Status migrainosus

Shuhan Zhu MD (Dr. Zhu of Jefferson Headache 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 Alder Biopharmaceuticals, Allergan, Amgen, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura, electroCore Medical, Lilly USA, Supernus Pharmacerticals, Teva, and Trigemina for consulting and/or advisory panel membership.)
Originally released May 6, 1994; last updated November 7, 2015; expires November 7, 2018

This article includes discussion of status migrainosus, intractable migraine, and 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. Status migrainosus may occur in migraineurs with or without aura.

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 underlying diagnosis of migraine and 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 Headache Classification Committee of the International Headache Society formally defined status migrainosus with subsequent updates in the 2nd and 3rd (beta) editions of the ICHD. The most recent diagnostic criteria for status migrainosus according to the 2013 third (beta) edition of the International Classification of Headache Disorders is reviewed below:

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

(Headache Classification Committee of the International Headache Society 2013)

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