What Is Status Migrainosus?
Last updated: August 2024
Most migraine attacks last between 4 and 5 hours. Longer migraine can be a cause for concern.1,2
Status migrainosus is the name for a migraine attack that lasts longer than 72 hours or does not respond to treatment. Status migrainosus can sometimes require special treatment. In some cases, it may also require a hospital visit.1,2
What is status migrainosus?
Chronic migraine is defined as headache occurring on 15 or more days per month for more than 3 months, where at least 8 of those headache days have migraine features. In status migrainosus, these migraine last much longer. Status migrainosus is a single debilitating migraine that lasts longer than 72 hours. It also may not respond to treatment, or the pain could be more severe than with your usual migraine.1,2
Symptoms of status migrainosus include:1,2
- Throbbing head pain
- Sensitivity to light and sound
- Nausea or vomiting
- Extreme tiredness
- Difficulty concentrating
Recognizing migraine attack symptoms and treating them early can prevent status migrainosus.1,2
In serious cases, status migrainosus can cause severe dehydration due to vomiting. If you experience a severe headache for longer than 72 hours, contact your doctor. If the pain stops for less than 12 hours because you are asleep or took a drug to treat it, you may still have status migrainosus.1,2
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What causes status migrainosus?
We do not know why some standard migraine progress to status migrainosus. It may be that certain triggers cause status migrainosus, such as:1,2
- Stress
- A new medicine
- Lack of sleep
Status migrainosus can happen in migraine with and without aura. Migraine with aura is a migraine with visual symptoms like flashes of light or blind spots.1,2
How is it diagnosed?
- Diagnosing status migrainosus involves ruling out other conditions with similar symptoms. This includes:
- Hemicrania continua
- Medication overuse headache
- Post-traumatic headache
Your doctor will ask questions about your symptoms and medical history to make an accurate diagnosis. They may also want to rule out more serious conditions such as a stroke.1,2
How is it treated?
The pain from status migrainosus can be difficult to treat. And the longer it lasts, the harder it is to treat. More research is needed to better understand how to treat status migrainosus. Because of the severe pain, drugs are often given directly through an intravenous (IV) line. These drugs might include:2,3
- Non-steroidal anti-inflammatory drugs (NSAIDs) – These are common types of pain relievers. Low doses are available over the counter.
- Triptans or dihydroergotamine – These are drugs that are often effective for treating or preventing migraine. But status migrainosus may not always respond to them.
- Steroids – Steroids can treat inflammation and may help some people. They may also prevent future status migrainosus when taken regularly.
- Nerve blocks – These are used to treat many different types of pain. They work by blocking pain from specific nerves.
When should you go to urgent care or the ER?
You may also need treatment to manage other symptoms. For example, antinausea medication may help. But if you are dehydrated, you may need to go to urgent care or the emergency room. These places can give fluids with an IV to treat dehydration. Emergency care can also be helpful in managing the pain, especially when drugs need to come from an IV.3,4
Why should you create an action plan?
If you have a history of status migrainosus, it may help to work with your doctor to develop an action plan. This is a plan you can follow if you feel status migrainosus symptoms. Having a plan can help reduce guesswork and uncertainty in the future when you are experiencing severe symptoms. It may also help reduce the number of times you have to go to the hospital.1,3
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