Status Migrainosus — Not Your Average Migraine

B.S. Dietetics, Dietitian, Health Professional
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Status migrainosus refers to a debilitating condition in which a Migraine attack can last three days or longer with little to no relief. In most cases, status migrainosus can be treated in the emergency room or doctor’s office and won’t lead to any permanent damage. But because of the increased risk of stroke associated with the condition, it is considered a medical emergency and must be evaluated.

What causes status migrainosus?

Most Migraine attacks are treated by triptans, but for up to 40 percent of Migraine attacks, triptans don’t do the job. This can lead to a cycle where the Migraine attack can last longer than 72 hours. We know status migrainosus quite well as our daughter has had many Migraine attacks that have lasted at least, if not longer, than 72 hours. It can be really scary to have such severe pain for so long and, as my 12-year-old daughter, Ella, says: “It makes me feel like my eyeball is going to fall out. I want to pull all my hair out and eliminate all noise and light. Even then, it is still really painful. Then when the medications at home don’t even work it is really frustrating.”

How is status migrainosus treated?

Status migrainosus is most often treated in the ER for the first instance, and for most future cases, in the neurologist’s office. Intravenous fluids, subcutaneous triptans, ketorlac (Torodol), chlorpromazine (Thorazine), metaclopramide (Reglan), and steroids like dexamethasone may be used in the treatment plan depending on the individual patient. It has been our experience that they start with one or two medications, including diphenhydramine (Benadryl), before adding others if the first medications don’t alleviate the Migraine.

Unfortunately, there is no way to know how long it will be until this type of Migraine attack returns. Our daughter had been in the ER for hours only to find relief for a few days. That is when it becomes really important to work with your neurologist to prevent Migraine attacks and limit Migraine triggers.

When does it become more serious?

Most Migraine attacks are not life threatening, but a few can lead to a migrainous stroke, so all episodes of status migrainosus should be treated as a medical emergency — prompting evaluation by your physician, neurologist, or or a visit to the ER.

Who is most likely to get status migrainosus?

While it is unclear exactly why some people end up with multiple episodes of status migrainosus, we do know that hormone changes (especially estrogen in women), family history, lifestyle triggers, being overweight, lack of exercise, and dehydration can precipitate these attacks. Talk with your neurologist about how to define and limit your triggers.

Our experience with status migrainosus

Our daughter was diagnosed with Migraine when she was 11. I also have Migraine attacks but not as frequently as hers. Status migrainosus has been an evil we have fought over the last two years, trying to treat and find ways to prevent it. It has taken a lot of time away from school, sports, and church. It can be life altering, to say the least.. It’s not “just a headache” and it’s not “in her head.” We have found that a little compassion from those around us, and a quick access to abortive medications can make all the difference during these serious migraine events.

See more helpful articles:

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Understanding the Anatomy of a Migraine