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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.

Diagnostic criteria:

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.


 

Treatment

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.

Helpful tips

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders 2nd Edition." Cephalalgia;2004;24:8-160.

Comments

  • Soteria
    4 years ago

    I agree with Jackieshakoor – we have to do the research ourselves to save ourselves. Most of my migraines a 6 hours or less in duration, but I had a 2-day migraine in 2013 – with constant vomiting and the ‘think I’m dying” feeling. I went to the ER where they promptly said “virus” and despite my protests, sent me home after 5 hours. I was back the next day with uncontrollable shaking and couldn’t walk. Found out later that they had sent me home with a blood sodium level of 126 – anything under 125 is considered life-threatening. When I came back the second day, my sodium was 112 and I was admitted for 3 days. had I not come back, I was told I would have gone into a coma and died. You really have to fight the ignorance regarding migraines among the medical community. If they have no familiarity with migraines, they can easily misdiagnose or fail to address the situation with the proper severity.

  • Sandy
    5 years ago

    thank you for this. did not understand why i had migraines for so days. i take meds. don’t go away. dark, quiet room when i can.sometimes can’t leave work have to endure or can’t leave life at home. migraines have become 4-5 day migraines for 1-2 months. have to take care of self now bc as i read, having status migraine can lead to stoke the longer u have a migraine.

  • jackieshakoor
    7 years ago

    I have been dealing with migraines for over 10 years and my last neurologist told me and i quote “There is nothing else I can do for you” i have also made my trips to the er and was given pain meds after telling the doctor that this particular episode had been going on the over a week.I don’t think that anyone is aware of what we go through. I made the choice to do some research and i just found my migraine. Status Migraine-something NO doctor has ever mentioned to me-actually my last er visit the nurse stated to me that she had never heard of a migraine lasting for more than a week. We have to do the research our self to save ourself

  • Ellen Schnakenberg author
    7 years ago

    jackieshakoor – I’m so sorry you have not had luck finding a doctor who is able to help you. I must ask however, are you seeing a board certified headache specialist? These doctors are specially trained and do almost nothing all day long but treat Migraine and headache patients. They are the very best resource we have when we are having difficult with Migraine management.

    Congratulations on becoming a proactive patient! It’s sad that we are forced to have to go looking for ourselves, but can sometimes be literally life saving. The very best patient is an educated patient, as you have discovered. I would encourage you, even challenge you to become as educated as you possibly can about Migraine. When you are educated, you can begin to demand better treatment from your doctor, and it will no longer make sense that they simply give up on you.

    Hang in there! It’s almost impossible to try every single treatment possibility in one lifetime. Not correctly anyway…

  • Lola Aileen Vanslette
    7 years ago

    I wonder if the typical hospitals are aware, or were aware in 1998, of this type of migraine. All they did for me was a ct scan and mri. He gave me pain medication that did nothing but make me groggy. I could swear I was dying then, but the doctor at the ER didn’t seem concerned. I still have these migraines, but I don’t bother with the hospital anymore. They don’t seem to know much of anything around here.

  • Lisa Kaelin
    7 years ago

    I have this kind several times a year never realized there was a name for them I have gone to ER for them before but usually just deal with them at home.

  • Sheena Selvey
    7 years ago

    I get these at least once a year. The first time it happened, it last 10 days and I was in and out of the emergency room 7 times! I have a standing script for Medrol at my local pharmacy to take anytime I get a status migraine.

  • Samantha Nelson Churak
    7 years ago

    I have told you about my friend before…she gets hemipalegic migraines and has had the same migraine since August 2010…yes that’s right…2010. No relief and no one knows how to help her.

  • Jamie Valendy
    7 years ago

    Does the IHS address Status Migraine for those that have Migraine with aura?

  • Lynne Heller Smith
    7 years ago

    Well done, thanks! Great idea about have an Rx from one’s neurologist to use if you do end up in the ER. People would be less reluctant to go if they felt the ER had these instructions. This would be especially helpful if you were traveling or your neurologist was out of town.

  • Karen Klein Crow
    7 years ago

    Question: I’ve had Status Migraine before, and since my Gastric Bypass Surgery, many of the medications listed above I am no longer able to take due to potential serious ulcerations int he new stomach pouch and intestines (eg: Medrol, steroids, DHE, narcotics, NSAIDs). I’m already on valporic acid as a preventative, though I’m finding that since my RNY, it is not working nearly as well as it used to and know that when I see neurology next month, that needs to be addressed (I have been on MANY other drugs for prevention, and many of those I should not go on again because of the side effect of weight gain – among other reasons – BP medications are a no-go for me as well because they DROP my BP dangerously low). What CAN be done in this type of a situation for status migraines? What other types of medications (that do NOT have the side effect of weight gain) can I discuss with neuro about using as preventative? Currently, the prescription medications I’m on daily are Lyrica (trying to get off), Depakote (trying to get off), and Savella. The only triptan that works for me even remotely is Maxalt. I do take a multi vitamin, calcium w/ D3, Iron w/ vit C, and B12, as well as a probiotic and omezperazole.

  • Ellen Schnakenberg
    7 years ago

    Karen Klein Crow Your situation is only somewhat unique I’m afraid. The thing to keep in mind is that these are potential side effects. The side effects you will experience with any particular medication are going to be different than the side effects of someone else. For example: I have had gastric problems since my teenaged years and one of the meds I was on for years is considered one of the worst for the stomach/digestive system. I did fine on it for a very long time which surprised everyone. I often think that sometimes a trial and watchful management is sometimes the best bet for us tough patients. That said, only your doctor and you can make that decision together, but being educated on your options is important. There are other meds, such as anti-psychotics like haloperidol or thorazine that are very effective for Migraine and even status Migraine. They have their own list of side effects though and all medication choices must be seriously considered as to the benefits vs. potential for problems. At some point, many Migraineurs (like myself at the time) feel that the Migraine is so bad that they are willing to take the risk of side effects when they are confident enough that their doctor is carefully monitoring them.

  • Jane W Wallace
    7 years ago

    My last severe migraine ended up in the ER. My blood pressure was extremely high and I was not able to talk!

  • Barbara Collins
    7 years ago

    I have had this on a few occasions and have been instructed to use some Prednisone by mouth when it appears that the usual abortives aren’t helping. When you are limited to just a few triptans per attack, this happens sometimes. I wasn’t aware of the serious potential for stroke however.

  • Sue Ketchum Ramer
    7 years ago

    Thanks Barbara.

  • Jessica Smith
    7 years ago

    I had never heard the term before I landed in my ER with a migraine on day 4 of the attack. Was told I was lucky I went in when I did. I was severely dehydrated & my BP was sky high. A little longer & I could have died or had a stroke resulting in permanent disability. Wn’t make that mistake again.

  • Jessica Smith
    7 years ago

    It is possible. A little research could be in order. I know in all I spent about 16 hours in the ER b4 they let me go home. Still semi AMA.

  • Scott Spillane
    7 years ago

    i wonder if this had anything to do with my stroke? probably not but it makes me wonder.

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