1. Magnesium, Menstrual Migraines, & PMS By: Tori Couch

2. 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

3. 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

4. Magnesium  Important for nerve transmission  Heart & Muscle contraction  Insulin release from the pancreas  Dilates arteries  Aids in enzyme function

5. Magnesium 2+  Regulates neurotransmitters & 325 enzyme systems  Low Mg2+:  Produce cerebrovascular constriction  Increased vascular reactivity  Membrane receptor activity to mediators (serotonin)

6. 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.

7. Classification of PMS Symptoms Table 1. Classification of premenstrual syndrome (PMS) symptoms according to Abraham [9] PMS-A: AnxietyPMS-C: CravingPMS-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 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.

8. Results  38 patients  Caucasian except 2  Screening 1 – visit & visit 2 – control visit  Screen 3 – end of 3 month treatment phase.  MMDQ  Diary

9. PMS Symptom Scores during Treatment

10. 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

11. 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 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.

13. 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.

14. 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.

15. 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.