Status migrainosus

Shuhan Zhu MD (

Dr. Zhu of Boston Medical Center has no financial relationships to disclose.

)
Stephen D Silberstein MD, editor. (Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Allergan, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura,  INSYS Therapeutics, Lilly USA, Supernus Pharmacerticals,  Thernica and Trigemina for consulting. He is also the  principal investigator for a clinical trials conducted by Alder Biopharmaceuticals, Amgen, electroCore Medical, Lily USA and Teva.)
Originally released May 6, 1994; last updated August 28, 2018; expires August 28, 2021

This article includes discussion of status migrainosus, intractable migraine, or pernicious migraine. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Status migrainosus is an attack of severe migraine lasting more than 72 hours accompanied by debilitating symptoms and is not attributable to another disorder.

For patients presenting with the first or worst prolonged headache, a thorough neurologic evaluation with collateral imaging and/or spinal fluid sampling is indicated to assess for secondary causes of pain.

In a patient with diagnosis of migraine without a secondary attributable cause of prolonged headaches, focus should be on swift and effective treatment with the primary aim of aborting the migraine.

Historical note and terminology

The term “status migrainosus” was first used by Taverner in 1978 to describe “severe and prolonged, or frequently repeated migraine” (Taverner 1978).

The most recent diagnostic criteria for status migrainosus according to the 2018 third edition of the International Classification of Headache Disorders is (ICHD-3) is reviewed below (Anonymous 2018):

Table 1. International Headache Society Diagnostic Criteria for Status Migrainosus

Description: A debilitating migraine attack lasting for more than 72 hours

Diagnostic criteria:

A. A headache attack fulfilling criteria B and C

B. Occurring in a patient with 1.1 Migraine without aura and/or 1.2 Migraine with aura, and typical of previous attacks except for its duration and severity

C. Both of the following characteristics:

 

1. Unremitting for more than 72 hours

2. Pain and/or associated symptoms are debilitating

D. Not better accounted for by another ICHD-3 diagnosis

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