Intravenous magnesium as acute treatment for headaches: a pediatric case series
Emily Gertsch1, Sheila Loharuka2, Kristine Wolter-Warmerdam3
1Section of Child Neurology, Children's Hospital Colorado, Aurora, Colorado.
Insights
Intravenous magnesium shows promise for acute pediatric headache treatment, with minimal side effects observed in adolescents. Further research is needed to confirm its effectiveness in managing severe headaches in children.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Pharmacology
Background:
- Acute intravenous treatment for pediatric headache lacks standardized protocols.
- Variability exists in current treatment approaches for children experiencing severe headaches.
Purpose of the Study:
- To describe the institutional experience using intravenous magnesium for acute pediatric headache management.
- To assess the safety and tolerability of intravenous magnesium in this patient population.
Main Methods:
- Retrospective review of electronic medical records for patients aged 5-18 treated with intravenous magnesium for headache.
- Exclusion criteria included unstable medical conditions or secondary headache causes.
- Data collected on headache diagnosis, prior treatments, side effects, and treatment response.
Main Results:
- Twenty patient encounters met inclusion criteria; diagnoses included migraine, tension-type headache, and status migrainosus.
- Intravenous magnesium was administered in the emergency department and inpatient settings.
- Minimal side effects were reported, including localized pain, redness, burning, and transient decreased respiratory rate without oxygen desaturation.
Conclusions:
- Intravenous magnesium appears to be a safe abortive therapy for acute headaches in adolescents.
- The observed side effect profile was favorable.
- Further prospective studies are warranted to establish the efficacy of intravenous magnesium for pediatric headaches.
Background:
Acute i.v. treatment for pediatric headache varies widely.
Objectives:
Our aim was to describe our experience with i.v. magnesium for acute treatment of pediatric headache.
Methods:
We reviewed the electronic medical records of all patients ages 5 to 18 years old treated with a standard dose of i.v. magnesium for headache at our institution from January 2008 to July 2010. Charts were assessed for headache diagnosis, prior medications given, side effects, tolerability, and response to treatment. Individuals were excluded if they had an underlying unstable medical condition or a secondary etiology for headache. Only first encounters were included if the patient had multiple encounters.
Results:
There were 34 episodes of children who received i.v. magnesium in the emergency department (ED) or hospital. Of these, 14 were excluded because the patients had complex medical conditions (n = 6), they were repeat encounters (n = 7), or known secondary etiology for the headache (n = 1). Of the 20 included charts (range 13-18 years old), 5 had migraine, 4 had tension-type headache, and 11 had status migrainosus. Thirteen were treated in the ED and seven as an inpatient with a standard i.v. dose of magnesium. Ten of thirteen adolescents receiving i.v. magnesium in the ED were admitted for further headache treatment but not for side effects, and three were discharged home. Side effects of treatment included pain (1 of 20), redness (1 of 20), burning (1 of 20), and decreased respiratory rate without change in oxygenation (1 of 20).
Conclusions:
In our case series, adolescents given i.v. magnesium as an abortive therapy for headache experienced minimal side effects and further studies should evaluate for effectiveness.
