Quote from Jolie
My experience with IV infusion of mag sulfate comes strictly from the OB setting (as a nurse and patient), so I can't offer any insight on office practices or standards of care.
But I don't understand the use of IV mag sulfate for the treatment of a migraine in an ambulatory patient. The side effects of this drug (especially with rapid infusion) are horrific, and include intense dizziness, nausea, vomiting, weakness, flushing, tachypnea, tachycardia, etc., etc., etc. I can't imagine a migraine so bad that I would be willing to add these symptoms to the mix. Nor do I understand how you would then discharge this patient from the office without a lengthy recovery period, a ride home, and a caretaker.
Aren't there plenty of other options for migraine treatment that are less invasive, and leave the patient in a more functional condition?
I'll check back on this thread. This is very interesting to me
Yes, for the "occasional" migraine patient, there are many other options. There is a subset of migraine patient, though, that require heavy duty, sometimes unusual meds. I'm one of those worst-of-the-worst chronic migraneurs. My background is L&D, so I was expecting bad side effects from mag, but honestly, compared to what I was going through with a days long migraine, the mag was NOTHING. I love mag. LOVE IT. I would have it on tap in my home if I could. It's a first line drug for my neurologist. It's cheap and it works when the triptans, NSAIDs, preventatives, and narcotics have failed. Why does it work for migraines? Probably some of the same reasons it prevents seizures in preeclampsia. It's also neuro-protective for fetuses.
If the idea of mag amazes you, then the list of things I've tried over the years would probably leave you speechless. There is only 1 medications FDA approved for migraine prevention, Topomax. But the list of things that migraine specialists will try stretches past 200. I've tried Risperdal, Seroquel, Lamictal, DHE, methergine (yeah, methergine), and Botox just to name a few. And I don't have any mental health dx, so the Risperdal and Seroquel were solely for migraine prophylaxis. I've been given lidocaine, magnesium, steroids, ketamine, benadryl, and toradol in different IV sessions in attempts to break long cycles of migraines. If I walked into my neuro's office for my next visit and he told me that there was a new treatment from Asia involving IV water buffalo urine, I'd probably consent to it because I'm that desperate for relief.
So, in summary, if the migraine patient can usually take something PO or just go to bed, and that's all it takes to get rid of their 3-times-a-year migraine, then mag may be a bit of overkill. But for the patients who are chronic and difficult to treat, mag is a very useful, basic step in treatment.