What is Status Migrainosus?
Although the vast majority of Migraine attacks are not life threatening, status Migraine can be dangerous and is considered an emergency.
In some rare instances, status Migraine can result in Migrainous stroke. Status Migraine (also known as Status Migrainosus or Status Migrainous) is a term Migraineurs should be familiar with, yet surprisingly few have ever heard of it.
The International Headache Society has classified Status Migraine as “A debilitating Migraine attack lasting for more than 72 hours.
A. The present attack in a patient with Migraine without aura is typical of previous attacks except for its duration.
B. Headache has both of the following features:
- Unremitting for more than 72 hours
- Severe intensity
C. Not attributed to another disorder
Interruption during sleep is disregarded. Short-lasting relief due to medication is also disregarded. Status may often be caused by medication overuse (MOH) ...”
Unraveling the diagnosis
Other headache types can often resemble status Migraine. For example, episodic Migraine can transform into chronic Migraine and results in daily attacks which resemble status Migraine, although can be less severe. Status Migraine is a single debilitating Migraine attack of 72hrs or more duration however, not repeated Migraine attacks. Hemicrania Continua may sometimes resemble status Migraine, but tends to be less severe and responds completely to treatment with indomethacin (necessary dosages may vary greatly from relatively small, to dangerously high). Medication Overuse Headache (MOH) may also resemble status Migraine, but is secondary to the use of precipitating medications.
Treating status Migraine can be complicated. The longer the condition has been present, the less it tends to respond to normal abortives and the greater the chance central sensization and allodynia will become a problem. Additionally, because the Migraine attack is so prolonged, there are often other symptoms that require diligent management as well.
- Suppository, IV and injection therapies tend to be more effective at this point than oral Migraine treatments due to prolonged gastric stasis (stomach doesn’t empty properly), nausea, vomiting and malabsorption. Your doctor’s choice may include drugs such as magnesium sulfate, DHE, Benadryl, valproic acid, lidocaine, steroids or a combination of these and other drugs.
- When steroids are used for status Migraine, it is often more effective to give Depo Medrol and saline IV in a large bolus over 30 minutes or more, followed by up to a month or more of prednisone step down therapy.
- Nausea and vomiting may result in dehydration and electrolyte imbalance and should be treated normally with IV solution, electrolytes and anti-nausea medication. Anti-nausea medication used in concert with some types of rescue/pain medications result in a synergistic effect in which the two drugs together are more effective than if they were used separately.
- Some physicians feel that a trial of non-oral indomethacin is prudent in these patients to be sure they are not suffering hemicrania continua.
Please remember: Any change in your normal Migraine pattern needs to be discussed with your doctor.
Not every Migraineur will eventually suffer status Migraine. However, it is wise to discuss how your physician would prefer you address a debilitating Migraine attack that lasts beyond 72 hours. Some offices are able to treat you, while others prefer you visit the emergency department of your local hospital. Talking about this before it happens will help you prepare and ease your stress should you suffer an attack of status Migraine.
If you suffer frequent bouts of status Migraine, consider asking your headache specialist for a written prescription for your next emergency department visit. This often helps patients receive faster and more effective treatment, and usually lessens the chance they will be mislabeled as a drug seeking patient.
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