Placebo

Magnesium (Mg(2+)) is an essential ion to the human body, playing an instrumental role in supporting and sustaining health and life. As the second most abundant intracellular cation after potassium, it is involved in over 600 enzymatic reactions including energy metabolism and protein synthesis. Although Mg(2+) availability has been proven to be disturbed during several clinical situations, serum Mg(2+) values are not generally determined in patients. This review aims to provide an overview of the function of Mg(2+) in human health and disease. In short, Mg(2+) plays an important physiological role particularly in the brain, heart, and skeletal muscles. Moreover, Mg(2+) supplementation has been shown to be beneficial in treatment of, among others, preeclampsia, migraine, depression, coronary artery disease, and asthma. Over the last decade, several hereditary forms of hypomagnesemia have been deciphered, including mutations in transient receptor potential melastatin type 6 (TRPM6), claudin 16, and cyclin M2 (CNNM2). Recently, mutations in Mg(2+) transporter 1 (MagT1) were linked to T-cell deficiency underlining the important role of Mg(2+) in cell viability. Moreover, hypomagnesemia can be the consequence of the use of certain types of drugs, such as diuretics, epidermal growth factor receptor inhibitors, calcineurin inhibitors, and proton pump inhibitors. This review provides an extensive and comprehensive overview of Mg(2+) research over the last few decades, focusing on the regulation of Mg(2+) homeostasis in the intestine, kidney, and bone and disturbances which may result in hypomagnesemia.

Magnesium in Man: Implications for Health and Disease

### Philosophy of the guideline

### Assessing patients



Figure 1 Chart 1: Oxygen prescription for acutely hypoxaemic patients in hospital. ABG, arterial blood gas; COPD, chronic obstructive pulmonary disease; Fio2, fraction of inspired oxygen; ICU, intensive care unit; NIV, non-invasive ventilation; Pco2, carbon dioxide tension; Spo2, arterial oxygen saturation measured by pulse oximetry.

View this table:

Table 1 Critical illnesses requiring high levels of supplemental oxygen (see section 8.10)

### Oxygen prescription

View this table:

Table 2 Serious illnesses requiring moderate levels of supplemental oxygen if the patient is hypoxaemic (section 8.11)

View this table:

Table 3 COPD and other conditions requiring controlled or low-dose oxygen therapy (section 8.12)

### Oxygen administration



Figure 2 Chart 2: Flow chart for oxygen administration on general wards in hospitals. ABG, arterial blood gas; EPR, electronic patient record; EWS, Early Warning Score; Spo2, arterial oxygen saturation measured by pulse oximetry.

### Monitoring and maintenance of target saturation

https://thorax.bmj.com/content/thoraxjnl/63/Suppl_6/vi1.full.pdf

BTS guideline for emergency oxygen use in adult patients

Background and purpose:  Headache disorders are very common, but their monetary costs in Europe are unknown. We performed the first comprehensive estimation of how economic resources are lost to headache in Europe.

Methods:  From November 2008 to August 2009, a cross-sectional survey was conducted in eight countries representing 55% of the adult EU population. Participation rates varied between 11% and 59%. In total, 8412 questionnaires contributed to this analysis. Using bottom-up methodology, we estimated direct (medications, outpatient health care, hospitalization and investigations) and indirect (work absenteeism and reduced productivity at work) annual per-person costs. Prevalence data, simultaneously collected and, for migraine, also derived from a systematic review, were used to impute national costs.

Results:  Mean per-person annual costs were €1222 for migraine (95% CI 1055–1389; indirect costs 93%), €303 for tension-type headache (TTH, 95% CI 230–376; indirect costs 92%), €3561 for medication-overuse headache (MOH, 95% CI 2487–4635; indirect costs 92%), and €253 for other headaches (95% CI 99–407; indirect costs 82%). In the EU, the total annual cost of headache amongst adults aged 18–65 years was calculated, according to our prevalence estimates, at €173 billion, apportioned to migraine (€111 billion; 64%), TTH (€21 billion; 12%), MOH (€37 billion; 21%) and other headaches (€3 billion; 2%). Using the 15% systematic review prevalence of migraine, calculated costs were somewhat lower (migraine €50 billion, all headache €112 billion annually).

Conclusions:  Headache disorders are prominent health-related drivers of immense economic losses for the EU. This has immediate implications for healthcare policy. Health care for headache can be both improved and cost saving.

The cost of headache disorders in Europe: the Eurolight project.

Abbreviations and symbols used in this guideline 

Executive summary 

Summary of recommendations 

Section 1 Introduction 

Section 2 Methodology of guideline production 

Section 3 Normal values and definitions

https://thorax.bmj.com/content/thoraxjnl/72/Suppl_1/ii1.full.pdf

BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings

Migraine is one of the most frequent disabling neurological conditions with a major impact on the patients' quality of life. To give evidence-based or expert recommendations for the different drug treatment procedures of the different migraine syndromes based on a literature search and an consensus in an expert panel. All available medical reference systems were screened for all kinds of clinical studies on migraine with and without aura and on migraine-like syndromes. The findings in these studies were evaluated according to the recommendations of the EFNS resulting in level A,B, or C recommendations and good practice points. For the acute treatment of migraine attacks, oral non-steroidal anti-inflammatory drugs (NSAIDs) and triptans are recommended. The administration should follow the concept of stratified treatment. Before intake of NSAIDs and triptans, oral metoclopramide or domperidon is recommended. In very severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are drugs of first choice. A status migrainosus can probably be treated by steroids. For the prophylaxis of migraine, betablockers (propranolol and metoprolol), flunarizine, valproic acid, and topiramate are drugs of first choice. Drugs of second choice for migraine prophylaxis are amitriptyline, naproxen, petasites, and bisoprolol.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-1331.2009.02748.x

EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force.

Cluster headache and the other trigeminal-autonomic cephalalgias [paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome] are rare but very disabling conditions with a major impact on the patient's quality of life. The objective of this study was to give evidence-based recommendations for the treatment of these headache disorders based on a literature search and consensus amongst a panel of experts. All available medical reference systems were screened for any kind of studies on cluster headache, paroxysmal hemicrania and SUNCT syndrome. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies resulting in level A, B or C recommendations and good practice points. For the acute treatment of cluster headache attacks, oxygen (100%) with a flow of at least 7 l/min over 15 min and 6 mg subcutaneous sumatriptan are drugs of first choice. Prophylaxis of cluster headache should be performed with verapamil at a daily dose of at least 240 mg (maximum dose depends on efficacy or tolerability). Although no class I or II trials are available, steroids are clearly effective in cluster headache. Therefore, the use of at least 100 mg methylprednisone (or equivalent corticosteroid) given orally or at up to 500 mg i.v. per day over 5 days (then tapering down) is recommended. Methysergide, lithium and topiramate are recommended as alternative treatments. Surgical procedures, although in part promising, require further scientific evaluation. For paroxysmal hemicranias, indomethacin at a daily dose of up to 225 mg is the drug of choice. For treatment of SUNCT syndrome, large series suggest that lamotrigine is the most effective preventive agent, with topiramate and gabapentin also being useful. Intravenous lidocaine may also be helpful as an acute therapy when patients are extremely distressed and disabled by frequent attacks.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-1331.2006.01566.x

EFNS guidelines on the treatment of cluster headache and other trigeminal‐autonomic cephalalgias

Background: Migraine is one of the most frequent disabling neurological conditions with a major impact on the patients quality of life. Objectives: To give evidence-based or expert recommendations for the different drug treatment procedures in the particular migraine syndromes based on a literature search and the consensus of an expert panel. Methods: All available medical reference systems were screened for the range of clinical studies on migraine with and without aura and on migraine-like syndromes. The findings in these studies were evaluated according to the recommendations of the European Federation of Neurological Societies (EFNS) resulting in level A, B, or C recommendations and good practice points. Recommendations: For the acute treatment of migraine attacks, oral non-steroidal antiinflammatory drug (NSAID) and triptans are recommended. The administration should follow the concept of stratified treatment. Before intake of NSAID and triptans, oral metoclopramide or domperidone is recommended. In very severe attacks, intravenous acetylsalicylic acid or subcutaneous sumatriptan are drugs of first choice. Status migrainosus can be treated by cortoicosteroids, although this is not universally held to be helpful, or dihydroergotamine. For the prophylaxis of migraine, betablockers (propranolol and metoprolol) flunarizine, valproic acid, and topiramate are drugs of first choice. Drugs of second choice for migraine prophylaxis include amitriptyline, naproxen, petasites, and bisoprolol.

M. Linde

Papers

EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force.

EFNS guidelines on the treatment of cluster headache and other trigeminal‐autonomic cephalalgias

EFNS guideline on the drug treatment of migraine - revised report of an EFNS task force

Cluster Headache and Other Trigemino‐Autonomic Cephalgias

Drug Treatment of Migraine