Intravenous magnesium sulphate for treatment of pediatric migraine: case series
1Department of Paediatric Emergency Medicine, Royal Medical Services Hospital, 907 Riffa, Bahrain
2Department of Paediatric Emergency Medicine, Women’s and Children’s Hospital, 5006 Adelaide, SA, Australia
3Department of Health and Sciences, University of Adelaide, North Terrace, 5000 Adelaide, SA, Australia
DOI: 10.22514/sv.2023.114 Vol.19,Issue 6,November 2023 pp.194-200
Submitted: 27 November 2022 Accepted: 20 February 2023
Published: 08 November 2023
Magnesium therapy may reduce migraine in children by reducing cortical spread depression and activation of the trigeminovascular complex. It is being used increasingly in Emergency Departments for migraine so we report a case series of children with migraine treated with intravenous (IV) magnesium sulphate. Electronic records were used to identify cases of migraine at our institution from May 2012 to September 2013. Patient records were reviewed to identify those with accurate migraine diagnoses and treatment with IV magnesium sulphate. 18 encounters were identified regarding 9 children. There was a good clinical response in 16 of these encounters and an average time to response of 2.3 hours. Discharge from the Emergency Department (ED) occurred in 10 of the 12 encounters where patients were administered IV magnesium sulphate in ED. Why should an Emergency Physician be aware of this? When oral non-steroidal anti-inflammatories and triptans aren’t successful for Emergency presentations of migraine there are a range of therapeutic options with limited evidence. Some of those options have well known risks, for example extra-pyramidal side effects with prochlorperazine and excessive sedation with propofol. Intravenous magnesium sulphate has a good safety profile, minimal side effects and is familiar to most medical and nursing staff. It is a good option as the infusion is brief and the clinical response is timely.
Migraine; Pediatric; Intravenous; Magnesium; Emergency
Hytham Ghanem,Priya T Wilson,Davinder S Gill. Intravenous magnesium sulphate for treatment of pediatric migraine: case series. Signa Vitae. 2023. 19(6);194-200.
 Lewis DW. Pediatric migraine. Neurologic Clinics. 2009; 27: 481–501.
 BILLE B. Migraine in school children. Acta Paediatrica. 1962; 51: 614–616.
 Özge A, Termine C, Antonaci F, Natriashvili S, Guidetti V, Wöber-Bingöl C. Overview of diagnosis and management of paediatric headache. Part I: diagnosis. The Journal of Headache and Pain. 2011; 12: 13–23.
 Abu-Arafeh I, Russell G. Prevalence of headache and migraine in schoolchildren. The BMJ. 1994; 309: 765–769.
 Sillanpaa M. Prevalence of headache in prepuberty. Headache. 1982; 23: 10–14.
 Raieli V, Raimindo D, Cammalleri R. Migraine headache in adolescents: a student population-based study in Monreal. Cephalgia: An International Journal of Headache. 1995; 15: 5–12.
 Wöber-Bingöl Ç. Pharmacological treatment of acute migraine in adolescents and children. Pediatric Drugs. 2013; 15: 235–246.
 Deubner DC. An epidemiologic study of migraine and headache in 10–12 year olds. Headache. 1977; 17: 173–180.
 Sillanpaa M. Changes in the prevalence of migraine and other headache during the first seven school years. Headache. 1983; 23: 15–19.
 DALSGAARD-NIELSEN T. Some aspects of the epidemiology of migraine in Denmark. Headache: The Journal of Head and Face Pain. 1970; 10: 14–23.
 Laurell K, Larsson B, Eeg-Olofsson O. Prevalence of headache in Swedish school-children, with a focus on tension-type headache. Cephalgia: An International Journal of Headache. 2004; 24: 380–388.
 Bailey B, McManus BC. Treatment of children with migraine in the emergency department: a qualitative systematic review. Pediatric Emergency Care. 2008; 24: 321–330.
 Lipton RB, Silberstein SD, Stewart WF. An update on the epidemiology of migraine. Headache: The Journal of Head and Face Pain. 1994; 34: 319–328.
 Mortimer MJ, Kay J, Jaron A. Epidemiology of headache and childhood migraine in an urban general practice using ad hoc, Vahlquist and HIS criteria. Developmental Medicine & Child Neurology. 1992; 34: 1095–1101.
 Stewart WF, Linet MS, Celentano DD, Van Natta M, Ziegler D. Age and sex-specific incidence rates of migraine with and without visual aura. American Journal of Epidemiology. 1991; 34: 1111–20.
 Stuart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA. 1992; 267: 64–69.
 Anttila P, Metsahonkala L, Sillanpaa M. Long term trends in the incidence of headache in Finnish schoolchildren. Pediatrics. 2006; 117: e1197–201.
 Oskoui M, Pringsheim T, Holler-Managan Y, Potrebic S, Billinghurst L, Gloss D, et al. Practice guideline update summary: acute treatment of migraine in children and adolescents. Neurology. 2019; 93: 487–499.
 Sheridan DC, Spiro DM, Meckler GD. Pediatric migraine: abortive management in the emergency department. The Journal of Head and Face Pain. 2014; 54: 235–245.
 Lanteri-Minet M, Valade D, Geraud G, Lucas C, Donnet A. Revised French guidelines for the diagnosis and management of migraine in adults and children. The Journal of Headache and Pain. 2014; 15: 2.
 Assarzadegan F, Asgarzadeh S, Hatamabadi HR, Shahrami A, Tabatabaey A, Asgarzadeh M. Serum concentration of magnesium as an independent risk factor in migraine attacks. International Clinical Psychopharmacology. 2016; 31: 287–292.
 Talebi M, Savadi-Oskouei D, Farhoudi M, Mohammadzade S, Ghaemmaghamihezaveh S, Hasani A, et al. Relation between serum magnesium level and migraine attacks. Neurosciences. 2011; 16: 320–3.
 Samaie A, Asghari N, Ghorbani R, Arda J. Blood magnesium levels in migraineurs within and between the headache attacks: a case control study. Pan African Medical Journal. 2012; 11: 46.
 Soriani S, Arnaldi C, Carlo L, Arcudi D, Mazzotta D, Battistella PA, et al. Serum and red blood cell magnesium levels in juvenile migraine patients. Headache: The Journal of Head and Face Pain. 1995; 35: 14–16.
 Assarzadegan F, Asadollahi M, Derakhshanfar H, Kashefizadeh A, Aryani O, Khorshidi M. Measuring serum level of ionized magnesium in patients with migraine. Iranian Journal of Child Neurology. 2015; 9: 13–16.
 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013; 33: 629–808.
 Sun-Edelstein C, Mauskop A. Role of magnesium in the pathogenesis and treatment of migraine. Expert Review of Neurotherapeutics. 2009; 9: 369–379.
 Ramadan NM, Halvorson H, Vande-Linde A, Levine SR, Helpern JA, Welch KMA. Low brain magnesium in migraine. Headache: The Journal of Head and Face Pain. 1989; 29: 590–593.
 Goadsby PJ, Edvinsson L, Ekman R. Vasoactive peptide release in the extracerebral circulation of humans during migraine headache. Annals of Neurology. 1990; 28: 183–187.
 Mauskop A, Varughese J. Why all migraine patients should be treated with magnesium. Journal of Neural Transmission. 2012; 119: 575–579.
 Chiu HY, Yeh TH, Huang YC, Chen PY. Effects of intravenous and oral magnesium on reducing migraine: a meta-analysis of randomized controlled trials. Pain Physician Journal. 2016; 19: E97–E112.
 Choi H, Parmar N. The use of intravenous magnesium sulphate for acute migraine. European Journal of Emergency Medicine. 2014; 21: 2–9.
 Wang F, Van Den Eeden SK, Ackerson LM, Salk SE, Reince RH, Elin RJ. Oral magnesium oxide prophylaxis of frequent migrainous headache in children: a randomized, double-blind, placebo-controlled trial. Headache: The Journal of Head and Face Pain. 2003; 43: 601–610.
 Gertsch E, Loharuka S, Wolter-Warmerdam K, Tong S, Kempe A, Kedia S. Intravenous magnesium as acute treatment for headaches: a pediatric case series. The Journal of Emergency Medicine. 2014; 46: 308–312.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.