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

Headache. 2021;61(2):276-286.

Conclusion

Only one in five adults with migraine consumed their recommended magnesium levels (RDA) through the diet in this study; this number improved to one in four when including dietary supplement intake. Those who achieved their RDA through diet and supplements had 17% lower odds of reporting migraine than those who did not. Furthermore, adults in the highest Q of magnesium consumption through diet had 24% lower odds of reporting migraine than those in the lowest consumption Q. These findings suggest that inadequate magnesium consumption through the diet is associated with migraine in adults and support further investigation of this association. Prospective observations of the relationship between magnesium intake and migraine are needed.

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Abbreviations
BMI, body mass index; CLMD, chronic latent magnesium deficiency; CIs, confidence intervals; ICHD, International Classification of Headache Disorders; MEC, Mobile Examination Centers; NCHS, National Center for Health Statistics; NHANES, National Health and Nutrition Examination Survey; ORs, odds ratios; PIR, poverty income ratio; Q, quartile; RDA, recommended dietary allowance; USDA, United States Department of Agriculture.

Institutional Review Board
NCHS Research Ethics Review Board/Institutional Review Board.

Table 1. Demographic characteristics of participants according to migraine status (NHANES 2001–2004, 20–50 years)
	Total	Migraine^a	Control	p ^c
	n = 3626	n = 905	n = 2721
	Mean [SE] or n (%)^b	Mean [SE] or n (%)^b	Mean [SE] or n (%)^b
Age, years, mean	35.1 [0.2]	34.7 [0.4]	35.2 [0.3]	0.408
Male	35.8 [0.2]	35.8 [0.5]	35.8 [0.3]
Female	34.3 [0.3]	34.1 [0.5]	34.4 [0.4]
Gender				<0.001
Male	1989 (54.0)	342 (37.6)	1647 (59.4)
Female	1637 (46.0)	563 (62.4)	1074 (40.6)
BMI (kg/m²)				0.023
<18.5	69 (2.2)	25 (3.1)	44 (1.9)
18.5–<24.9	1242 (36.0)	292 (33.5)	950 (36.9)
25–<30	1205 (32.1)	278 (30.3)	927 (32.7)
≥30	1110 (29.6)	310 (33.2)	800 (28.5)
Alcohol consumption				<0.001
<1 drinks/mo	1511 (39.1)	442 (45.2)	1069 (37.0)
1–19 drinks/mo	1386 (40.1)	345 (41.4)	1041 (39.7)
≥20 drinks/mo	729 (20.8)	118 (13.4)	611 (23.3)
Poverty income ratio				<0.001
0–1	719 (15.0)	229 (19.8)	490 (13.4)
1–2	884 (19.6)	259 (26.2)	625 (17.4)
2–3	567 (15.6)	142 (15.2)	425 (15.7)
3–4	478 (15.4)	114 (15.8)	364 (15.3)
≥4	978 (34.4)	161 (23.0)	817 (38.2)

Abbreviations: BMI, body mass index; NHANES, National Health and Nutrition Examination Survey; SE, standard error.
^aMigraine group: who answered yes to question "During the past 3 months, did you have severe headaches or migraines?"
^bSurvey-weighted mean or percentage.
^c p values represent results of represent results of t-test for two means for continuous and Chi-square tests for categorical variables.

Table 2. Average daily dietary, supplement, and total magnesium intake (mg/day) of study participants according to migraine status and gender
Magnesium intake (mg/day)	Total	Migraine^a	Control	p ^b
	n = 3626	n = 905	n = 2721
	Mean [SE]	Mean [SE]	Mean [SE]
All participants
Dietary	289.9 [3.8]	264.6 [4.8]	298.2 [3.9]	<0.001
Supplement	28.4 [1.7]	25.5 [2.5]	29.4 [2.0]	0.198
Total	318.3 [4.5]	290.1 [5.7]	327.6 [4.7]	<0.001
Male
Dietary	327.5 [4.4]	317.2 [6.9]	329.7 [4.8]	0.109
Supplement	26.5 [1.9]	23.9 [3.4]	27.0 [2.3]	0.467
Total	354.0 [4.9]	341.1 [6.8]	356.7 [5.5]	0.059
Female
Dietary	245.8 [3.94]	233.0 [5.2]	252.2 [4.8]	0.007
Supplement	30.7 [2.0]	26.4 [3.3]	32.9 [2.5]	0.136
Total	276.5 [4.7]	259.4 [6.6]	285.2 [5.5]	0.003

Abbreviation: SE, standard error.
^aMigraine group: who answered yes to question "During the past 3 months, did you have severe headaches or migraines?"
^b p values represent results of t-test for two means.

Table 3. Odds of migraine by magnesium RDA intake achievement
	Migraine^a n = 905	Control n = 2721	OR [CI] unadjusted	p	OR [CI] adjusted^c	p
	n (%)^b	n (%)^b	OR [CI] unadjusted	p	OR [CI] adjusted^c	p
Dietary magnesium intake
RDA not achieved	719 (79.3)	2098 (75.4)	1.00 (ref)	0.010	1.00 (ref)	0.091
RDA achieved^d	186 (20.7)	623 (24.6)	0.80 [0.68–0.94]	0.010	0.87 [0.75–1.02]	0.091
Total magnesium intake (diet + supplement)
RDA not achieved	679 (73.9)	1939 (68.5)	1.00 (ref)	0.004	1.00 (ref)	0.035
RDA achieved	226 (26.1)	782 (31.5)	0.77 [0.64–0.91]	0.004	0.83 [0.70–0.99]	0.035

^aMigraine group: who answered yes to question "During the past 3 months, did you have severe headaches or migraines?"
^bSurvey-weighted percentage.
^cLogistic regression using the first quantile as reference. Adjusted for gender, BMI, PIR, and alcohol consumption.
^dMagnesium RDA levels: females 19- to 30-years old—310 mg/day, females 31- to 50-years old—320 mg/day; males 19- to 30-years old—400 mg/day, males 31- to 50-years old—420 mg/day.

Table 4. Odds ratios of migraine in empirical magnesium intake quartiles
Mag intake, mg/day	Migraine^a (n = 905)	Control (n = 2721)	OR [CI] unadjusted	p ^b	OR [CI] adjusted^c	p
Mag intake, mg/day	n (%)	n (%)	OR [CI] unadjusted	p ^b	OR [CI] adjusted^c	p
Dietary			p _trend < 0.001^d		p _trend = 0.009
Q1 (15–189 mg)	317 (33.2)	683 (22.4)	1.00 (ref)		1.00 (ref)
Q2 (190–271 mg)	229 (25.1)	683 (25.4)	0.67 [0.53–0.83]	0.001	0.80 [0.62–1.02]	0.072
Q3 (272–363 mg)	187 (22.6)	659 (25.3)	0.60 [0.47–0.77]	<0.001	0.83 [0.61–1.12]	0.211
Q4 (364–1297 mg)	172 (19.0)	696 (27.0)	0.47 [0.38–0.59]	<0.001	0.76 [0.63–0.92]	0.006
Supplement (n = 958)	(n = 233)	(n = 725)	p _trend = 0.779		p _trend = 0.765
Q1 (0.2–33 mg)	63 (25.6)	195 (25.4)	1.00 (ref)		1.00 (ref)
Q2 (33–83 mg)	63 (27.3)	180 (25.6)	1.07 [0.57–2.00]	0.824	1.14 [0.60–2.15]	0.678
Q3 (83–100 mg)	66 (27.8)	232 (31.9)	0.88 [0.54–1.43]	0.587	0.97 [0.58–1.60]	0.889
Q4 (101–1100 mg)	41 (19.6)	118 (17.1)	1.16 [0.57–2.36]	0.683	1.21 [0.58–2.53]	0.607
Total			p _trend < 0.001		p _trend = 0.019
Q1 (15–206 mg)	319 (32.4)	721 (23.1)	1.00 (ref)		1.00 (ref)
Q2 (207–294 mg)	243 (26.6)	662 (23.9)	0.80 [0.64–0.99]	0.042	0.96 [0.77–1.21]	0.751
Q3 (294–394 mg)	177 (22.4)	663 (25.9)	0.61 [0.48–0.78]	<0.001	0.86 [0.66–1.12]	0.243
Q4 (395–1325 mg)	166 (18.6)	675 (27.0)	0.49 [0.39–0.63]	<0.001	0.78 [0.62–0.99]	0.042

Abbreviations: CI, 95% confidence interval; Mag, magnesium; OR, odds ratio.
^aMigraine group: who answered yes to question "During the past 3 months, did you have severe headaches or migraines?"
^bLogistic regression using the first quantile as reference.
^cAdjusted for gender, BMI, PIR, and alcohol consumption.
^d p _trend: Median regression.

Table 5. Odds ratios of migraine in empirical magnesium intake quartiles stratified by sex
	Female (n = 1637)					Male (n = 1989)
	Mag intake, mg/day	OR [CI] unadjusted	p ^a	OR [CI] adjusted^b	p	Mag intake, mg/day	OR [CI] unadjusted	p	OR [CI] adjusted	p
Dietary		p _trend = 0.018^c		p _trend = 0.119			p _trend = 0.049		p _trend = 0.467
Q1	15–163	1.00 (ref)		1.00 (ref)		34–228	1.00 (ref)		1.00 (ref)
Q2	164–224	1.15 [0.82–1.62]	0.394	1.18 [0.83–1.67]	0.347	229–308	0.92 [0.59–1.45]	0.711	1.02 [0.66–1.60]	0.913
Q3	225–311	0.96 [0.76–1.20]	0.698	1.04 [0.82–1.32]	0.745	309–407	0.80 [0.60–1.05]	0.105	0.95 [0.70–1.29]	0.726
Q4	312–917	0.70 [0.48–1.03]	0.071	0.81 [0.55–1.19]	0.265	408–1297	0.77 [0.57–1.04]	0.087	0.92 [0.69–1.23]	0.578
Supplement (n = 463)		p _trend = 0.808		p _trend = 0.696		(n = 495)	p _trend = 0.525		p _trend = 0.509
Q1	0.2–33	1.00 (ref)		1.00 (ref)		0.39–37.51	1.00 (ref)		1.00 (ref)
Q2	33 – 72	0.98 [0.44–2.17]	0.954	0.96 [0.40–2.33]	0.931	39–83	1.03 [0.44–2.45]	0.940	1.08 [0.42–2.75]	0.871
Q3	74 –100	1.02 [0.56–1.87]	0.950	1.05 [0.58–1.91]	0.870	84–100	1.10 [0.50–2.45]	0.807	1.12 [0.49–2.56]	0.774
Q4	101–1000	1.08 [0.46–2.52]	0.853	1.13 [0.47–2.74]	0.774	102–1100	1.30 [0.50–3.33]	0.577	1.42 [0.52–3.87]	0.479
Total		p _trend = 0.007		p _trend = 0.085			p _trend = 0.058		p _trend = 0.525
Q1	15–180	1.00 (ref)		1.00 (ref)		34–242	1.00 (ref)		1.00 (ref)
Q2	181–251	0.89 [0.64–1.24]	0.475	0.91 [0.64–1.28]	0.560	243–330	0.98 [0.72–1.33]	0.879	1.08 [0.78–1.50]	0.615
Q3	252–347	0.76 [0.56–1.03]	0.074	0.85 [0.62–1.16]	0.289	330–435	0.77 [0.50–1.19]	0.226	0.93 [0.59–1.45]	0.733
Q4	347–1194	0.65 [0.46–0.91]	0.014	0.77 [0.54–1.08]	0.123	436–1325	0.79 [0.59–1.04]	0.094	0.96 [0.71–1.29]	0.765

Abbreviations: CI, 95% confidence interval; Mag, magnesium; OR, odds ratio.
^aLogistic regression using the first quantile as reference.
^bAdjusted for BMI, PIR, and alcohol consumption.
^c p _trend: Median regression.

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Dietary Magnesium and Migraine in Adults

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

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