Dietary Magnesium and Migraine in Adults

A Cross-sectional Analysis of the National Health and Nutrition Examination Survey 2001-2004

Margaret Slavin PhD, RDN; Huilun Li MS; Manisha Khatri BPS; Cara Frankenfeld PhD

Disclosures

Headache. 2021;61(2):276-286. 

In This Article

Abstract and Introduction

Abstract

Background: Clinical trials have demonstrated magnesium supplements to be effective for prophylactic treatment of migraine. Dietary magnesium intake of many Americans is known to be below nutritional recommendations, but typical magnesium intake from dietary sources in adults with migraine has not previously been evaluated.

Objective: This study aimed to quantify dietary and total (diet + supplement) magnesium consumption of adults with migraine or severe headache in the United States, and to investigate the relationship between magnesium consumption levels and prevalence of migraine or severe headache.

Methods: This analysis included cross-sectional data from 3626 participants, 20- to 50-years old in the National Health and Nutrition Examination Survey between 2001 and 2004. Presence of migraine or severe headache in the past 3 months was determined by questionnaire. Individuals responding affirmatively were classified as having migraine, and individuals reporting not experiencing migraine or severe headache were classified as controls. Dietary magnesium intake was determined from a 24-hour recall interview, supplemental magnesium intake was determined from the dietary supplements interview, and total magnesium intake was the sum of dietary and supplement intake.

Results: Mean dietary consumption of magnesium was below the recommended dietary allowance (RDA) for both migraine (n = 905) and control groups (n = 2721). Attainment of the RDA through a combination of diet and supplements was associated with lower adjusted odds of migraine (odds ratio [OR] = 0.83, 95% confidence intervals [CIs] = 0.70, 0.99, p = 0.035). Magnesium consumption in the highest quartile (Q) was associated with lower odds of migraine than in the lowest Q for both dietary (OR = 0.76, 95% CI = 0.63, 0.92, p = 0.006) and total (OR = 0.78, 95% CI = 0.62, 0.99, p = 0.042) magnesium intake in adjusted models.

Conclusion: These results suggest inadequate consumption of magnesium intake is associated with migraine in U.S. adults ages 20–50. Further prospective investigations are warranted to evaluate the role of dietary magnesium intake on migraine.

Introduction

Migraine is a common neurological condition that is responsible for considerable disability worldwide. In the 2016 Global Burden of Disease Study, migraine was ranked as the top cause of disability in adults under 50 years of age, as measured in years lived with disability.[1] Despite significant advances in the treatment of migraine, uncertainties regarding its pathophysiology remain,[2,3] and demand for economical, effective, and safe prevention modalities remains high. To this end, an improved understanding of diet's influence on migraine may enable development of evidence-based dietary interventions for migraine prevention.

There are several indications that individuals with migraine are more likely to have lower magnesium status than individuals without migraine. Those with migraine have been shown to have lower levels of magnesium in their saliva, serum, and brains interictally; supplementation with magnesium produced changes in their serum magnesium levels; and an oral magnesium load test demonstrated those with migraine retained a greater proportion of the oral magnesium dose, indicating systemic deficiency.[4,5] The underlying cause(s) of the hypomagnesemia observed in individuals with migraine remains unknown, but postulated reasons include inadequate intake, inadequate absorption in the gut, excessive loss in the urine, genetic influence, or some combination thereof.[6]

Regarding magnesium intake, individuals with migraine were observed to consume diets of lower nutritional quality than similar individuals without migraine,[7] and women with chronic migraine were observed to consume diets with lower nutritional quality than their counterparts with episodic migraine,[8] which may result in an overall lower magnesium intake. Meanwhile, magnesium supplements are recommended for the prevention of migraine on the basis of clinical trial evidence in combination with their good safety profile and affordability.[9,10] Supplementation with various magnesium salts (approximately 100–300 mg elemental magnesium per day) resulted in reduced migraine attack frequency, decreased pain intensity, decreased attack duration, and/or reduced migraine days.[11–13] However, most supplementation trials did not assess background magnesium status before assessing efficacy of supplementation, and the role of usual dietary intake of magnesium and migraine is unclear. This is an important contribution to the field because while supplements are safe and reasonably accessible, they are not accessible to everyone and dietary modifications may be an important additional route to consider for migraine.

To our knowledge, no research has examined the levels of magnesium provided by the usual dietary intake of individuals with migraine in the United States. Therefore, this study aimed to investigate the typical magnesium consumption of adults with and without migraine in the National Health and Nutrition Examination Survey (NHANES). Based on dietary patterns observed in this population, we hypothesized that individuals with migraine would consume lower magnesium through the diet. We also examined the relationship between amount of magnesium consumption and the presence of migraine.

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