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Woman with headache

Status Migrainosus: Symptoms, Treatment, Prevention

Migraines are severe headaches that cause throbbing pain, nausea, and sensitivity to light and sound. Status migrainosus is an especially severe and long-lasting form of migraine headache. It’s also called an intractable migraine. 

Most migraines follow a distinct pattern. The pattern may include a warning period, during which a person experiences symptoms historically associated with a migraine.

Migraines may also include changes in consciousness, the appearance of an aura or visual disturbance, a headache, and then a fade-away period, during which a person may feel unlike themselves.

This pattern sets migraines apart from other headaches, including long-lasting or very painful headaches.

Status migrainosus headaches affect less than 1 percent of people with migraines. However, they’re intense and they stick around for longer than 72 hours. Even treatment with traditional migraine medicines like triptans and ergots often won’t cut through the pain of a status migraine. The pain and nausea can be severe enough to require a hospital visit for treatment.

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.

A typical migraine can sometimes turn into status migrainosus if:

  • You don’t get treatment early enough after the attack starts.
  • You don’t get the right treatment.
  • You use too much headache medicine.
  • A status migrainosus is a migraine attack that lasts longer than 72 hours. It is also known as intractable migraine.
  • Most people with status migrainosus headaches find that their usual migraine treatments do not help, or that they offer only brief relief. The migraine attacks can be debilitating and interfere with everyday life.

Who is at risk?

Woman with migraine

All of these factors can trigger status migraines:

    • dehydration
    • meningitis (very rare)
    • stress
    • overuse of medicines such as pain relievers and narcotic drugs used to treat headaches (these can cause what are called rebound headaches)
    • surgery on the head or face
    • skipped meals
    • changes in weather
    • hormone imbalances
    • head injuries
    • brain tumor (very rare)
    • lack of sleep
    • surgery to the sinuses, teeth, or jaw
    • an infection, such as the flu or a sinus infection
  • changes to medicines you take, especially hormone treatments like birth control pills, hormone therapy for menopause, or antidepressants
    • injuries to the neck or head
    • changes in sleeping or eating patterns

    Symptoms

    A status migrainosus is not necessarily different from a typical migraine, except in its duration and severity. In fact, people who experience status migrainosus find that the attack is the same as a regular migraine, except for the headache portion lasting much longer.

    In some people, however, the pain and nausea are so debilitating that they have to be hospitalized.

    Status migrainosus tends to have the same symptoms as migraine but more noticeable or severe. The symptoms vary from person to person but often include:

    • Headache. The pain may be intense and often on just one side of the head. It may spread to the other side of the head.
    • Nausea. This is usually a feeling of wanting to be sick accompanied by a little appetite for any kind of food.
    • Trouble thinking clearly 
    • An aura. This happens when a person sees lights, unusual patterns, or other changes in their vision.
    • Sensitivity to light and sounds
    • Intense throbbing in the head. Unlike a tension headache, a migraine can feel sharp and overpowering and does not get better with a massage.
    • Dizziness 
    • Changes in consciousness. Someone with migraine may have difficulty concentrating, feel confused, sleepy, or struggle to communicate.
    • Weakness in a part of the body, or tingling sensation in the arms, hands, or legs.

    Because the condition lasts for at least 3 days, you’re also at risk for dehydration and sleep loss because of prolonged vomiting and pain.

    The pain may get better for up to 12 hours with medication or rest but then returns. The pain must also be so bad that it is debilitating and not just an annoyance.

    Diagnosis

    Woman is holding her head

    Migraines are a poorly understood condition, and there is no single test to confirm them.

    Status migrainosus only occurs in people with migraines, and so diagnosing status migrainosus depends on a diagnosis of migraine. A doctor may diagnose status migrainosus, based on symptoms alone if a person has had migraines before.

    A doctor may perform tests, also, or take a detailed medical history to rule out other causes, such as a brain injury. The person's medical history may help decide if the headaches are consistent with migraines.

    One popular diagnostic process requires at least five previous 4- to 72-hour attacks of migraines without an aura or two previous attacks of migraines with an aura.

    Other headache types can often resemble status migraine. For example, episodic migraine can transform into a chronic migraine and results in daily attacks that resemble status migraine, although can be less severe. status migraine is a single debilitating migraine attack of 72 hours or more duration however, not repeated migraine attacks. Hemicrania continua may sometimes resemble status migraine but tend 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.

    Finally, other tests, such as neurological performance tests or magnetic resonance imaging (MRI) scans, to rule out other causes, may be done.

    Treatment

    Treating status migrainosus can be difficult since an aspect of this headache is that a person's usual migraine remedies do not work.

    The longer the condition has been present, the less it tends to respond to normal abortives and the greater the chance central sensitization 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.

    No treatment can cure migraines, and researchers do not yet know of a way to shorten the length of status migrainosus. Instead, doctors focus on relieving symptoms with pain medications.

    Steroid medications, such as prednisone, can be helpful. Some people also find relief from anti-inflammatory drugs.

    Anti-nausea medications can reduce nausea, dizziness, and confusion some people feel. Other drugs, such as magnesium sulfate, Benadryl, and lidocaine may help, but evidence to support their use is limited.

    It is crucial to prevent excessive vomiting, particularly if a person is dehydrated. Dehydration can be a trigger for migraines. When vomiting is severe, a person may need an anti-nausea medication in a suppository form.

    If you have to go to an emergency room or stay in the hospital because of status migrainosus, doctors may need to treat other problems the migraine causes as well as the migraine itself.

    In the hospital, doctors may give you drugs through an IV to control pain. They'll treat dehydration by giving you fluids through an IV.

    Please remember: Any change in your normal Migraine pattern needs to be discussed with your doctor.

    Coping with status migrainosus

    Living with migraines, and particularly with status migrainosus headaches, can be difficult.

    Treatment should focus not only on the immediate pain of a migraine but also on its long-term psychological effects. The fear of another migraine, frustration with not being able to carry out plans, plus other challenges can all make life with migraines difficult.

    Some people find that support groups help them cope while offering useful suggestions for managing the pain.

    Psychotherapy can also help people deal with the psychological effects of pain and the anxiety that often comes with a chronic medical condition.

    Migraine Prevention

    It is not possible to completely prevent migraines or status migrainosus. However, many people who get migraines notice that specific triggers, such as perfumes, allergens, stress, or exhaustion cause their headaches.

    People should keep a log of events surrounding each migraine to help them figure out triggers, and then avoid those triggers, as much as possible.

    To prevent status migraines, avoid the triggers that set them off. The following suggestions may help:

    • Eat small meals throughout the day, so you don’t get hungry.
    • Drink eight or more glasses of water per day to prevent dehydration.
    • If you can’t sleep at night, try sleep-hygiene techniques. Keep your bedroom cool, quiet, and dark. Go to sleep at the same time each night. Do something relaxing before bed. Take a warm bath or read a book. If you still can’t get to sleep, ask your doctor about taking a sleep aid.
    • Try stress-relieving techniques such as deep breathing or meditation.
    • Only take migraine pain relievers when you need them. Don’t overuse them.

    Helpful Tips

    Not every Migraineur will eventually suffer status Migraine. However, it is wise to discuss how your physician would prefer you to address a debilitating Migraine attack that lasts beyond 72 hours. Some offices are able to treat you, while others prefer you to 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 seeding patient

    Regular Migraine vs. Status Migrainosus

    The difference is in the duration and the response to treatment. A regular migraine attack usually lasts between 4 and 72 hours. Treatments like triptan drugs and pain relievers can often relieve migraine pain and other symptoms.

    Status migraine symptoms last for longer than 72 hours, even with treatment. The headache might go away for a few hours, but it keeps coming back.

    Symptoms of a status migraine can be severe enough to disrupt your life. Vomiting can also lead to dehydration and an electrolyte imbalance.

    People with status migraines should see a primary care doctor or neurologist for treatment. The doctor will look for any health issues or lifestyle factors (such as stress) that might trigger your headaches. They’ll recommend treatments based on this information.

    Status migrainosus can be frightening and painful. Understanding what causes the pain can ease a person's mind and help them avoid future attacks.

    Once the attack relents, a person should ask a doctor for a referral to a neurologist who specializes in migraines.

    A specialized treatment plan may help prevent or reduce the severity of the next attack and offer insight into potential triggers that can be avoided.

     

    Compiled using information from the following sources:

    https://www.webmd.com/migraines-headaches/status-migrainosus-symptoms-causes-treatment#2

    https://www.healthline.com/health/migraine/status-migrainosus#prevention

    https://www.medicalnewstoday.com/articles/320247.php#symptoms

    https://migraine.com/blog/what-is-status-migrainosus/

    https://www.medlink.com/index.php/article/status_migrainosus

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