A comprehensive review of the relationship between magnesium and migraine headaches, published in the journal Nutrients, described the relevant physiology and evidence for clinical benefit. Affecting approximately 15% of the population, migraine was recognized in 2024 to be the leading neurological cause of disability-adjusted life years (DALYs) among children and adolescents ages 5 to 19, and the second leading cause among adults ages 20-59. Magnesium may have one of the broadest ranges of physiological roles of any nutrient, participating as a cofactor in over 600 enzymatic reactions, including many related to migraine pathophysiology.
Most adults in the U.S. have a deficient dietary intake of magnesium (below the RDA), per a study published in 2021 in Headache, a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES). Indeed, in the publication “What we eat in America,” based on NHANES data from 2017 to 2020, 51% of adult men consume below the EAR (estimated average requirement) for magnesium, as do 45% of adult women. Notably, the EAR is a lower threshold than the RDA, reflecting a level of intake adequate to meet the needs of 50% of healthy individuals, in contrast to the RDA, a threshold designed to meet the nutritional needs of roughly 98% of healthy individuals. For example, for women ages 19-30, the EAR is 255 mg vs. an RDA of 310 mg magnesium per day. It’s striking that roughly half of the population isn’t even meeting a threshold designed to reflect adequate intake for only 50% of healthy people.
In the analysis published in Headache, meeting the RDA (through diet and supplements) was associated with a 17% lower risk of migraine, and comparing the highest quartile of dietary consumption to the lowest resulted in a 24% lower risk. Similar findings were published in the International Journal of Women’s Health, including an analysis of over 3,000 women enrolled in NHANES. Comparing the highest (> 345 mg/day) to the lowest quintile (< 158 mg/day) of intake, there was a 37% significantly lower risk for migraine in a fully adjusted model for premenopausal women. A protective effect seemed to plateau around the current RDA, and no association was observed among postmenopausal women (though the prevalence of migraine was lower in this age group).
In addition to dietary intake, serum levels of magnesium have also been associated with migraine prevalence. In one small study, the odds of acute migraines increased over 35-fold when serum levels were below normal levels. Although several other studies have found significant differences, not all studies report a significant difference in blood levels of magnesium between migraineurs and healthy controls, most likely because serum and plasma magnesium levels are kept fairly constant and may not accurately represent body totals or intracellular levels. This was demonstrated in a study comparing the serum total magnesium and serum ionized magnesium (physiologically active form of magnesium) levels among older participants with diabetes. They found very little difference in serum total levels between people with diabetes and controls, but nearly half of people with diabetes had lower ionized magnesium levels compared to controls, and ionized levels were also associated with fasting blood glucose and hemoglobin A1c levels. Thus, normal serum magnesium levels are not likely to rule out a subclinical deficiency.
Regarding supplementation, the Nutrients review pointed to a number of meta-analyses, the most recent of which was published in Neurological Sciences. This systematic review found that magnesium supplementation was associated with a reduced number of migraine attacks, decreased headache severity, and a reduced number of days with migraine compared to control groups. This review also found benefits for other supplements, such as riboflavin and alpha-lipoic acid, but the size of the benefit was largest for magnesium. One umbrella review of systematic reviews was also mentioned in the Nutrients review, published in 2020 in the European Journal of Clinical Nutrition, which found a strong level of evidence that magnesium supplementation reduces the intensity and frequency of migraine headaches. It’s worth noting that the benefits of oral magnesium supplementation are largely related to migraine prophylaxis for chronic migraines, while nearly all studies evaluating magnesium treatment during an acute migraine utilize intravenous magnesium.
This review also discusses the various forms of magnesium that have better absorption, including magnesium citrate and glycinate, with organic salts generally more bioavailable than inorganic ones (e.g., oxide, carbonate, chloride, etc.). Also included is a discussion of the potential mechanisms for magnesium’s effects; this ranges from dampening hyperexcitable neuron activity by blocking the NMDA receptor (a key mechanism in migraines) to inhibiting pro-inflammatory signaling via nuclear factor kappa B pathway inhibition and supporting mitochondrial function, all pathways implicated in migraine pathophysiology. Magnesium has also been shown to reduce circulating levels of calcitonin gene-related peptide (CGRP), a signaling molecule that dilates intracranial blood vessels and sets off a pain cascade. Multiple headache societies recommend a daily dose of 400-600 mg elemental magnesium, although an optimal dosage has not been clearly established.
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