Status Migrainosus

Status migrainosus by definition is a migraine that has progressed beyond 72 hours. Certain neurochemical changes occur within the brain during a migraine. The longer a migraine (or any pain for that matter) progresses, the worse it may become and the more difficult to treat.

Unfortunately, many times people will delay treating their migraines for a variety of reasons. They may be looking for "sinus pressure relief", unaware of the fact that they are really having a migraine.

Watch a video about the cause of migraine. (Give this a few seconds to download!) If you watched the video you can see how many elements are involved in the migraine attack.

Neuroimaging In Status Migrainosus

Many times when patients come to me with a migraine that has been ongoing for weeks, if their exam is normal and if this has happened before, I will treat the headache and defer imaging. However, there are a few exceptions to this. If someone has never had a headache go on this long, then that is a "chang" in their headache profile and imaging most probably should be performed.

I also advise patients, that if the treatment doesn't work and they still have a bad headache the next day (after an IV infusion or injection), then I would also consider imaging with an MRI of the brain.

Additionally, as always, if there are any other neurological complaints such as new onset of seizures, OR any abnormalities on the physical exam, then I order the MRI to be done immediately.

Other Testing

If imaging is normal, and someone has never had this happen before, then I consider bloodwork. Many times I have found that when someone is sliding into vitamin deficiencies, particularly vitamin B12 deficiency, this will kick off status migrainosus.

Treatment Of Status Migrainosus

Treatment of any migraine involves being aggressive with the pain and getting the medication in you within the first hour. Studies on migraine have shown that if you treat within the first hour you have a 90% chance of aborting the headache. If you wait until the second hour your chances drop to 15%!

Treatment of this condition may vary. Of course if the headache has gone on for several days, and no medications are working, a visit to the emergency room is warranted.

If the headache has gone on for days and is not disabling, call your physician's office. A medrol dose pak is quite effective in breaking this pain. This is a one week course of low dose steroid and really does help. While on the dose pak, I also advise patients to take a triptan such as Frova, morning and evening for the first two days of the dose pak. This longer acting triptan really helps treat migraine headache symptoms.

Remember to stay hydrated! Dehydration during a migraine only makes the symptoms worse, as does lack of food.

Anti-nausea medications such as compazine will also treat the headache pain (bet you didn't know that did you!) and help break the status migrainousus.

If all of the above is not working, you may need to visit an urgent care center or the emergency room. Rarely, a severe unrelenting headache may be a dangerous headache that could require prompt medical attention. Urgent care centers can also offer IV hydration and medications to break status migrainosus.

Read more about different types of headaches.

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