1. 3. Results 6. References Experiences of an outpatient infusion program of an academic headache center with intravenous magnesium therapy Sahai-Srivastava S, Arakelyan A, Nworie O, Green L, Csere A, Khan KJ, Xu F, Cesar PF University of Southern California Department of Neurology, Los Angeles, California, USA Experiences of an outpatient infusion program of an academic headache center with intravenous magnesium therapy Sahai-Srivastava S, Arakelyan A, Nworie O, Green L, Csere A, Khan KJ, Xu F, Cesar PF University of Southern California Department of Neurology, Los Angeles, California, USA 2. Methods Cross-sectional study of 88 patients who presented February 2014 - January 2015 at an academic center. 87 patients had a diagnosis of chronic migraine with status migrainosus, and 1 patient had chronic cluster headaches. Intravenous magnesium sulfate (2 g diluted with 50-100 cc of normal saline) was administered over 1-2 hours. Immediately before and after infusion, self-reported pain levels were recorded using the Wong- Baker FACES Pain Rating Scale (0-10). Additional intramuscular (IM) injections for nausea (prochlorperazine) or for refractory pain (ketorolac and dexamethasone), were administered as necessary. After treatment, patients were asked to rate overall impression of treatment efficacy with the Patients’ Global Impression of Change (PGIC) scale (1-7). 1. King DE, Mainous AG, Geesey ME, Woolson RF. Dietary Magnesium and C-reactive Protein Levels. J of Am Coll of Nutrition 2005;24(3): 166-171. 2. Yates AY, Schlicker SA, Suitor CW. Dietary Reference Intakes: The New Basis for Recommendations for Calcium and Related Nutrients, B Vitamins, and Choline. J Am Diet Assoc 1998; 98699-706. 3. Talebi, Mahnaz, et al. Relation between serum magnesium level and migraine attacks. Neurosciences; 2011: 320-3. 4. Peikert A, Wilimzig C, Köhne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16(4):257-63. 5. Martin, V T. Menstrual migraine: A review of prophylactic therapies. Curr Pain and Headache Reprts;2004 8:229-237. 6. Maizels, M., Blumenfeld, A. and Burchette, R. A Combination of Riboflavin, Magnesium, and Feverfew for Migraine Prophylaxis: A Randomized Trial. Headache: The Journal of Head and Face Pain. 2004; 44: 885–890. 7. Sun-Edelstein C, and A Mauskop A. Role of magnesium in the pathogenesis and treatment of migraine. Exper Rev Neurother 2009: 369-379. 8. Gallelli, L., Avenoso, T., Falcone, D., Palleria, C., Peltrone, F., et al Effects of Acetaminophen and Ibuprofen in Children With Migraine Receiving Preventive Treatment With Magnesium. Headache 2014; 54: 313–324. 9. Mauskop A, Altura BM. Magnesium and Migraines. CNS Drugs, 1998, Volume 9, Issue 3, pp 185-190. 10. Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain: 2009; 25(5):446-452. 11. Demirkaya S, Vural O, Dora B, Topcuoglu MA. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache. 2001; 41(2):171-177. 12. Mauskop A, Altura BT, Cracco RQ, Altura BM. Intravenous magnesium sulphate relieves migraine attacks in patients with low serum ionized magnesium levels: a pilot study. Clin Sci. 1995; 89(6):633-636. 13. Bigal ME, Bordini CA, Tepper SJ, Speciali JG. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. Cephalalgia. 2002;22(5):345-353. 1. Background Oral magnesium has been used extensively as preventative treatment for migraine headache, 1-10 but there is only limited information on its intravenous use as an acute abortive agent for headaches in an outpatient setting. Intravenous magnesium, with or without intramuscular medications can result in significant pain relief in status migrainosus. In a subset of patients, intravenous magnesium alone reduces pain to a manageable level. Other studies have supported the role of intravenous magnesium as an acute abortive agent for migraines. 11-13 Further research should seek to characterize patients who respond optimally to intravenous magnesium. Overall reduction in pain demonstrates that outpatient infusion centers can be an efficient and cost-effective way to provide headache rescue treatment, thereby decreasing the need for emergency room visits. The majority of patients were female (n=69) with mean age 48±17. 32 patients received intravenous magnesium only, and 56 received additional IM injections after the infusion; 39 received ketorolac, 30 received dexamethasone, and 28 received prochlorperazine. There was a significant reduction from the pre-treatment pain score 5.47±2.91 to 3.33±2.62 (P<0.001) after intravenous therapy. In patients who received intravenous magnesium only, pain score decreased significantly from 4.78±3.18 to 2.84±2.37 (p<0.001). In patients who received additional IM injections, pain score decreased significantly from 5.69±2.78 to 3.61±2.74 (p<0.001). For female patients (n=69), the pain score decreased from 5.63±2.96 to 3.22±2.68 (p<0.001). Male patients (n=19) had a slightly smaller reduction from 4.90±2.75 to 3.74±2.42 (p=0.05). Patients rated their overall impression of treatment efficacy as 4.38±1.72 on the PGIC scale (“somewhat better”/”moderately better”). However, PGIC response rate was low, at 23.9%. 5. Conclusion Aim: To determine the feasibility and effectiveness of intravenous magnesium as an abortive for headaches in an academic infusion center. 4. Data Table 1 95% CI MeanSDMinMaxLowerUpperP-ValueN Age4817168844.9652.12~88 Male Age4519228137.5853.63~19 Female Age5017168845.5853.42~69 Pre-Treatment Pain Score5.472.910104.856.09<.001*87 Male Pre-Treatment Pain Score4.902.750103.646.150.0519 Female Pre-Treatment Pain Score5.632.960104.926.35<.001*68 Pre-Treatment Pain Score with IM Meds5.692.780104.956.44<.001*55 Pre-Treatment Pain Score without IM Meds4.783.180103.665.90<.001*32 Post-Treatment Pain Score3.332.620102.743.86~88 Male Post-Treatment Pain Score3.742.42082.634.84~19 Female Post-Treatment Pain Score3.222.680102.533.82~69 Post-Treatment Pain Score with IM Meds3.612.740102.834.30~56 Post-Treatment Pain Score without IM Meds2.842.37082.013.68~32 Pain Score Difference (Post - Pre)-2.062.42-80-2.57-1.54~87 Pain Difference with IM Meds-2.132.53-84-2.81-1.450.76155 Pain Difference without IM Meds-1.942.26-74-2.73-1.14~32 PGIC4.381.72173.605.16~21