Magnesium Sulfate to Treat Acute Headaches in the Emergency Department: A Systematic Review – A Comment
One-Year Consistent Safety, Utilization, and Efficacy Assessment of Remote Electrical Neuromodulation (REN) for Migraine Treatment

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Kirk Hamilton PA-C
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
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krhammer@surewest.net
www.StayingHealthyToday.com
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