Intravenous magnesium sulphate for treatment of pediatric migraine: case series

Magnesium therapy may reduce migraine in children by reducing cortical spread depression and activation of the trigeminovascular complex. It is being used increasingly in Emergency Departments for migraine so we report a case series of children with migraine treated with intravenous (IV) magnesium sulphate. Electronic records were used to identify cases of migraine at our institution from May 2012 to September 2013. Patient records were reviewed to identify those with accurate migraine diagnoses and treatment with IV magnesium sulphate. 18 encounters were identified regarding 9 children. There was a good clinical response in 16 of these encounters and an average time to response of 2.3 hours. Discharge from the Emergency Department (ED) occurred in 10 of the 12 encounters where patients were administered IV magnesium sulphate in ED. Why should an Emergency Physician be aware of this? When oral non-steroidal anti-inflammatories and triptans aren’t successful for Emergency presentations of migraine there are a range of therapeutic options with limited evidence. Some of those options have well known risks, for example extra-pyramidal side effects with prochlorperazine and excessive sedation with propofol. Intravenous magnesium sulphate has a good safety profile, minimal side effects and is familiar to most medical and nursing staff. It is a good option as the infusion is brief and the clinical response is timely.