Magnesium, Menstrual

Migraines, & PMS

By: Tori Couch

What is PMS?

Premenstrual Syndrome (PMS) is characterized by emotional, behavioral, and physical symptoms that occur during the luteal phase before the menstrual period.

All symptoms vary in severity

20-80%

PMDD

What are Menstrual Migraines?

International Headache Society

Migraine without aura that occur during 5-day premenstrual period

2 days before to 3 days after onset of menstruation

2 out of 3 cycles

Affects 11-14% of the population

Magnesium

Important for nerve transmission

Heart & Muscle contraction

Insulin release from the pancreas

Dilates arteries

Aids in enzyme function

Magnesium2+

Regulates neurotransmitters & 325 enzyme systems

Low Mg2+: Produce cerebrovascular constriction Increased vascular reactivity Membrane receptor activity to

mediators (serotonin)

Quaranta S., et al. (2007). Pilot Study of the Efficacy and Safety of Modified-Released Magnesium 250mg Tablet for the Treatment of Prementrual Syndrom. Clin Drug Invest; 27(1); 51-58.

Modified-Release Magnesium 250mg Tablet

Women aged 18-45 years with regular menstrual cycles, affected by PMS

>25 pts on MMDQ

Italy 2004-2006

3-month observation period followed by a 3-month treatment period

1-screening visit

2-control visit

After 3 menstrual cycles occurred on treatment

Quaranta S., et al. (2007). Pilot Study of the Efficacy and Safety of Modified-Released Magnesium 250mg Tablet for the Treatment of Prementrual Syndrom. Clin Drug Invest; 27(1); 51-58.

Classification of PMS Symptoms

Table 1. Classification of premenstrual syndrome (PMS) symptoms according to Abraham [9]

 

PMS-A: Anxiety PMS-C: Craving PMS-D: Depression PMS-H: Hydration

 Nervous tension, mood-swings, irritability, anxiety

Headache, craving for sweets, increased appetite, heart pounding, fatigue, dizziness or faintness

Depression, forgetfulness, crying, confusion, insomnia

Weight gain, swelling of extremities, breast tenderness, abdominal bloating

Results

38 patients

Caucasian except 2

Screening 1 – visit & visit 2 – control visit

Screen 3 – end of 3 month treatment phase.

MMDQ

Diary

PMS Symptom Scores during Treatment

Baseline (n=40)

Cycle 1 (n=39)

Cycle 2 (n=39)

Cycle 3 (n=38)

0

5

10

15

20

25

30

PMS: DPMS: CPMS: HPMS: A

Treatment Cycles

PM

S S

ym

pto

m S

core

Conclusion Study #1

Modified-release magnesium tablet Magnesium ions coincident with

circadian rhythms of hormones related to PMS symptoms

2am melatonin, 10pm-2am LH Peaks of estradiol and prolactin

Mauskop, A., et al. (2002). Serum Ionized Magnesium Levels and Serum Ionized Calcium/Ionized Magnesium Ratios in Women with Menstrual Migraine. Headache. 42:242-248.

Serum Ionized Magnesium Levels & Menstrual

Migraines

61 women with migraine without aura during menstruation at The International Headache Society (IHS) = occurred within a week of onset

menstruation.

IMg2+, ICa2+ and TMg levels measured, & ICa2+/Img2+ ratios calculated

Values are mean (mmol/L +SEM)

IMg2+ ICa2+/IMg2+ TMg

Controls (n=66) 0.600 + 0.004 1.95 + 0.006 0.834 + 0.008

During menstrual attacks (n=20)

0.559 + 0.012* 2.19 + 0.052* 0.842 + 0.015

Abnormal, % 45%** 50%**

During nonmenstrual attacks (n=13)

0.578 + 0.012 2.12 + 0.037* 0.888 + 0.022

Abnormal, % 15% 31%

During Menses (n=14)

0.571 + 0.009 2.11 + 0.03* 0.874 + 0.019

Abnormal, % 14% 36%

Between attacks & menses (n=20)

0.579 + 0.009 2.09 + 0.038* 0.876 + 0.014

Abnormal, % 15% 25%

Mauskop, A., et al. (2002). Serum Ionized Magnesium Levels and Serum Ionized Calcium/Ionized Magnesium Ratios in Women with Menstrual Migraine. Headache. 42:242-248.

Conclusion of Study

Low Mg2+ (extracellular/intracellular) known to produce cerebrovascular constriction and increased vascular reactivity and membrane receptor activity (mediated by influx & release of Ca2+)

High incidence of Mg2+ deficiency in patients during menstrual migraine attacks indicate that Mg may have a role in the development of this disease.

Significant difference in IMg2+ between women with low to normal serum IMg2+ levels suggest that this abnormality plays a key role only in certain group of women and not continuously distributed.

Conclusion Continued

Recent evidence indicates that in young, healthy cycling women and on isolated, primary cerebrovascular muscle cells in culture, circulating levels of estrogen and progesterone play major roles in regulating levels of circulatory Mg2+ and Ca2+.

It could be said that in women with low serum IMg2+, hormonal actions on Mg2+ may be responsible for the menstrual migraine syndrome and administration of Mg2+ to those women may be effective in terminating headache attacks.

Resources

MacGregor, A. (2010). Prevention and Treatment of Menstrual Migraine. Drugs, 70(14), 1799-1818. Retrieved from Ebscohost: Medline.

Mauskop, A., Alutra, B. T., Altura, B. M. (2002). Serum Ionized Magnesium Levels and Serum Ionized Calcium/Ionized Magnesium Ratios in Women with Menstrual Migraine. Headache, 42, 242-248. Retrieved from Ebscohost: Medline.

Quaranta, S., Buscaglia, M. A., Meroni, M. G., Columbo, E., Cella, S. (2007). Pilot Study of the Efficacy and Safety of a Modified-Release Magnesium 250mg Tablet (Sincromag ®) for the Treatment of Premenstrual Syndrome. Clin Drug Invest, 27(1), 51-51. Retrieved from Ebscohost: Medline.