Department of Neurology, Room G03.228, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
J Neurol Neurosurg Psychiatry. 2010 May;81(5):490-3. doi: 10.1136/jnnp.2009.181404. Epub 2009 Oct 13.
In patients with aneurysmal subarachnoid haemorrhage (SAH), headache typically is severe and often requires treatment with opioids. Magnesium has analgesic effects in several conditions, but whether it reduces headache after SAH is unknown.
In a cohort of 108 SAH patients included in the randomised controlled trial Magnesium in Aneurysmal Subarachnoid Haemorrhage-II (MASH-II), severity of headache was regularly assessed on an 11-point scale until day 10 after SAH. Headache was treated according to a standardised protocol with acetaminophen, codeine, tramadol or piritramide. Serum magnesium levels were assessed every other day. Differences in mean headache scores between patients with mean high (>1.0 mmol/l) and normal (< or =1.0 mmol/l) magnesium levels were analysed with a Student t test. Crude and adjusted ORs for the use of codeine, tramadol and piritramide for patients with high versus normal magnesium levels were calculated with logistic regression.
The 61 patients with high magnesium levels had lower mean headache scores (4.1) than the 47 patients with normal magnesium levels (4.9; mean difference, 0.8; 95% CI 0.1 to 1.6) and required less tramadol (adjusted OR, 0.3; 95% CI 0.1 to 0.7) or piritramide (adjusted OR 0.2; 95% CI 0.1 to 0.5). There were no differences in the use of acetaminophen or codeine.
In SAH patients, elevated serum magnesium levels are associated with slightly less severe headache and less frequent use of opioids. These data imply that intravenous magnesium therapy, besides a supposed beneficial effect on outcome, also provides pain relief for SAH patients, for whom it might also improve functional outcome.
在患有蛛网膜下腔出血（SAH）的患者中，头痛通常很严重，往往需要使用阿片类药物进行治疗。镁在几种情况下具有镇痛作用，但它是否能减轻 SAH 后的头痛尚不清楚。
在一项纳入随机对照试验 Magnesium in Aneurysmal Subarachnoid Haemorrhage-II（MASH-II）的 108 例 SAH 患者队列中，在 SAH 后第 10 天之前，定期使用 11 分制评估头痛的严重程度。根据标准化方案使用对乙酰氨基酚、可待因、曲马多或哌替啶治疗头痛。每隔一天评估血清镁水平。使用学生 t 检验分析平均高（>1.0mmol/l）和正常（<=1.0mmol/l）镁水平患者的平均头痛评分差异。使用逻辑回归计算高与正常镁水平患者使用可待因、曲马多和哌替啶的粗和调整后的 OR。
61 例高镁血症患者的平均头痛评分（4.1）低于 47 例正常镁血症患者（4.9；平均差异，0.8；95%CI，0.1 至 1.6），需要更少的曲马多（调整后的 OR，0.3；95%CI，0.1 至 0.7）或哌替啶（调整后的 OR，0.2；95%CI，0.1 至 0.5）。对乙酰氨基酚或可待因的使用无差异。
在 SAH 患者中，血清镁水平升高与头痛稍轻和阿片类药物使用频率降低相关。这些数据表明，静脉内镁治疗除了对预后有预期的有益作用外，还为 SAH 患者提供了疼痛缓解，也可能改善其功能预后。
