What meds can I use for Status Migraine & Status Aura?

Full Question:

Is What pain meds can I use ? FOR STATUS MIGRAINE & STATUS AURA?

NSAIDS ARE BANNED DUE TO BLEEDING & CODIENE CONSTIPATES & THEN MORE BLEEDING



I HAVE BEEN REFERRED TO A PAIN MANAGEMENT DOCTOR.



THE NEUROLOGIST (ALSO MIGRAINE CERTIFIED) AND THE INTERNIST & GASTRO DOCTORS HAVE CONFLICTING IDEAS AND DRUGS.



WHAT ELSE IS LEFT TO TAKE FOR SEVERE PAIN?



I HAVE BEEN TO THE ER AND THEY GAVE ME STRONGER CODIENE



ANY SUGGESTIONS OUT THERE? maryjuliamac.
 

Answer:

Dear Mary,

Not sure what you mean by "status aura," so let's address status Migrainous first. Status Migrainous is defined by Migraine pain lasting longer than 72 hours without a solid four-hour pain-free break, while awake. See Status Migrainous - The Basics for more information on this.

Status Migrainous (SM) is not best addressed by the use of pain meds, especially pain meds that you could take at home. When you reach the point of SM, it's time to be treated by your doctor or in the ER to break the Migraine. Sometimes, pain meds (usually along with antinausea meds) can be administered IV to break the Migraine. Other medications that are frequently used IV to break a Migraine are Depakon, steroids, and simple magnesium sulfate, among others. Pain management is not effective in the treatment of SM because it's not just the pain that needs to be addressed, but the Migrainous process in the brain. Pain management cannot address that.

Also, if a doctor has told you that you have "status aura," it's time for a new doctor. There is no such diagnosis. Without more information, it's extremely difficult to comment on this part of your question. There is a type of aura called "persistent aura." Here's the International Headache Society's description and diagnostic criteria for that:

1.5.3 Persistent aura without infarction (stroke)
Description:
Aura symptoms persisting for more than 1 week without radiographic evidence of infarction.

Diagnostic criteria:

1. The present attack in a patient with 1.2 Migraine with aura is typical of previous attacks except that one or more aura symptoms persists for more than 1 week
2. Not attributed to another disorder

Comments:
Persisting aura symptoms are rare but well documented. They are often bilateral and may last for months or years. Reliably effective treatment is not known though acetazolamide and valproic acid have helped in a few cases. Exclude posterior leukoencephalopathy by diffusion MRI among other things. Exclude 1.5.4 Migrainous infarction by MRI.

Painkillers cannot help with persistent aura because it is not a pain issue.

Sorry there isn't an easier answer, but there simply isn't. Not sure what "migraine certification" your doctor has, but if he's referring you out to pain management for the treatment of SM, it may well be time for a new doctor. There's a link below to our listing of patient recommended specialists.

Good luck,
John Claude Krusz and Teri Robert