Abstract & Commentary
Synopsis: Low levels of serum IMg seem to be associated with menstrual migraines, although causal etiology and pathogenesis have not been defined.
Source: Mauskop A, et al. Headache. 2002;42:242-248.
In this prospective study, 270 women seen at a headache clinic, including 61 patients with menstrual migraine, had measurements of serum ionized magnesium (IMg) levels and serum ionized calcium/ionized magnesium ratios (ICa/IMg). The incidences of IMg deficiency were 45% during menstrual migraines, 15% during nonmenstrual attacks, and 14% during menstruation without migraine (P < 0.01). Similarly, the ICa/IMg ratios were elevated during menstrual migraine (P < 0.01).
Comment by Brian R. Apatoff, MD, PhD
In some series the incidence of menstrual migraines is 24%, and their management is often difficult. The decline in estrogen occurring before menstruation has been implicated as a precipitating factor, although benefits of hormonal manipulation with agents like danazol or tamoxifen are unclear. Magnesium supplementation for prophylaxis in menstrual migraine has met with some success. In this study by Mauskop and colleagues, low levels of serum IMg seem to be associated with menstrual migraines, although causal etiology and pathogenesis have not been defined. Possibly, subtle derangements in levels of these divalent cations directly affects cerebrovascular constriction or neurotransmitter release.
Dr. Apatoff is Associate Professor of Neurology, New York Presbyterian Hospital-Cornell Campus, New York, NY.