Magnesium Intake and Odds of Migraine Occurrence in Pre- and Peri-Menopausal Women Participating in the Study of Women’s Health Across the Nation (SWAN)

Abstract

Background: Migraine is a neurological disorder that causes disabling headaches that can impede day-to-day normal activities. It is three times more prevalent in women than men following puberty. Menstrual migraine, a subtype of migraine that occurs during the perimenstrual period, is typically more difficult to treat than non-menstrual migraine and can be exacerbated during peri-menopause. Magnesium supplementation has shown promising results in reducing the occurrence and intensity of migraine attacks, including menstrual migraines, but information on dietary magnesium intake in pre- and peri-menopausal women in relation to migraine and menstrual migraine is scarce. Objective: The overall aim of the study was to observe the association between dietary magnesium intake and migraine status in pre- and peri-menopausal women. Methods: This analysis included cross-sectional data from 3,022 pre- and peri-menopausal women, aged 42-52 years old participating in the Study of Women’s Health Across the Nation (SWAN). Migraine status was determined from an interview questionnaire, and individuals were classified into four groups: menstrual migraine (n=794), non-menstrual migraine (n=43), history of migraine (n=181), and never migraine (control) (n=2,004). Dietary magnesium intake was determined through the Block Food Frequency Questionnaire. Odds ratios and 95% confidence intervals were calculated using multinomial logistic regression, and p-trends were calculated using median regression. Variables adjusted in different regression models included BMI, race/ethnicity, menstrual status, alcohol consumption, total family income, health insurance, and food group (fruit, vegetable, dairy, grain, and meat) and magnesium intake. Results: Mean dietary intake of magnesium at baseline was below the recommended age-based and gender-based dietary allowance in all migraine status groups. In the unadjusted model, women had higher odds of non-menstrual migraine (ORQ4=2.69 [1.11-6.49], ptrend=0.014) with increasing dietary magnesium intake quartiles as compared to controls. The relationship remained consistent when the model was adjusted for food groups and demographics. For dietary magnesium intake, no statistically significant relationship was observed (ptrend>0.05) in the unadjusted and adjusted models for the menstrual migraine group and the history of migraine group. Except for meat, the mean intake of all other food groups was below the recommended age-based and gender-based food group servings for all the migraine status groups. Conclusions: Dietary magnesium intake and food group intake of pre- and peri-menopausal women with different migraine status are lower than the recommended intake levels. The debilitating nature of migraine might affect the dietary choices of individuals which could lead to inadequate intake of healthy food groups and micronutrients such as magnesium. A statistically significant difference was observed in the non-menstrual migraine group in relation to dietary magnesium. These findings suggest this group may not have been limiting their food choices to avoid triggers or in response to symptoms as they indicated they consumed medication for migraine. However, the results in our study did not show any statistically significant difference in the menstrual migraine group in relation to dietary magnesium intake. Menstrual migraine is harder to treat and does not respond well to migraine medication. This could indicate that diet alone may not prevent menstrual migraine symptoms and may require supplemental treatment(s), which is to be expected given current understanding of migraine pathophysiology. Limited studies that have observed improved symptoms in women with menstrual migraine have made use of supplemental magnesium in high doses. More research is needed on the effect of dietary magnesium intake on features of migraine such as frequency, intensity, and attack duration in this population, particularly in relation to hormonal fluctuations and other pathophysiological mechanisms specific to this population.