Stopping a Migraine Attack That Just Won't End
When a loved one I’ll call Shannon went into status migrianosus — that’s a migraine attack that lasts for 72 hours or more — getting treatment to break the attack was difficult. Her PCP was willing to prescribe anything that might help, but didn’t have many ideas of what to try. She eventually saw two different headache specialists and was able to break the attack with a combination of treatments.
What did she try to stop the migraine?
This article is for anyone else who is in a similar position and doesn’t know what to try. Any one of these is potentially enough to break an attack, though some people need to try multiple treatments. For Shannon, each one brought some relief. It’s hard to know if each treatment was necessary to break the attack or if the last one she tried would have worked on its own if she had tried it first.
After a week of taking triptans twice most days, Shannon’s PCP prescribed Fioricet. She was reluctant to take it since it can be a major culprit for medication adaptation headache, but decided to try it a few times. It did help a little, but didn’t break the attack. She didn’t want to use it much because she knew the risk was high that it could worsen the attack, so she stopped taking it as soon as she knew it didn’t making a lasting difference.
The next at-home treatment she tried was a combination of OTC meds and those prescribed by her PCP: promethazine (Phenergan), Benadryl, naproxen, and a triptan. Promethazine and Benadryl are commonly used in the ER to break a migraine attack. Shannon took oral versions combined with naproxen and her triptan of choice. I know many people for whom a similar cocktail does the trick, but, like Fioricet, it only helped Shannon for a short time. (Note: Consult your health care provider before combining any medications. Your unique medical situation needs to be considered to do so safely.)
The first headache specialist Shannon saw prescribed a three-day oral steroid pack. The specialist debated oral steroids versus an infusion and because of scheduling concerns, went with the steroid pack. It’s a less invasive and less expensive treatment that works for a lot of people, so it’s often the first choice.
When the oral steroids didn’t work fully, Shannon went in for an infusion of a steroid, Depakote, and magnesium. Again, it helped some, but not enough to completely break the attack.
Another at home treatment is to combine a three-day course of steroids with a five-day course of Depakote. Shannon’s headache specialist prescribed this to try to extend the benefit from the infusion.
When Shannon switched headache specialists, the new one suggested a five-day course of both nasal DHE and Depakote. It made the biggest difference for her and is now what she stocks at home in case of another long-lasting migraine attack. If she’s had two migraine days in a row, she supposed to start the drugs on the second day. DHE can’t be taken within 24 hours of a triptan, so she has to time it accordingly. So far, she hasn’t had to use it.
What about preventive treatments?
Once the migraine attack finally broke, Shannon’s headache specialist recommended a preventive to try to avoid another onset of status migranosis. She’s still working out exactly the right preventive regimen for her, but has so far avoided another long-lasting migraine attack.
What should you take away from this list?
This long list of treatments might seem daunting, but I don’t mean it to be. I find it hopeful that there are so many possibilities available — and this list isn’t exhaustive. Although it was frustrating for Shannon to keep trying different treatments, she now has a game plan to avoid status migrainosus in the first place, which is the best treatment of all.
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