Intravenous magnesium as acute treatment for headaches: a pediatric case series.

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.