What Is Status Migrainosus?

Status migrainosus, also known as an intractable migraine attack, is a particularly severe migraine headache that lasts longer than 72 hours. Oftentimes, status migrainosus does not respond to traditional medications (triptans, ergots, NSAIDs, etc.) used to treat migraines.

Symptoms

The symptoms of status migrainosus are the same as the symptoms of a typical migraine, except they are often more severe and last longer than a regular migraine. Typical migraines last between four and 72 hours; whereas, status migrainosus lasts longer than 72 hours. Symptoms include the following:

• Throbbing or pulsing pain on one or both sides of the head
• Nausea or vomiting
• Sensitivity to bright lights, loud sounds, or strong odors
• Dizziness

Causes

A typical migraine can progress to an intractable migraine attack if treatment is not started early enough or if treatment is not effective. Status migrainosus can also develop if headache medications are taken too frequently.

The specific cause of migraines and status migrainosus is not known, but genetics, hormonal changes, and environmental factors are thought to play a part.

Risk factors

Status migrainosus is rare, affecting less than 1% of individuals who experience migraines. The risk factors for intractable migraines are the same as those for regular migraines, including being female, having a family history of migraines, and taking certain medications.

Treatment

Status migrainosus often requires treatment in an emergency room or hospital setting. Intravenous fluids may be needed to treat dehydration from prolonged nausea and vomiting. Medications, such as chlorpromazine, metoclopramide or prochlorperazine, can be given to stop vomiting. Strong migraine medications, such as dihydroergotamine, sumatriptan, or valproate, can be administered intravenously, subcutaneously or intramuscularly — depending on the type of medication — to treat status migrainosus. Corticosteroids, such as dexamethasone or prednisolone, may also be helpful.