migraine

Magnesium: a natural alternative therapeutic agent for migraines

By Virginia Thornley, M.D., Neurologist

February 21, 2018

Many migraine sufferers are turning more towards all natural organic ways of managing migraines disillusioned by the side effects of conventional medications. Much attention is directed towards safe, healthy non-prescription agents in dealing with medical conditions. There is growing attention directed towards a more natural way of dealing with migraines with the incompletely effective measures that are available through conventional medicine. Several nutraceutical options are found to have growing evidence of effectiveness including magnesium, feverfew, coenzyme Q and riboflavin(1). Level B evidence exists for riboflavin, magnesium and feverfew(2). They have been found to be useful in treating the pediatric population because the risk of side effects is less(4). Many physicians practicing evidence-based medicine are still very reluctant to recommend nutraceuticals despite evidence in the literature of its effectiveness. This seeks to explore the mechanism of action and studies supporting the use of magnesium in migraine management.

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Proof is in the pudding

Doctors are reluctant to advise using supplements but there is a growing body of evidence supporting its use. In one report reviewing a wide range of studies evaluating the use of magnesium in migraine Level I evidence supports the use of magnesium in managing migraine(5). Magnesium is an important cofactor in many metabolic processes in the body. Optimizing its use appears well-documented in several medical conditions including migraine. In one study, there was a 50% reduction in the number of days with migraine using magnesium which increased in number of days the longer the supplement was used (6). With high dose IV magnesium in another study, in 93% of patients the migraine attack ended, in 1% the symptoms reduced in severity, in 100% the accompanying symptoms disappeared(7). High dose IV is a conventional treatment widely used in the hospital setting to abort debilitating migraines and often part of the “migraine cocktail” widely used in the ER setting.

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How does magnesium in a migraine work?

Magnesium is a mineral found naturally in the diet and is used in IV form to break the excruciating condition status migrainosus in the hospital setting. It is frequently used as a safe, healthy organic measure in migraine prevention. It has been found that people with migraines are magnesium deficient compared to healthy controls. Magnesium deficiency may be important in platelet hyperaggregation(3), cortical spreading depression, affect serotonin receptor function and affect many neurotransmitters and their release and functions. Migraineurs may suffer from magnesium deficiency due to genetic abnormalities, abnormal renal secretion and reduced consumption in the diet among other mechanisms. Magnesium may be deficient in more than 50% of patients warranting a trial in all migraine sufferers. It cannot be measured in the blood because most of the mineral is found in the bone at about 67% and intracellularly at 31% leaving less than 2% that can be measured extracellularly.

Consult with your neurologist.

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  1. D’Onofrio, et al, “Usefulness of nutraceuticals in migraine prophylaxis,” Neurological Science, 2017, May, 38 (Suppl1):117-120.
  2. Tepper, et al, “Nutraceutical and other modalities of treatment for migraine,”Continuum: Lifelong Learning, 2015, August, 21 (4, Headache);1018-31.
  3. Mauskop, et al, “Why all migraine patients should be treated with magnesium,”Journal Neural. Transm., 2012, May, 119(5):575-579.
  4. Sangermani, et al, “The use of nutraceuticals in children’s and adolescent’s migraines,”Neurological Science, 2017, May, 38 (Suppl 1):121-124.
  5. Schwalfenberg, et al, “The importance of magnesium in clinical healthcare,” Scientifica (Cairo), 2017:4179326.
  6. Guilbot, et al, “A combination of coenzymeQ10, feverfew and magnesium for migraine prophylaxis: a prospective observational study,” BMC Complement. Altern. Medicine, 2017, Aug., 30 (7):433.
  7. Demirkaya, et al, “Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks,”Headache, 2001, Feb., 41(2):171-7.
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migraine

Migraine:Non-Pharmacologic Ways to Deal with Migraines

By Virginia Thornley, M.D., Neurologist
February 15, 2018

Introduction
Migraines are characterized by recurrent pounding, throbbing pain, occurring on one side of the head. At times, it alternates.  At its highest intensity, it is rated a 10/10 on the pain scale. It is often accompanied by nausea, vomiting, sensitivity to bright lights and loud noises. It may or may not be accompanied by visual symptoms which can range from seeing bright lights to seeing sophisticated patterns of color called fortifications that often migrate across your visual fields. The frequency may vary from infrequent to a daily basis. Some patients may have other neurological symptoms that accompany it, however, migraine is a diagnosis of exclusion. In other words, other more serious causes are ruled out before a diagnosis of migraine can be concluded if you also experience other neurological symptoms. It is important to be fully evaluated by a neurologist to exclude other possible neurological etiologies.

Lifestyle changes that help reduce migraine frequency
There are non-pharmacologic measures which may reduce the frequency of migraines. Oftentimes, triggers can be found. Lifestyle changes are the hardest to do but they greatly minimize the frequency of migraines.

Avoidance of caffeine
If large amounts of coffee are consumed, tapering can help ease into complete cessation. A sudden cessation may result in withdrawal effects of caffeine which can involve headaches. Common sources of caffeine include coffee, tea, soda, and chocolate. Avoidance of beverages labeled as decaffeinated as there is still a small amount of caffeine is also beneficial.

There is a lot of myth and misinformation. Many migraineurs say that caffeine alleviates their headaches. Caffeine can help a migraine in the short-term, however, it prolongs a migraine cycle. Refer to a neurologist for questions.

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Obtain adequate sleep
Adequate rest at night is important. This may vary from 6-8 hours. A rule of thumb is if one cannot drag themselves out of bed sleep is inadequate.  Adequate sleep means waking up refreshed. Sleep requirements vary per individual. Sleep deprivation propagates the migraine cycle. Sleep must be continuous and nocturnal allowing the body to enter the restorative deep wave sleep at stages 3 and 4 of sleep. Even if prolonged sleep occurs if constantly interrupted one will not wake up refreshed since the natural sleep cycle is disrupted and only light sleep stages 1 and 2 will occur. It should be nocturnal, the body is designed to sleep at night when hormones are secreted, daytime sleep will not have the same quality.

Avoidance of food triggers
A food journal provides much useful information. Common culprits include wine, cheese, hot dogs, and fish. Certain red meat may trigger migraine. Food triggers vary per patient and are unique to each individual.

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Avoidance of excessive use of over the counter medications
Over the counter medications are easily accessible and consumable. A common pitfall is to overuse these medications. When stopped abruptly, rebound headache may result. It is not infrequent for patients with migraine headaches to have rebound headaches compounding the condition.

Magnesium use
Magnesium is known to help with migraine. Intravenous magnesium is often used in the hospital setting in status migrainosus which is a continuous extremely painful migraine which sometimes lasts up to weeks. Magnesium is a mineral found naturally in food. Oral magnesium oxide at specific doses is helpful in preventing the migraine cycle.

Riboflavin use
Riboflavin is found naturally in the diet. It can prevent the migraine cycle at specific doses.

Other lifestyle changes
Other lifestyle changes include keeping hydrated especially during hot weather, eating 3 meals a day and avoiding hunger. Some triggers are unique to individuals. Avoiding stress helps with migraines. A zen-like environment is optimal.

Medications are often prescribed for the management of frequent migraine headaches. They are divided into 2 classes, preventative and abortive agents. However, even the best medications will not work effectively if triggers or aggravating factors are still present as mentioned above in daily life.

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Epilepsy, migraine

Sleep Hygiene especially for Migraineurs and those with Epilepsy

By Virginia Thornley, M.D., Neurologist, Epileptologist
February 15, 2018

Introduction
Many neurological diseases are affected by lack of sleep most significantly migraine and epilepsy. A person performs suboptimally with lack of sleep with inattention and lack of coordination. In someone with a neurological condition, the symptoms become even more manifest. Weakness becomes more prominent, double vision may be more pronounced and difficulty speaking will become more prominent. Sleep plays a vital role in the restorative function of the body.

Stages of sleep, why adequate and continuous sleep is refreshing
Sleep is divided into 2 categories, Non-REM (rapid eye movement) sleep and REM sleep. During non-REM sleep, there are 4 stages. Stage 1 and 2 constitute drowsiness which transitions into light sleep. The electroencephalogram is a study that reflects brain activity. Stages 1 and 2 demonstrates sleep complexes including vertex waves then K complexes. Sleep spindles occur during stage 2 sleep. During stages 3 and 4 also known as slow-wave sleep, delta waves which are the slowest waves between 1-3 Hertz start to occur. Stage 4 shows delta waves of greater than 50% of the recording. People enter these stages of sleep and then subsequent REM sleep. REM sleep is where dreaming occurs.

One can go through a few cycles of these so that you wake up refreshed. Continue reading

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