Symptoms and Treatment of Status Migrainosus

Symptoms and Treatments for This Long, Severe Migraine

Symptoms and Treatment of Status Migrainosus
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Status migrainosus is a debilitating and severely painful migraine attack that lasts longer than a usual migraine—more than 3 days—often sending you to the emergency room.

Symptoms of Status Migrainosus

The symptoms of status migrainosus are similar to whatever your typical migraine symptoms may be, whether it's a migraine with aura or a migraine without aura.

The main difference is that in status migraines, the symptoms are continuous for more than 72 hours. In a regular migraine with or without aura, the head pain lasts between 4 and 72 hours. In status migrainosus, there may be periods of relative relief that last up to 12 hours. These are usually due to sleep or medications.

Symptoms of a migraine include:

  • Unilateral location (one side)
  • Throbbing
  • Worsening pain with normal physical activity like walking
  • Dizziness
  • Moderate to severe intensity

In addition, you must have at least one of the following:

Treatments for Status Migrainosus

Nearly all patients with status migrainosus will tell you their regular migraine treatments are not helping. Besides trying to break the head pain, treatment of status migrainosus includes managing all of the additional problems, like nausea and vomiting or dehydration.

Status migraines are often treated in​ the emergency room. The usual treatment includes intravenous (IV) fluids and medications to control nausea and vomiting, like prochlorperazine (Compazine).

Medications used to alleviate a status migraine may include one of the triptans, especially subcutaneous sumatriptan or dihydroergotamine (DHE), followed by an intravenous NSAID, like ketorolac (Toradol). A class of medications called dopamine receptor antagonists, or dopamine blockers, have been shown to be especially effective in treating status migrainosus. This class includes drugs like metoclopramide (Reglan), fluphenazine hydrochloride (Prolixin) and chlorpromazine hydrochloride (Thorazine).

Sometimes steroids like dexamethasone are used. One recent study of a small sample showed that 80 percent of patients with status ​migrainosus had significant pain relief when they took dexamethasone twice a day for four days.

Intravenous sodium valproate, an anti-seizure medication, can be considered but one recent study indicated that it may not be as effective as ketorolac (Toradol) or metoclopramide (Reglan) and should be used with caution in women of child-bearing years.

What to Do If You Have Status Migrainosus

As with all headaches, try to notice if you're having new symptoms or symptoms that are more severe than usual. Also, be sure to notify your healthcare provider if you have a migraine that lasts long enough to be considered a status migraine.

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