Danielle Aberman, RD: One of my favorite topics to talk about is what you can do alongside of medications and working with your doctor to get better from migraine, and we’re all looking for that information. So why am I here? I’m here because, probably like a lot of you, I had terrible headache and migraine for quite a long time. My life was really shrinking. I got to the point where my life was truly unrecognizable. And I remember my husband very distinctly asking me from another room, like hey, when are we going to go on vacation? Let’s plan something. And I think you’ve all been there.

You just kind of sink down and you try to figure out, can I really muster up the energy to even answer back in a cheery voice because you just feel, or at least at that time in my life, I was really getting depressed because of my symptoms. I just didn’t feel like doing anything. But that was a few years ago. And since then, between the excellent help I’ve had from my doctors along with that yellow bucket that was in the image from Dr. McAlister’s talk and with Dr. Chua’s talk, where she talked about three different categories, I’ve really gotten to the point where I go on vacation.

That’s a picture of me with my daughter and my husband a few weeks ago. I’m also here because I really want to spread the word and help people to understand, especially about magnesium. Because I’m thrilled that neurologists are telling people to take magnesium, but a lot of times there isn’t enough information about how to take magnesium, as well as some of the other supplements. But today’s talk is on magnesium.

Now my dad is 83 years old, and he was diagnosed with vestibular migraine, finally, after many years and properly treated. And he’s so much better, we actually go boating. And for somebody with vestibular migraine to go boating, that’s a big deal. But I will tell you that he listens to nothing that I say, so he doesn’t take magnesium. He doesn’t do anything with diet. So total strangers listen to me, but my dad does not. So, you’re here because you’re looking for additional information so that you can figure out how to get yourself better and feel like going on vacation like you want and to participate fully in life.

And there’s so much great information here. I mean, Dr. Nahas, with the different medications that are coming on, Dr. Chua with a whole big list of different things to try. There’s so much that we can glean from this. By the end of this talk, I want to get into the nitty-gritty of which types and the recommended amounts, but also just to give you a little bit of why magnesium. And what to do if you can’t tolerate magnesium, and what to do if you can tolerate magnesium, but it’s just not working like you wanted it to.

So, I work for Migraine Strong, and we have a pretty big footprint in social media, so we hear all kinds of things about magnesium. So, the thing we love to hear the most about is how much it has helped. But we also hear that my levels are normal, so my doctor said I don’t need to take it. Well, serum magnesium is not a good indicator of what your true magnesium status is like. So, I don’t want to get into the specifics of that, but there is still a possibility that you would respond well to magnesium even if you have normal serum magnesium levels.

For many people, they try it, and they say it didn’t help. Some people say it makes them feel worse, and you just have to respect when they say that because it truly might be making them feel worse. And some say, I tried it, but it killed my gut because certain ones really can be tough on your GI system. So, what is so great about magnesium? On our website, most of what I’m going to talk about is here. So, if you go to MigraineStrong.com you can find my article there, and it goes into a little bit more of the science behind it.

But in general, magnesium is thought of as a head-friendly substance. I was a patient at Jefferson Headache. I didn’t have Dr. Nahas, but when I was there getting some IV cocktails, magnesium was part of it. And I asked and the nurse practitioner just said, hey, it’s a head-friendly substance. So, when you dive into that a little bit deeper, as we learned in the talk before this, there are several ways that it works, but it tends to truly influence our neurotransmitters so the chemical messengers in the body that can prevent headache and possibly interfere with the migraine process.

Magnesium is also potentially good for blocking pain. It’s not only used for migraine pain; it’s possibly helpful in other diseases and is recommended, I believe, for arthritis. It’s also a substance that can be helpful in terms of calming muscles and calming the nervous system. So the best form is what your body absorbs. And like I said before, I am thrilled that more doctors are recommending it. It’s usually at the top of their list for supplements. But what kind of magnesium do you think they recommend? Anybody?

Yes, they’ll do that, or they’ll just say just magnesium. So, then what people do is they go, and they run to their Walgreens, like I did right before I was putting these slides together, and I just took all the magnesium and I put them on the shelf, and all of those are either magnesium oxide or magnesium citrate. So those are not the ones that are probably going to get you where you want to be with magnesium. I’ll go into that in a little bit more detail. My favorites for magnesium are the chelated varieties. And the ones that I think get the most recognition are magnesium glycinate and magnesium threonate. They’re well-absorbed.

Magnesium threonate is thought to potentially cross the blood-brain barrier. We don’t know if that’s really true. It was one small study not on humans, so it may or may not be true. But I just have a couple of pictures of it here, not promoting any one particular brand, but magnesium glycinate and magnesium threonate. I just wanted you to remember those two as being the better ones. The downside of them is they tend to be more expensive than magnesium oxide and citrate, so you do have to kind of figure that buying these supplements is going to be worked into your budget.

CogniMag is the magnesium threonate, and I’m not convinced that that’s worth the additional money because I’m not convinced it crosses the blood-brain barrier and can be better. These are also pretty bulky supplements to take, so a lot of us are already on a lot of medications and maybe taking other supplements, so they tend to be pretty bulky.

What I believe is the second best is magnesium citrate, which I mentioned before, which is now my number one, and magnesium carbonate. The reason I really like citrate and carbonate is they are available in a couple of different forms. These are my daughter’s magnesium citrate gummies, and they really taste good. This is Garden of Life brand. So, it’s nice when you just don’t want to have to keep taking these capsules because sometimes people really have a hard time swallowing them and the magnesium glycinate, the chelated varieties, all tend to be pretty bulky, so they’re bigger capsules.

They’re tolerated by a lot of people, but I have that little restroom sign there because magnesium citrate is also prescribed for constipation. So, if you try to reach the levels that are recommended for migraine prevention, you might be spending a lot of time in the bathroom. But here magnesium citrate is available in a capsule. I just don’t recommend that form.

Magnesium carbonate does this label look familiar to many people? Because this brand, Natural Vitality Calm, is available in a lot of larger grocery stores, most health food stores. It comes in a lot of different varieties. It tends to be very well-tolerated, and you can mix it just with some water. So it’s part of keeping you better hydrated during the day as well. So how much magnesium is recommended? The Headache Center at Johns Hopkins recommends up to 400 milligrams twice per day. So, they’re saying between 400 and 800.

Dr. Alexander Mauskop, who is a key researcher in magnesium for migraine, did a lengthy talk about this topic in the 2016 Migraine World Summit that was excellent. And he starts his patients…now granted he’s working with them one-on-one. So he recommends that they start at 400, and then if they don’t see results but they’re tolerating it, to double that to 800 milligrams. And if they’re not noticing a difference, to increase it to 1,200 because he says that some people really do need the higher amounts to see a benefit in migraine prevention.

If you go to his blog, he recommends the 400 milligrams, to use that. Because I think it’s important that whenever we’re taking these supplements, that you work closely with your doctor because there are some contraindications to taking magnesium. So you really need to make sure you’re working with your doctor, especially when you’re going up to higher levels. So to successfully take it, I think most people do better if they take it slowly, if they take it with meals, and they mix and match different forms.

Like I said before, I wouldn’t try to do this all with magnesium citrate. Definitely would not try 800 milligrams of magnesium citrate. It’s also, you know, from a budgetary standpoint, once you’re trying to get that amount of magnesium, it’s significant. There are other forms that you can get on the internet or at health food stores that are good to try as well. I’ve recently been taking this brand for a couple of months now, and I like it.

It’s a combination of two different chelated forms. So, it’s magnesium glycinate, magnesium malate, and magnesium citrate. So it’s a blend. It’s not as bulky, and it’s not causing any problems for me, and I like it because it’s not quite as expensive, and it’s already mixed. So what do you do if they’re not helping? If you tried it a few years ago after your doctor suggested it, and it didn’t work ,or you’re using it now and you don’t think it’s helping you at all, you can question the type that you’re taking.

Years ago, if you tried it, was it magnesium oxide or citrate? So that would be one question to ask yourself. What about the amount? Did you just take one or two capsules when you should have taken a dose that got you closer to maybe 800 milligrams in a day, and also did you give it enough time? You’re not going to give it enough time if you have to spend a lot of time in the bathroom. That I understand. But if you were tolerating it, did you give yourself just a couple of weeks on it? Like a lot of medications, to see the preventive effect from magnesium for migraine, you need at least six weeks.

So what do you do if you can’t tolerate oral magnesium? Some places will offer magnesium infusions. That’s something to ask about. I live in Florida, and there are all these wellness centers that offer magnesium infusions. I haven’t personally gone, but I would ask your doctor if he or she doesn’t offer it, if that would be something to consider. So, let’s say you can’t tolerate oral magnesium, or it’s not working, and you can’t get infusions, I think it’s important that you accept that. There are plenty of other things to try.

Remain hopeful. There’s so many more things that you can do in terms of what was in Dr. McAlister’s yellow bucket as well as so many of the other things that were on Dr. Chua’s slide. At Migraine Strong, we like to talk about the treatment pie, which is here. It’s pretty much looking at nine different modalities or different approaches that you can do to kind of throw everything at migraine. Migraine’s complex, as you know, and it’s usually not one thing that’s going to help. Magnesium is just one little wedge in that pie, and it’s just one of the supplements.

CoQ10 could be the supplement for you. Riboflavin could be the supplement, feverfew, butterbur. There’s so many different options, and that’s just one piece. So, if you’re working with your doctor throwing everything at migraine, and you get 50% better but that’s still not good enough, then maybe you can get 25% better by adding some dietary modifications and supplements in there, and then maybe you can get 10% better with something else, whether it’s cognitive behavioral therapy.

Well next door they did a whole segment on sleep, maybe prioritizing sleep, because that’s so important for migraine, but pretty soon you can get yourself much better. But in summary, the better or what I think are the best types of magnesium to take are the chelated varieties like magnesium glycinate, magnesium threonate. Magnesium citrate and carbonate are also good ones to take. Some specialists recommend 400 to 1,200, but whatever you’re going to propose with your doctor make sure you’re working with your doctor to find the right dosage for you. And just keep experimenting with the guidance of your doctor. And I thank you for your attention.

Voice-over: Thank you for tuning into Spotlight on Migraine. For more information on migraine disease, please visit MigraineDisorders.org.

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*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.