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How Do You Break a Migraine That Won’t Stop?

A frustrated, worried reader asked us: “I’ve had this same migraine for two weeks. This has never happened to me before. How do I break this?”

This problem can happen to anyone with migraine. When our typical medicines stop working and migraine keeps going beyond the usual 4-72 hours, we may be experiencing a complication of migraine called Status Migrainosus. In A Neurologist’s Guide to Status Migrainosus Therapy in the Emergency Room, Drs. Gelfand and Goadsby state, It must be stated at the outset that an ED visit for migraine represents a failure of appropriate outpatient management, and modifications in the patient’s rescue plan need to be made to avoid such visits in the future.”

The missing link

One of the common failures in acute treatment of migraine is the lack of rescue treatments. A rescue treatment is different than the typical medicine you use to abort a migraine. Most often, patients are prescribed a triptan, NSAID, or ergot-derivative to abort a migraine attack. These are acute medications that can be used at the first sign of symptoms. When these treatments fail, it is appropriate to use a rescue treatment. Most commonly, rescue treatments are strong NSAIDS like toradol or difenolac, but can also be diphenhydramine, anti-emetics (like Zofran, Compazine, or Phenergan), or even opioids. A rescue treatment should be a medicine that you can administer at home when your abortives fail. The goal of a rescue treatment is to prevent you from having to seek treatment at the ER.

If you do not have a rescue treatment available for home use when abortives fail, then please talk to your doctor. This is an essential part of migraine management that is often overlooked.  For decades, I would ask my doctor what to do if my triptan failed. His only response was to visit the ER. It wasn’t until I pushed back, insisting that a visit to the ER for a cocktail shot of Toradol, Benadryl, and Phenergan was unnecessarily expensive and wasteful did he agree to prescribe these medicines to me for home use. Starting in 2013, I began using IM injections of Toradol with a Phenergan suppository as my rescue treatment. Thanks to this, I have been able to avoid the ER ever since. Instead, a few times each year, I am able to treat unresponsive attacks at home, saving me thousands of dollars and avoiding the unnecessary use of the ER.

Getting Immediate Help

Unfortunately, all of this good advice doesn’t help you stop a prolonged attack in progress. If you’ve already exhausted all of your home treatments, and the attack is still going strong after 72 hours, you do need to call your doctor.   In most cases he or she will recommend you go to the emergency room for evaluation and treatment. Most likely, the problem is Status Migrainosus which can be stopped in the ER or with a brief inpatient stay.

Common medicines used to treat Status Migrainosus

IV Fluids
When migraine is prolonged, there is an increased risk of dehydration which can make treating Status Migrainosus more difficult. In most ERs, the first step in treating Status Migrainosus is IV fluids to correct any dehydration that may be present, especially if the patient has been vomiting.

If someone presents at the ER with migraine and has not been prescribed a triptan, the first option is usually to administer a subcutaneous injection of sumatriptan.

Toradol (ketorolac) is most often used in the ER to treat Status Migrainosus. There are numerous studies to support its effectiveness, which can be as high as 80%. The typical dose is 60 mg via IV. When toradol fails or is not available, 75 mg of diclofenac is another option.

Chlorpromazine (Thorazine), Procholorperazine (Compazine), and Promethazine (Phenergan) are commonly used to treat Status Migrainosus when first-line NSAIDs fail. They all have the risk of causing temporary dystonia or akathisia. Diphenhydramine is often used as a pretreatment to prevent these side effects. Chlorpromazine (Thorazine) is an older medicine with a long history of effectively breaking status migrainosus. Prochloroperazine (Compazine) is more commonly used in children. The typical dose is 10 mg IV or IM or 25 mg suppository. Promethazine has fallen out of common use due to the risk of soft tissue injury. All phenothiazines have the secondary benefit of antiemetic properties and may also be used as rescue treatments at home.

Both droperidol (Inapsine) and haloperidol (Haldol) have been used when other measures have failed. They are not typically first-line options because both can cause uncontrollable limb movements, restlessness, and agitation (akathisia).

Dihydroergotamine (DHE)
A typical dose of DHE is 0.5 to 1 mg IV, repeated up to a total of 3 mg over 24 hours. Nausea is a common side effect, so patients are often pretreated with an antiemetic such as Zofran, Phenergan, or Compazine. It has a proven efficacy rate of 60% within 1 hour of administration. Unfortunately, there has been a shortage of DHE in many locations, which is also contributing to rising costs. Outside of major headache centers, many doctors are reluctant to use it.

Although commonly used, there is little evidence that corticosteroids are effective at treating Status Migrainosus. In fact, a meta-analysis of existing studies showed that migraine often recurred 24-72 hours after discharge when corticosteroids were used.

Sodium Valproate
Also known as Depakote, a typical dose ranges from 300 to 1200 mg IV. It is contraindicated during pregnancy, liver disease, and kidney disease.

While generally avoided when treating migraine, opioids are occasionally used to break intractable pain. They are not as effective as other treatments. When used long term, they can contribute to the development of chronic migraine and medication overuse headache. They may be considered for short-term use during pregnancy when many migraine-specific treatments are contraindicated.

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

Gelfand, A. A., & Goadsby, P. J. (2012, April 16). A Neurologist's Guide to Status Migrainosus Therapy in the Emergency Room. The Neurohospitalist, 2(2), 51-59. doi:10.1177/1941874412439583


  • njr008
    6 months ago

    My son has had a consistent migraine for approximately 12 weeks with no relief in sight. He has no access to a specialist as they have no appoints available to see him. He gets worse when he manages to go to school and passes through a noisy corridor or has a noisy classroom and this will make his head pain excruciating for up to a week at a time. All the doctor does is prescribe him pain medication which does nothing. He desperately needs something to break the cycle so that he has some sort of pain relief but the doctor does not seem to see that or understand that just handing out pain medication is not going to cut it.

  • CobyMeg
    1 year ago

    Interesting! My current attack has lasted 53 days. The following treatments have failed in the past (non-inclusive), lignocaine, largactil, triptans, sodium valproate, DHE, ketamine, amitriptilyne, Cefaly, periactin, voltarin suppositories, Botox. Aimovig, fentanyl, etc.

  • annehart
    1 year ago

    I have been on the migraine elimination diet for 17 days, and have had two migraines during this time. Oddly, though unmistakable they were much more mild than usual. I am wondering if that means the diet is helping? Or does it show that diet is not a factor for me. Any ideas would be greatly appreciated. Thanks

  • annehart
    1 year ago

    Hi Aaron I’m sorry for your pain! Try feverfew, ginger, magnesium, calcium and vitamins D and b complex. It is no cure but helps as much as strong meds, and no side effects. Hope that helps!

  • Joanna Bodner moderator
    1 year ago

    Thank you for sharing your feedback with @AaronS15. I am so sorry you are experiencing such pain @AaronS15. Be sure to discuss any treatment and/or supplement before starting it with your doctor. Truly hope you begin to experience SOME relief soon. Best, Joanna ( Team)

  • AaronS15
    2 years ago

    Can’t sleep and I feel unpleasant pains in head. But I don’t want to take strong meds. PLEASE RECOMMEND SOMETHING TO ME, WHAT SHOULD I DO?

  • Josiezee
    3 years ago

    I have found that a course of steroids will break a long-term (week or more) migraine. Sometimes it needs to be repeated. I don’t like to take steroids but when my migraine has lasted a week I just want it to end.

  • rebecca
    3 years ago

    My migraines are bad enough that for the last couple years I’ve landed in the ER every 6-8 weeks for status migrainosis. I have rescue meds, and abortives, but when the migraines last for a week there’s only *one* combination that works for me in the ER: 1 bag of saline, 4 or 8mg Zofran, and 2mg IV Dilaudid. I used to take opioids as rescue meds (because nothing else worked) and when they stopped working the only recourse I had was the IV Dilaudid.

    I no longer take opioids but I’m not sure I can avoid the ER altogether, just because I can only put up with a migraine for about six days before I lose it.

  • DonnaFA moderator
    3 years ago

    Hi Rebecca, thanks for sharing your story with us. I’m so sorry to hear that the past few years have been so difficult for you. We’re sending all good wishes for some lon-term relief.

    Thanks for being part of the community, we’re glad you’re here. -All Best, Donna ( team)

  • thoroughbred31
    3 years ago

    What wonderful doctor do I contact to obtain an at home prescription of toradol!? I am an emt and medical assistant and can easily do these shots at home for my pain. Any advice on getting through to a doctor about how I need rescue meds?

  • DonnaFA moderator
    3 years ago

    Hi thoroughbred31! Thanks for being part of the community, we’re glad you’re here! Have you read Is It Time For a New Migraine Doctor?It can help you connect with a headache specialist in your area. -All Best, Donna ( team)

  • Tamara
    3 years ago

    Yup me this week …. migraine flare started early early morning dec 23 imitrex nasal spray stopped it ( bad idea because I continued on my plans that day and it came back when we were stuck on crappy roads when I needed to eat and had no snacks and then I had to drive home). Diclonfanac powder helped for a few hours here and there 24 and 25 (barely made it through Christmas dinner and missed every other Christmas event), took another imitrex and it worked well.

    Boxing Day I barely could move and talk but still needed to get me and my pets home (she wanted her house back to normal) big big big mistake – more rescue meds and crashed at home. Finally gave in on the 27th and went to urgent care. My typical (they know me by face) –
    IV maxaran, toradol and then an injectable new triptan (nurse didn’t know the name and it was super busy so I will find out in a few days).

    I felt awesome yesterday when I left but it all came back today :(. Not bad enough for inpatient just enough to make my body feel like 1000 pounds and 7/10 pain. Aren’t chronic migraines fun? Thank god I don’t have to work week but my family doc, trigger point doc, acupuncture and all them are on holiday waaaaaaah!

    Oh I also have zofran, toradol, Cambia – dicolfnac powder all as rescue meds.

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