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What is Status Migrainosus?

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What is Status Migrainosus?

If you live with migraine and have experienced one that lasted longer than usual, you may be familiar with the term status migrainosus.

Status migrainosus, also known as “intractable migraine,” is a complication of migraine headache disorder characterized by especially severe symptoms and a duration longer than 72 hours. By comparison, the more pervasive form of migraine headache disorder — “not intractable migraine” — typically lasts under 72 hours and is usually treatable with migraine medication.

Status Migrainosus Symptoms

Although there is little data on the prevalence of status migrainosus, it’s believed to affect at least 10% of people who get migraines and can have quite a debilitating effect on daily life. 

The symptoms of status migrainosus are similar to those of regular migraine attacks, but even more extreme. Like typical migraine, status migrainosus can manifest as a throbbing pain on either side of the head, frequently accompanied by nausea, vomiting, dizziness, and sensitivity to light and/or sound. But while the normal timeline for a migraine headache phase is 4-5 hours (and can last as long as 72 hours), status migrainosus lasts longer than 72 hours.  

It’s worth noting that this condition also differs from chronic migraine, a situation in which an individual experiences 15 or more migraine attacks per month. Rather, status migrainosus is one continuous migraine attack exceeding 72 hours. 

A person who experiences status migrainosus is at risk of becoming dehydrated due to prolonged vomiting. The continuous severe pain may also cause a seriously degraded quality of sleep, and this loss of sleep can also worsen the migraine headache.

Status Migrainosus Causes and Triggers

Although the cause is largely unknown, headache specialists characterize status migrainosus as a regular migraine episode that’s gone out of control. Typical migraine may progress to status migrainosus if an individual doesn’t receive prompt or proper treatment early in the migraine cycle. Taking too much pain medication can also cause status migrainosus in the form of a medication overuse headache.

Typical migraine triggers can potentially increase the risk of inducing status migrainosus, including dehydration, lack of sleep, skipped meals, hormonal imbalances, stress, medication overuse, changes in medication, changes in weather, as well as surgery to head and face or a flu and sinus infections. Certain foods and exercises may also increase a person’s risk of migraine. In much rarer instances, conditions such as meningitis or brain tumor may cause continual excessive migraine.

Status Migrainosus Diagnosis

No single test will diagnose migraine or status migrainosus. To make a diagnosis and rule out other disorders, a doctor will consider an individual’s medical history and previous diagnoses, including any prior experience with headaches, and will conduct a physical examination.

According to the International Classification of Headache Disorders (ICHD-3), status migrainosus is indicated if:

  • The head pain occurs in a patient who typically lives with migraine (with or without aura) and if symptoms are typical of previous attacks, except for its duration and severity
  • Symptoms are unremitting for more than 72 hours, although remission of up to 12 hours due to medication or sleep can occur
  • Pain and/or associated symptoms are debilitating
  • Symptoms cannot be better explained by any other ICHD-3 diagnosis

The physician will also assure that symptoms are not potentially related to a more severe condition. For instance, sudden changes in vision or double vision, sudden numbness and weakness, or changes in speech may indicate a stroke calling for a different, immediate treatment plan. A neurological test or MRI scan may also be conducted to rule out brain trauma or brain tumor.

Status Migrainosus Treatment

People experiencing status migrainosus should seek medical attention as quickly as possible. Because of its extreme symptoms, this condition may call for nausea medication and stronger painkillers to be prescribed by a physician. Medical attention is also warranted if symptoms persist or worsen, particularly if you are becoming dehydrated.

During a visit to your local emergency room or urgent clinical care center, doctors will likely administer a combination of pain medications and fluids intravenously (IV) and administer antiemetics to help with nausea and vomiting. They will monitor your condition and adjust medications and dosages as needed, tailoring the best treatment for you.

Status migrainosus can be more challenging to treat than typical migraine. A small study showed that steroids may improve pain in people with status migrainosus; however, long-term use of steroids may lead to negative side-effects like bone weakening, weight gain and insomnia. Another recent observational study suggested that current treatments for status migrainosus are only 11-31% effective, with more research needed to find better treatments for this condition.

Status Migrainosus Prevention

The best course of action when dealing with status migrainosus is early treatment during a migraine, to help the condition from getting out of control. Identifying the prodrome, or pre-headache stage of migraine, is important.

In addition, certain preventive medications available under prescription can help those who experience high-frequency severe migraine. These include medication for seizures or high blood pressure, antidepressants, CGRP inhibitors, and botox injections. 

Alternative preventive methods include avoiding triggers and leading a healthy lifestyle. Since migraine triggers may vary from individual to individual, journaling your symptoms and identifying your own triggers are an important part of any migraine prevention plan. Eat small healthy meals throughout the day, drink eight or more glasses of water every day to prevent dehydration, and take advantage of stress-relieving techniques such as meditation, yoga and breathing exercises. Take painkillers only when necessary and not for long periods of time to help avoid medication-overuse headaches. 

Other alternative practices such as acupuncture and the use of essential oils are not backed by concrete scientific research into their ability to reduce migraine risk; however, they’re unlikely to be harmful if performed appropriately. 

Conclusion

Status migrainosus, or intractable migraine, is a subtype of migraine headache that presents with more severe and longer-lasting symptoms than regular migraine attacks. This painful condition may resist regular migraine medication and can often lead to a hospital visit. 

Because of its extreme symptoms, it is recommended that an individual with status migrainosus reach out immediately to a medical professional who can help.

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Sources
  1. American Migraine Foundation. What is Status Migrainosus? https://americanmigrainefoundation.org/resource-library/what-is-status-migrainosus/
  2. Healthline. What is Status Migrainosus? https://www.healthline.com/health/migraine/status-migrainosus
  3. WebMD. Status Migrainosus.  https://www.webmd.com/migraines-headaches/status-migrainosus-symptoms-causes-treatment
  4. ICHD-3. Migraine/Complications of Migraine/Status Migrainosus. https://ichd-3.org/1-migraine/1-4-complications-of-migraine/1-4-1-status-migrainosus/
  5. Medical News Today. What is status migrainosus? https://www.medicalnewstoday.com/articles/320247#definition
  6. The Migraine Institute. Is My Headache Status Migrainosus? https://www.themigraineinstitute.com/status-migrainosus-migraines/
  7. Very Well Health. An Overview of Status Migrainosus. https://www.verywellhealth.com/status-migrainosus-overview-1719541
  8. Iljazi A, Chua A, Rich-Fiondella R, Veronesi M, Melo-Carrillo A, Ashina S, Burstein R, Grosberg B. Unrecognized challenges of treating status migrainosus: An observational study. Cephalalgia. (2020) 40(8):818-827. doi: 10.1177/0333102420911461 https://pubmed.ncbi.nlm.nih.gov/32162976/

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Updated on
September 23, 2022
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