Status migrainosus is migraine that lasts more than 72 hours. It is also called intractable migraine.
Migraine attacks may be exhausting and make it difficult to perform our everyday activities.
In this article we look at what causes status migrainosus, how it differs from other types of migraine, and what the treatment options are.
What Is Status Migrainosus (Migraine Headaches)?
Status migrainosus is a more severe and prolonged form of migraine. The symptoms of status migrainosus may be similar to the usual pattern of migraines, or they may be more severe.
The main aspect of this type of migraine is that the headache is persistent. A person's usual strategies for stopping the headache, including rest and medication, often won't work.
Most migraines follow a different pattern. The pattern may include a warning period in which a person experiences symptoms historically associated with migraines.
Migraines may also involve changes in consciousness, the onset of aura or vision disturbances, headaches, and then a period of subsidence during which the person may feel like it.
This pattern sets migraines apart from other headaches, including prolonged or very painful headaches.
In status migrainosus, the main part of a normal migraine headache lasts much longer than usual, more precisely 72 hours or 3 days or more.
Symptoms
The condition of migraine does not necessarily differ from typical migraine except in its duration and severity. In fact, people who experience status migrainosus find that the attack is the same as a regular migraine, except for the headache part, which lasts much longer.
In some people, the pain and nausea are so exhausting that they have to be hospitalized.
Status migrainosus tends to have the same symptoms as migraines, but more noticeable or severe. Symptoms vary from person to person, but often include the following:
- Changes in consciousness. A person suffering from migraines may have difficulty concentrating, may have a feeling of confusion, drowsiness or be unable to talk.
- Aura. This happens when a person sees lights, unusual patterns, or other changes in their vision.
- Headache. The pain may be severe and often only on one side of the head. It may also spread to the other side of the head.
- Intense throbbing in the head. Unlike a tension headache, migraine may be sharp and unbearable and does not improve with massage.
- Nausea. This is usually connected to urges of sickness, accompanied by weak appetite for food of any kind.
- Weakness in a part of the body or a tingling feeling in the arms, hands, or legs.
Migraines which include a part of the headache that lasts more than 72 hours are qualified as a migraine headache. The pain may improve for up to 12 hours with medication or rest, but then it returns. The pain is so bad that it is exhausting, not just an annoyance.
Diagnosis
Migraines are conditions we do not have much information about and there is no single test to confirm them.
Status migrainosus only manifests in people with migraines, so diagnosing the condition of migraines depends on the diagnosis of the migraine. A doctor may diagnose Status migrainosus based on symptoms alone if a person has had migraines before.
The doctor may perform other tests or take a detailed medical history to rule out other causes, such as a brain injury. A person's medical history may help you decide if the headaches are consistent with migraines.
A popular diagnostic process requires at least five previous 4- to 72-hour migraine attacks without aura or two previous migraine attacks with aura.
Finally, other tests, such as neurological tests or magnetic resonance imaging (MRI), may be done to rule out other causes.
Treatment
Treating the Status migrainosus may be difficult because an aspect of this headache is that the usual migraine medications do not work.
There is not treatment for migraines, and researchers do not yet know how to shorten the duration of migrainosis. Instead, doctors focus on relieving symptoms with analgesics.
Steroid medications, such as prednisone, may help. Some people also find relief from anti-inflammatory medications.
Anti-emetic drugs may reduce the nausea, dizziness and confusion that some people experience. Other drugs such as magnesium sulphate, bendadryl and lidocaine may help, but there is limited evidence to support their use.
It is crucial to prevent excessive vomiting, especially if the person is dehydrated. Dehydration may be a migraine trigger. When vomiting is severe, a person may need anti-nausea medication in the form of suppositories.
Medicine that is administered into the vein to rehydrate the body may prevent the headache from worsening and fight dehydration.
Living with Migraines, and Especially with Status Migrainosus Headaches, May Be Difficult.
Treatment should focus not only on the immediate migraine pain, but also on the long-term psychological effects. The fear of another migraine, the frustration of no plans, plus other challenges, may make living with migraines difficult.
Some people find that support groups help them cope by offering helpful suggestions for dealing with the pain.
Psychotherapy may also help people cope with the psychological effects of pain and the anxiety that often comes with chronic illness.
Prevention
It is not possible to completely prevent migraines or status migrainosus. However, many people who get migraines notice that specific triggers, such as perfumes, allergens, stress, or exhaustion cause headaches.
People should keep records of the events surrounding each migraine to help them understand the triggers and then avoid these triggers as much as possible.
The most common causes of status migrainosus headache include:
- hormonal imbalances
- stress
- changes in medication, such as antidepressants or birth control pills
- neck or head injuries
- changes in sleep or diet
- changes in the ambient air
- infections such as colds or flu
- head or facial surgery
Staying hydrated and getting enough rest on a regular schedule may reduce the frequency of migraines. People should aim to drink at least 1.5-2 litres of water per day.
Perspective
Migraines are a neurological disorder and it is important that people are screened for the underlying neurological problems that may be causing them.
Neurological conditions, such as multiple sclerosis, may sometimes cause migraine headaches. This is not a likely cause but should be investigated by a migraine specialist.
Status migrainosus may be frightening and painful. Understanding what is causing the pain may ease person's mind and help them avoid future attacks.
Once an attack is averted, one should ask a doctor to refer them to a neurologist who specializes in migraines.
A specialized treatment plan may help prevent or reduce the severity of the next attack and provide insight into potential triggers that may be avoided.