Reader's Mail: Magnesium Preventing My Headaches?

Q. What role does magnesium play in preventing headaches? I’ve had migraines for 20 years and have tried several things, including diet modification, to alleviate them. Magnesium seems to help prevent them. When I have an aura, I take 250 mg of magnesium and it prevents the migraine from occurring. I also take magnesium every morning and evening.

A. Magnesium is an essential mineral and is responsible for over 300 metabolic reactions in the body. It is required for synthesizing proteins in the mitochondria and for generating energy in most of the body’s basic cellular reactions. It affects serotonin receptors, nitric oxide synthesis and release, and other migraine-related receptors and neurotransmitters. Low magnesium levels may increase the likelihood of cramps, seizures and even irregular heart beat. Indeed, magnesium is used for some cases of seizures, preeclampsia and muscle cramps, and in the prevention of irregular heart beat after heart attacks.

There are some studies indicating a role for magnesium in migraine. Supplementation with magnesium reduces the irritability of brain cells and affects serotonin metabolism involved in migraine headaches. As a result, it may increase the migraine threshold, thus reducing the frequency of headaches.

Headache specialists suggest trying a daily dose of magnesium of 400 mg to 600 mg to reduce the frequency of migraine attacks, including menstrual migraines. An overdose of magnesium, however, may lead to tiredness, muscle weakness and lethargy. Diarrhea may be an unpleasant but benign side effect of magnesium supplementation. Because magnesium should not be taken in the presence of certain diseases, discuss its use with your healthcare professional.

George J. Urban, M.D.
Co-Director, Diamond Headache Clinic
Chicago, IL

Q. I have had very good results with my headaches by eliminating gluten from my diet. Are you aware of any formal studies that support this?

A. Gluten is a special type of protein that is commonly found in rye, wheat and barley, which means it is found in most types of cereals and in many types of bread. In susceptible individuals, gluten triggers an inflammatory reaction in the small bowel that results in a decrease in nutrient, fluid and electrolyte absorption. This condition is called celiac disease. The only treatment is a gluten-free diet.

There are multiple anecdotal reports and case studies linking gluten sensitivity, celiac disease and migraine headaches. However, a definitive conclusion is still pending. Some patients with migraine may benefit from a gluten-free diet.

It’s important to remember, however, that there are many triggers that may induce migraine headache. Usually a combination of triggers (food, stress, lack of sleep, hormonal and weather changes, etc.) sets off a headache. By keeping a headache diary, looking for patterns and tracking down foods eaten before the onset of headaches, you may be able to recognize what activates your migraine attacks.

George J. Urban, M.D.
Co-Director, Diamond Headache Clinic
Chicago, IL

Editor’s note: A free headache diary is available for download from the NHF Web site at www.headaches.org/For_Professionals/Headache_Diary.

Q. I’ve been a runner for many years. Lately, I’m having a hard time breathing while running. I’ve been taking Imitrex for migraines for the past three years and it has been a miracle medicine for me. Now I’m wondering, could the Imitrex be hard on my heart and somehow causing this breathing problem?

A. While triptans in general and Imitrex specifically carry a warning contraindicating them for use in patients with heart disease, use of these medications as indicated in the package insert has not been shown to cause heart disease. There have been only rare cases in which symptomatic coronary vasospasm has been associated with medication use in patients without pre-existing heart disease. Most cases have occurred in patients with pre-existing coronary artery disease. There is also no data that suggests that triptans can lead to congestive heart failure or cardiomyopathy, which would be a more chronic weakening of the heart.

The important question is how often you are using triptans. The available data is based on the treatment of no more than four headaches per month. If you are treating more than that, a trial of a preventive medication would be indicated to decrease your headache frequency. Since Imitrex was not studied for more frequent headaches, we do not know if there is an increased risk of heart problems over time if used frequently.

I would strongly recommend you see your healthcare professional since there are many other reasons why a runner might start having breathing issues.

Susan M. Rubin, M.D.
Director, Women’s Neurology Center, Glenbrook Hospital, NorthShore University HealthSystem

Q. I was referred by my neurologist for the physical therapy procedure called myofascial release. I have had chronic migraine for 11 years, but recently my doctor diagnosed me with tension-type headaches. I am treating them with indomethacin for pain and Skelaxin® for muscle relaxation, but the pain returns when the medicine wears off. I am anxious to get off as much medicine as possible! Could myofascial release provide long-term relief?

A. Myofascial release is a very effective hands-on technique that provides sustained pressure into myofascial restrictions to eliminate pain and restore motion. This technique may help to reduce pain arising from increased muscle spasm in different regions of the body, including the cervical (neck) region, and thus relieve tension-type headaches.

Myofascial release is most likely to provide short-term relief; there are no studies indicating long-term relief in the treatment of tension-type headache. This type of headache has multiple mechanisms of pathology. In many cases, depression and/or anxiety maybe an underlying cause.

George J. Urban, M.D.
Co-Director, Diamond Headache Clinic
Chicago, IL

Q. I have a lot of neck pain with my migraines. What is the cause of this? Is the neck pain part of the prodrome, like aura, or is it part of the actual migraine?

A. Neck pain is a very common symptom of migraine and can occur as part of the prodrome (warning symptoms that precede a migraine) as well as during the actual migraine. In fact, one study found that as many as 75% of patients who meet the criteria for migraine also complain of neck pain as part of the syndrome.

The actual cause of the neck pain is unclear. The trigeminal nerve nucleus, which is associated with the transmission of sensory and pain information, extends from the brainstem into the upper neck region where it can sensitize structures in the neck as well as the brainstem. Cervicogenic migraines (which is itself a controversial term) are thought to arise from the neck, but the mechanism is unknown. No specific neck abnormalities were found on x-rays of the necks of patients who met the criteria for cervicogenic migraines. Fortunately, treatments that are designed to control the pain of a migraine also seem to relieve neck pain.

Susan M. Rubin, M.D.
Director, Women’s Neurology Center, Glenbrook Hospital, NorthShore University HealthSystem

Q. I have been having severe headaches since a carbon monoxide poisoning four and half years ago. Do you know if a PET scan would be helpful in finding the cause of these headaches?

A. Carbon monoxide poisoning may induce acute as well as chronic headaches. PET scan, or Positron Emission Tomography, is used as a diagnostic tool for certain types of neurological diseases, cancers, heart diseases, etc. PET scan is a functional imaging, giving information about the function of certain parts of the body and activities of organs. It does not provide information about cause of diseases.

In your case, a PET scan may confirm your symptoms but not the cause. An MRI of the brain provides more information regarding causes of headaches.

George J. Urban, M.D.
Co-Director, Diamond Headache Clinic
Chicago, IL

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