What are the other Names for this Condition? (Also known as/Synonyms)

• Intractable Migraine
• Refractory Migraine

What is Status Migrainosus? (Definition/Background Information)

• Migraine headache is a longstanding neurological disorder and the most common form of headache that is characterized by severe pounding and pain on one side of the head, which can last for several hours
• Status Migrainosus is described by the International Classification of Headache Disorders as a complication of migraine and defined as “a debilitating migraine attack lasting for more than 72 hours”
• Status Migrainosus can occur in individuals with both ‘migraine with aura’ and ‘migraine without aura’. The most distinguishing feature being its severity and duration; it is also difficult to treat. Hence, the condition is also known as Intractable Migraine
• Sometimes, migraines in individuals develop in severity to form Status Migrainosus when aggravated by factors such as lack of prompt treatment and/or improper therapy, or an intake of excess antimigraine medications
• In addition to severe and prolonged headaches, individuals with Status Migrainosus also have nausea, continuous vomiting leading to dehydration, low blood sugar, sleep deprivation, and difficulty thinking/focusing clearly
• Conventional migraine headache medications are not effective in treating Status Migrainosus. The prognosis of the condition is based on several factors including its response to therapy. Status Migrainosus can be severely disabling in some individuals

Who gets Status Migrainosus? (Age and Sex Distribution)

• Status Migrainosus are observed in individuals with migraines in any age group; generally, adults over the age of 50 years report fewer cases of migraine
• Women are more commonly affected than men by migraines
• The condition is seen worldwide; there is no particular preference for any race or ethnicity

What are the Risk Factors for Status Migrainosus? (Predisposing Factors)

Any individual with migraine headache is at risk for Status Migrainosus. The condition may develop under the following circumstances:

• Overuse of medication that is used for migraines; this is a very important risk factor for the condition
• Lack of proper treatment of migraine headaches
• Late treatment of migraine (taking treatment sometime after the onset of a migraine attack)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Status Migrainosus? (Etiology)

• The exact cause for migraine headache is not clearly established
• Status Migrainosus develops as a severe complication of episodic migraine headaches propelled by factors such as the lack of early treatment, poor treatment, or frequently, from an excess and indiscriminate use of migraine medication

What are the Signs and Symptoms of Status Migrainosus?

The signs and symptoms of Status Migrainosus may include:

• Severe and debilitating pain for a period of 3 days or more defines the condition
• Usually the pain is constant in intensity
• Nausea
• Persistent vomiting that may result in dehydration
• Visual disturbances
• Dizziness and fatigue
• Lack of clarity, confusion, inability to focus
• Loss of sleep
• Hypoglycemia (low blood sugar levels)

Sleep or migraine medications may provide a relief for about 12 hours (maximum), although the condition usually needs to be treated at a healthcare facility.

How is Status Migrainosus Diagnosed?

Establishing a diagnosis of Status Migrainosus is not an easy process, but it can be considerably aided if the affected individuals have maintained a detailed (daily) headache diary and a complete list of medication use, including overuse, if any.

The diagnosis of Status Migrainosus may include the following tests and exams:

• Complete physical examination and assessment of signs and symptoms
• Thorough analysis of personal and family medical history
• Neurological examination by a qualified healthcare provider, if necessary
• Laboratory tests may be performed to rule out other causes for pain
• Computerized tomography (CT) scan of the head
• Magnetic resonance imaging (MRI) scan of the brain

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Status Migrainosus?

Status Migrainosus may lead to complications such as:

• Pain that can be excruciating and disabling
• Severe dehydration resulting in hospitalization
• Severe emotional and mental stress, including depression
• Reduced quality of life from pain and sleep loss
• Recurrence of the condition
• Side effects of medication

How is Status Migrainosus Treated?

Status Migrainosus is typically refractory to therapy when conventional migraine medications are used. In many cases, it can become an emergency situation with individuals requiring hospitalization for severe fluid loss from vomiting.

The following measures may be used in treating the condition:

• Medications to treat severe nausea and vomiting such as metoclopramide and prochlorperazine
• Administration of fluids intravenously
• Migraine medications, such as dihydroergotamine (ergot alkaloids) and sumatriptan (serotonin receptor), which are administered in the form of injections, nasal sprays, or even orally
• Corticosteroids such as prednisolone and dexamethasone

Individuals with severe migraine headaches that occur on four days (or more) each month may be placed under preventative medication therapy by the healthcare provider, in order to prevent complications, such as Status Migrainosus, occurring in the future. These include:

• Seizure medication
• Antidepressants
• Cardiovascular drugs including blood pressure medication
• Botox, to prevent recurrences

Some of the other therapies that may be used in treating Status Migrainosus include:

• Use of neuromodulation techniques such as:
  • Transcranial magnetic stimulation (TMS)
  • Non-invasive vagus nerve stimulation
  • Occipital nerve stimulation
• Anesthetic medication
• Chiropractic care
• Use of vitamin and mineral supplements

Certain home care treatments may include:

• Muscle relaxation exercises including meditation, yoga, listening to music, and gardening
• Getting adequate sleep; while sleeping, resting in a dark quiet room
• Applying ice packs

How can Status Migrainosus be Prevented?

The prevention of Status Migrainosus is related to addressing and controlling migraine attacks early and avoiding medication overuse. Other factors that may be considered include:

• Keeping a diary to record the headache episodes on a regular basis; also, listing and keeping track of any other associated symptoms that may occur with the headaches
• Eating healthy, staying well-hydrated, and exercising regularly; addressing factors that tend to increase stress
• Avoiding triggers of migraine headaches
• Reducing the effects of estrogen (for some women)
• Having a stress-free routine with regular sleeping habits
• Strictly following drug label instructions on usage and dose
• Always avoiding self-medication and self-adjustment of medication dose
• Checking with the healthcare provider on consumption of caffeine-based beverages, if the prescribed medication contains caffeine

Periodic monitoring and follow-up of any migraine condition with the healthcare provider is recommended.

What is the Prognosis of Status Migrainosus? (Outcomes/Resolutions)

• The long term outlook of Status Migrainosus varies from one individual to another and depends on several factors
• In general, Status Migrainosus can be painful, severely disabling, and depressing for many individuals

Additional and Relevant Useful Information for Status Migrainosus:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/neurological-institute/