Blood Tests
- CBC
- Comprehensive metabolic panel
- RBC magnesium (should be > 5 mg/dL; normal = 4.2 – 6.8 mg/dL)
- B12
- Vitamin D
- TSH
- For patients with aura, homocysteine
Oral magnesium supplementation according to Alexander Mauskopf
- Start with 400 mg chelated magnesium (glycinate, aspartate, threonate, gluconate, etc.)
- If one type is not tolerated, try a different salt of magnesium (citrate, oxide, chloride)
- If tolerated but ineffective (abdominal pain or diarrhea), consider increasing the dose to 400 mg two or three times daily (always with food). Recheck RBC magnesium.
Suggested Goal RBC Magnesium Level in Migraine Management
| RBC Mg Level | Interpretation for Migraine |
|---|---|
| <4.2 mg/dL | Low — associated with increased risk of migraine, especially with aura |
| 4.2–5.5 mg/dL | Normal — may be sufficient for most people |
| 5.5–6.5 mg/dL | Optimal therapeutic range often targeted in integrative/functional medicine for migraine and neuromuscular symptoms |
| >6.8 mg/dL | High — rarely toxic at this level but may indicate over-supplementation if sustained |
Target Serum B12 Levels in Migraine Patients
There is no universally established optimal serum vitamin B12 level specifically for migraine prevention, but several studies suggest that higher-normal B12 levels may be beneficial, particularly in migraine with aura, elevated homocysteine, or MTHFR mutations.
| Serum B12 Level | Interpretation for Migraine Context |
|---|---|
| <200 pg/mL (150 pmol/L) | Deficient — can cause neurologic symptoms, including headache |
| 200–400 pg/mL (150–300 pmol/L) | Borderline — often inadequate for optimal neurologic function |
| 400–900 pg/mL (300–660 pmol/L) | Optimal range for migraine, especially if homocysteine is elevated |
| >1,000 pg/mL | Usually safe, but levels above this may reflect supplementation; clinical benefit plateaus |
| >2,000 pg/mL | May raise concern for assay interference or underlying pathology if not supplementing (e.g., liver disease, myeloproliferative disorders) |