Anyone in the know about migraine knows about the migraine and magnesium connection. But, when you see a neurologist or headache specialist, the doctors may not lead with specific information on magnesium for migraine. They may even forget to mention it as they focus on other priorities like medications, therapies and/or tests for you.
Your doctors may be like mine – they have info about it on a faded handout that they intend to give to you, but cannot locate the paper before you leave the office. So, you may head home without learning the importance of magnesium for migraine. Or, you may leave the office with incomplete information about how to optimize this supplement. They might have mentioned taking it, but failed to suggest the best form magnesium or dosage.
As a registered dietitian with migraine, this is one of my favorite topics because people are hungry for information about non-pharmaceutical relief. There are many forms available on the market and some conflicting information about which is the best form of magnesium as well as how much someone with migraine should take.
By the end of this article you will understand why magnesium is important to us, which is the best magnesium for migraine and typical suggested doses. I’ll also spend some time helping those who have had some trouble taking magnesium figure out alternatives.
Why Magnesium for Migraine is so Important
Many headache specialists know that magnesium is a head-friendly substance. They know it can often play a role in preventing migraine as well as treating an attack.
While I was getting magnesium infused at Jefferson Headache Center a few years ago I asked how magnesium worked. The nurse practitioner said, “Magnesium for headache is just good. It’s a head-friendly substance.” Unsatisfied with that answer, I did a bit of research of my own.
Magnesium plays a number of roles in migraine and its pain process.
This important nutrient is literally involved in hundreds of chemical reactions in the body. Some biochemistry that may be related to helping prevent or treat migraine are:
- Magnesium is needed to form neurotransmitters and to properly metabolize glutamate and other substances. Glutamate is a substance that gets a lot of attention in migraine research as some believe it has an important role in migraine.
- Magnesium is thought to blunt pain signals by blocking transmission of pain in the nervous system.
- Magnesium relaxes muscles. Lessening muscle tension may be helpful in helping an attack go away faster and allow the person to feel soothed.
- Magnesium is involved in the metabolism of nitric oxide, another compound possibly implicated in the migraine process.
Dr. Mauskop’s Study of Magnesium and Migraine
During one of the annual Migraine World Summits, Dr. Alexander Mauskop, director of the New York Headache Center, discussed the importance of magnesium at length. Not only is Dr. Mauskop a key researcher of magnesium for headache, he is a prominent headache specialist who uses magnesium in several forms in his practice to help abort and prevent attacks.
Interestingly, in one study Dr. Mauskop discussed, people who did not get relief from a popular triptan (Imitrex/sumatriptan) had low magnesium levels. When their magnesium levels were increased, they found relief from this frequently prescribed and effective migraine medication.
In Mauskop’s own study on magnesium infusions, he showed very interesting and promising results. Of those people that came to his office and received infusions of magnesium for migraine attacks, the people who experienced relief tended to be those who were deficient in red blood cell (RBC) magnesium. Those that weren’t deficient didn’t get relief.
Studies with oral magnesium had good results, but the previous red blood cell levels of magnesium weren’t measured before or after the study. Based on the info from Dr. Mauskop, you have to wonder if those who had the best results with magnesium were those who were deficient and had the most to gain from replenishing their bodies with the magnesium supplement.
How Do You Know if you Are Deficient in Magnesium?
Assessing your magnesium status is very tricky. Serum magnesium is not a good indicator as 98% of magnesium is stored inside cells or in bone. Serum magnesium test results can be normal or even a little high even when someone is considered deficient in magnesium.
Magnesium is found in large amounts in muscle and bone. Our bodies regulate serum magnesium well by taking what is needed from muscle and bone to maintain the serum magnesium levels we need. While imperfect, the best practical measure of magnesium is the red blood cell magnesium test. Ask your doctor to test your RBC magnesium if you are curious.
Why Do People with Migraine Need More Magnesium?
There are quite a few reasons that people with migraine may need more magnesium:
- Stress alters magnesium metabolism. Potentially, we use more magnesium during stressful times and/or end up losing more in our urine when stressed.
- Genetics – there may be a gene effecting how much magnesium we absorb from our gastrointestinal (GI) tract and how much we end up flushing down the toilet.
- Typical intake among healthy Americans is usually less than the recommended daily allowance for magnesium.
- Those who struggle with frequent or chronic migraine often are less concerned with healthy food choices. This is not a judgement. This is the reality for many who do not have the energy or ability to plan, shop and prepare nutrient-dense foods on a regular basis.
- Many of us avoid certain foods high in magnesium because they may trigger migraine attacks (i.e. nuts, chocolate, legumes and avocado).
- GI disorders – many people with migraine have irritable bowel syndrome or bouts of diarrhea for other reasons. They may not absorb magnesium as well as other important nutrients. GI diseases like celiac disease and inflammatory bowel disease also raise the risk for having inadequate magnesium.
- Diabetes and some other disorders are associated with low magnesium and affect so many of us. Diabetes is considered a near epidemic in the US with many people not knowing they have the disease or are on their way to having it (pre-diabetes).
Symptoms of Low Magnesium
Dr. Mauskop discussed the symptoms of low magnesium:
- Muscle cramps
- Cold hands and feet
- Premenstrual syndrome
- Mental fog
- Depression and irritability
What is the Best Magnesium for Migraine?
There are many different types of magnesium. This section will cover the most important forms of magnesium for headache and migraine.
If pressed to endorse just one form as the best magnesium for migraine, it would be magnesium glycinate (or magnesium bisglycinate). This chelated form is well absorbed by our GI tract. Chelated forms of magnesium are more bioavailable than other common forms. Practically speaking, this means that the magnesium glycinate you buy and take with your meals is actually being absorbed by your body rather than staying inside your GI tract and getting flushed down the toilet.
Since part of magnesium glycinate is the amino acid glycine, we may get some benefit there as well. Glycine may bring about a calming effect on our brain and help with sleep or in calming down dizziness in those with vestibular migraine. Most of us would benefit from help with sleep!
At Migraine Strong, our favorite brand is the Pure Encapsulations Magnesium Glycinate as the “other” ingredients are not common migraine triggers. We believe this is a great form and brand of magnesium for headache. Some people with migraine are very sensitive to gelatin, a common ingredient in many other magnesium supplements. Pure Encapsulations doesn’t use it.
This form is thought to improve cognitive function. Anecdotally, we have heard good feedback about increased energy and reduced brain fog with some people in our private Facebook group. We wish there were more studies on this form of magnesium for migraine and cognition. It is thought that this form of magnesium may be better able to cross that blood brain barrier and allow the magnesium to do its job where needed most. The downside of magnesium threonate is that it is pricey and less available at local stores. Many of us chose Pure Encapsulations for this form as well called CogniMag. Check out the Migraine Strong supplement dispensary for a discount on your supplement purchases.
Magnesium citrate is also very well absorbed so it can be helpful for those with migraine who also need some help with constipation. In large amounts, this form is sometimes used for bowel prep for colonoscopies. We do not recommend trying to get all of your supplemental magnesium this way especially if your bowels move along just fine. The main idea behind supplementing is to have it absorbed, not flushed down the toilet. Fortunately, for many people, the laxative effect only occurs with higher amounts.
Magnesium citrate tends to be inexpensive. For many people, this form may be the best magnesium for headache and migraine.
For kids and those who have trouble with swallowing big capsules, Nature’s Vitality has magnesium citrate gummies that are pretty good. My 11 year old approves!
When magnesium carbonate is digested by our stomach acid, it changes to a more bioavailable form. This Natural Vitality brand of magnesium, Natural Calm, is blended with citric acid. Anecdotally, this brand is helpful as it comes in different forms and flavors as well as an unflavored powder. As its name suggests, many find this form of magnesium for migraine calming. It’s also a good option for those who have difficulty swallowing capsules.
Magnesium Sulfate and Magnesium Hydroxide (milk of magnesia)
These forms are potent laxatives so beware if you try them. Since the role of these magnesium salts is to draw water into the GI tract and help move the bowels, the magnesium is not considered very bioavailable and is just flushed down the toilet. We do not recommend either type. Magnesium sulfate is also known as Epsom salt and can be used to boost your magnesium transdermally. Read on for more about magnesium baths.
This is the mostly common supplement on most shelves in pharmacies and grocery stores. It’s probably the most suggested by doctors as it’s familiar to them. We do not recommend this form of magnesium for headache and migraine due to its poor bioavailability, its laxative effect and GI distress.
Some sources say that only 4% of the magnesium in oxide capsules are absorbed, so the rest is flushed.
What’s most disappointing is that because this form is common and inexpensive and our physicians often do not specify taking the more bioavailable forms, many think they cannot tolerate magnesium. It’s a missed opportunity. If you tried magnesium and found you couldn’t tolerate it, please try the best form of magnesium for headache and migraine, magnesium glycinate.
What amount of magnesium for migraine is recommended?**
As per the John’s Hopkins migraine handout, it is recommended to take 400mg twice per day, so 800mg per day.
During the Migraine World Summit presentation, Dr. Mauskop suggested starting with 400 mg once per day. Once you know that amount is tolerated by your GI tract, double it. If that amount is tolerated, he suggests tripling it. That would mean 1,200 mg per day. That’s a LOT of supplementation with capsules and/or powders and gummies. However, some people may only see improvement with higher amounts.
Since achieving 800mg/day or more of magnesium means quite a few capsules to swallow as well as an adjustment to the family budget, many people find it effective, easier and more practical to take different forms. For instance, they may take 1-2 capsules/day of magnesium threonate, 2 -3 capsules/day of magnesium glycinate and they rest of the daily dose as a magnesium carbonate/citrate drink from Natural Calm or a magnesium foot soak.
How to read a magnesium label
Magnesium labels are not as straightforward as they would first appear. The amount of actual magnesium, or elemental magnesium, should be labeled very specifically. When you see the label indicating you are getting ‘Magnesium 400mg’ per tablet that seems like just what the doctor ordered. But, this labeling indicates that there is 400mg of the whole compound. Only a portion of that is actually magnesium. In this case, magnesium oxide (see label below) which is 60% elemental magnesium (the actual amount that matters). The 400mg magnesium oxide capsule therefore only contains 242mg of elemental magnesium.
The more accurate labeling of magnesium (see below) will result in a label that says ‘Magnesium (as Magnesium Oxide)…500mg’. This indicates that the actual amount in the capsule should be 500mg of elemental magnesium. We know that reading labels is so important when following an elimination diet for migraine. It’s equally important for supplements.
How long until you see results?
Some specialists consider magnesium supplementation both an acute treatment as well as a preventive. However, most would classify it as part of a good preventive regimen that needs some time.
According to a study that Dr. Mauskop published, magnesium levels decreased before or during an attack for many of the subjects. When he treated with intravenous magnesium the pain was relieved in 80% of the patients within 15 minutes.
Evidence that oral magnesium helps during an acute attack exists but is thin. Anecdotally, some people find relief. In my opinion, it’s a reasonable and safe intervention when trying to save our precious few acute medications or trying to attack the migraine from several angles including your acute medication.
When making the commitment to try magnesium supplementation, some neurologists believe you need to supplement for 2-3 months in order to see results. Perhaps this is how long it takes for some of us to replenish our magnesium stores and support important biochemical reactions in our nervous system.
Remember to track your progress- Adding magnesium for migraine control may help more than you realize. Of course, you’d notice if your attacks were reduced by 75% but would you notice if they were reduced by 25%? Whenever trying something new it’s important to track your results, so key an eye on your migraine diary.
Is supplementing with magnesium for migraine safe?
Many doctors say yes, but that doesn’t mean you should not do your own research as well as consult your own healthcare provider.
According to Dr. Mauskop, it’s one of the safest supplements to use for migraine, but urges caution when someone has kidney disease. In an article I consider a must-read about magnesium and migraine, Mauskop discusses risks in his final paragraph.
What if you cannot tolerate oral supplemental magnesium?
Unfortunately, some of us have very sensitive tummies. Even though the more absorbable and best magnesium for headache and migraine have been discussed above, some people may still have unacceptable symptoms. Here are a few suggestions:
- Always take magnesium with food.
- Since there are so many forms of magnesium, try each of the more absorbable types one by one. Yes, this can get frustrating and expensive, but is worth it if you find success. Give the ones that do not work well to someone you love. Magnesium is excellent for much more than migraine.
- Try two other forms that I did not mention above, magnesium chloride and magnesium malate. They are also typically well-tolerated.
- Experiment with the time of day that you take the supplement.
- Don’t get discouraged if you can tolerate only lower amounts of magnesium but not 400 mg/day or more. Take what you can and focus on eating some wholesome food sources of magnesium.
Topical or Transdermal Magnesium and Magnesium Baths
In addition to taking magnesium orally, you can try boosting the level of magnesium in your body via absorption through your skin. This is especially useful if you are unable to tolerate oral supplements.
To penetrate the many layers of our skin and get into our circulation, substances have to be able to penetrate the skin or get in via sweat glands and hair follicles. So, using topical magnesium in the form of gels, creams and oils may be helpful.
Bathing in magnesium sulfate (Epsom salts) and/or magnesium chloride salts may have even more benefit as the pores open and soften. Perhaps exposure of more concentrated amounts of magnesium to sweat glands and hair follicles helps to find its way inside.
Some people report consistent relief from warm foot soaks with magnesium chloride flakes. Jennifer Bragdon discusses how she relieves her dizzy symptoms from vestibular migraine in her recent article about natural remedies. Throwing a handful into a warming foot spa as you relax is a fun way to increase your daily magnesium intake. Topical lotions, sprays and roller balls are a nice option when you’re on the go. Whether it’s raised magnesium levels or the warm comforting self-care that salt baths represent, relief may be yours.
Intravenous (IV) magnesium infusions are another option to possibly help abort an acute attack. As mentioned above, Dr. Mauskop uses IV treatment in his office. He uses the treatment to help treat attacks as well as monthly infusions to steadily boost magnesium levels. Other doctor’s offices and headache centers also offer this treatment.
In some parts of the US, there are more infusion centers opening up that provide hydration, micronutrient drips as well as other treatments for acute and chronic conditions. This may be an option for you but ask your doctor for a referral if he/she does not provide the service. If they do not have one to recommend, be careful to only go to a facility that is run by a medical doctor.
Magnesium is one of the best “natural,” cheap, available, evidence-based and tolerated supplements there is for us. When asked about the things to do to help get control of migraine, considering magnesium is always at the top of the list.
** This has been written for educational purposes by a registered dietitian with migraine. It is not medical advice. Before starting supplements it is important that you do your own research including asking your healthcare providers.
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