Written by Sam Parnell
Intravenous (IV) magnesium appeared to have similar efficacy for migraine treatment compared to metoclopramide and prochlorperazine. Therefore, IV magnesium may be a useful alternative or adjunct in your standard migraine cocktail.
Why does this matter?
Migraine headaches are a common reason for acute care presentation. Pain control is the cornerstone of management, and everyone seems to have their own go-to migraine cocktail. IV magnesium is a relatively safe and inexpensive treatment option for migraines, but how effective is it compared to some of the other first line medications such as metoclopramide and prochlorperazine?
What’s in your migraine cocktail? I prefer my magnesium shaken, not stirred.
This was a single-center, prospective, double-blinded, randomized-controlled trial comparing IV magnesium 2 g, metoclopramide 10 mg, and prochlorperazine 10 mg for the treatment of migraine. Overall, there was no significant difference in change in pain score (NRS) at 30 minutes, 60 minutes, and 120 minutes between the treatment groups. Figure 2 from the study below depicts the effect of the treatment medications on the median pain scores.
There were no statistically significant differences in ED length of stay, rescue analgesia, or adverse effects, and a post hoc analysis determined that magnesium was non-inferior to the other treatment modalities. Though not statistically significant, there were more adverse effects with prochlorperazine (specifically dizziness, akathisia, and anxiety), and more patients in the magnesium group needed rescue analgesia.
There were several limitations in this study, including the unexpected premature termination of recruitment leading to the study being underpowered and potential confounding due to multiple additional adjunctive treatments given before and after the study medications.
Nevertheless, it appears that IV magnesium has similar efficacy compared to metoclopramide and prochlorperazine and may be used as a safe alternative or adjunct for migraine treatment.
MAGraine: Magnesium compared to conventional therapy for treatment of migraines. Am J Emerg Med. 2021 Jan;39:28-33. doi: 10.1016/j.ajem.2020.09.033. Epub 2020 Sep 14.