Intractable Migraine

Status migrainosus is an especially severe and long-lasting form of migraine attack. It’s also called intractable migraine. Put simply, it is a migraine attack that doesn’t go away. Status migrainosus attacks affect less than 1 per cent of people with migraine. However, they’re intense and they stick around for longer than 72 hours. Treatment with traditional migraine medicines like triptans and even stronger pain killers like codeine often won’t cut through a status migraine attack. The pain and nausea can be severe enough to require a hospital visit for treatment.

Status migraine attacks have the same basic symptoms as regular migraine attacks:

• throbbing pain on one or both sides of your head
• nausea and vomiting
• sensitivity to light, sounds and smell

REGULAR MIGRAINE VS. STATUS MIGRAINOSUS

The difference is in the duration and the response to treatment. A regular migraine attack usually lasts between 4 and 72 hours. Treatments like triptan drugs and pain relievers can often relieve migraine pain and other symptoms.

Status migraine symptoms last for longer than 72 hours, even with treatment. The headache might go away for a few hours, but it keeps coming back.

Symptoms of a status migraine can be severe enough to disrupt your life. Vomiting can also lead to dehydration and an electrolyte imbalance.

People with status migraines should see their GP or neurologist for treatment. The doctor will look for any health issues or lifestyle factors (such as stress) that might be causing your migraine attacks to behave differently, and whether you have medication overuse headache. They’ll recommend treatments based on this information.

STATUS MIGRAINOSUS TREATMENT 

You might first try a traditional migraine medicine. These include triptans or nonsteroidal anti-inflammatory drugs. If these medicines don’t work, ask your doctor about trying a stronger pain reliever. You might also need an antinausea medicine.

If your pain doesn’t improve or if you become dehydrated, you may need to be treated in a hospital. There you can get fluids and medicines intravenously. Migraine treatments you might get in the hospital include:

• fluids
• antinausea medicine such as ondansetron 
• opioid pain relievers
• anti-seizure and anti-psychotic drugs known to be effective for migraine, such as valproate (Depakote) or chlorpromazine (largactil)

The new CGRP medications may also be of benefit. Vyepti (Eptinezumab), is an intravenous infusion that is available for use in hospitals. There are also more serious interventions, like ketamine or lignocaine infusions, which may be considered.

You may need to stay in the hospital for a few days to control your symptoms. The doctors can try a few different migraine drugs until they find one that works for you.

Learn more about status migrainosus at the US National Headache Foundation