What is an intractable migraine?
Most people with status migrainosus headaches find that their usual migraine treatments do not help, or that they offer only brief relief. The migraine attacks can be debilitating and interfere with everyday life.
In this article, we take a look at what causes status migrainosus, how it differs from other types of migraines, and what treatment options are available.
What is status migrainosus?
Status migrainosus is also known as an intractable migraine.
Status migrainosus is a more severe and long-lasting form of migraine headache. The symptoms of a status migrainosus may be similar to a person's usual migraine pattern, or they may be more severe.
The main aspect of this type of migraine is that the headache is long-lasting. A person's usual strategies for stopping the headache, including rest and medication, will often not work.
Most migraines follow a distinct pattern. The pattern may include a warning period, during which a person experiences symptoms historically associated with a migraine.
Migraines may also include changes in consciousness, the appearance of an aura or visual disturbance, a headache, and then a fade-away period, during which a person may feel unlike themselves.
This pattern sets migraines apart from other headaches, including long-lasting or very painful headaches.
In a status migrainosus, the headache portion of a normal migraine headache lasts much longer than usual, specifically 72 hours or 3 days, or longer.
Lack of appetite and nausea may be symptoms of status migrainosus.
A status migrainosus is not necessarily different from a 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 portion lasting much longer.
In some people, however, the pain and nausea are so debilitating that they have to be hospitalized.
Status migrainosus tends to have the same symptoms as migraine but more noticeable or severe. The symptoms vary from person to person but often include:
- Changes in consciousness. Someone with a migraine may have difficulty concentrating, feel confused, sleepy, or struggle to communicate.
- An aura. This happens when a person sees lights, unusual patterns, or other changes in their vision.
- Headache. The pain may be intense and often on just one side of the head. It may spread to the other side of the head.
- Intense throbbing in the head. Unlike a tension headache, a migraine can feel sharp and overpowering, and does not get better with massage.
- Nausea. This is usually a feeling of wanting to be sick accompanied by little appetite for any kind of food.
- Weakness in a part of the body, or tingling sensation in the arms, hands, or legs.
The migraine must include a headache portion that lasts longer than 72 hours to qualify as a status migrainosus headache
The pain may get better for up to 12 hours with medication or rest but then returns. The pain must also be so bad that it is debilitating and not just an annoyance.
Migraines are a poorly understood condition, and there is no single test to confirm them.
Status migrainosus only occurs in people with migraines, and so diagnosing status migrainosus depends on a diagnosis of migraine. A doctor may diagnose status migrainosus, based on symptoms alone if a person has had migraines before.
A doctor may perform other tests, also, or take a detailed medical history to rule out other causes, such as a brain injury. The person's medical history may help decide if the headaches are consistent with migraines.
One popular diagnostic process requires at least five previous 4- to 72-hour attacks of migraines without an aura or two previous attacks of migraines with an aura.
Finally, other tests, such as neurological performance tests or magnetic resonance imaging (MRI) scans, to rule out other causes, may be done.
Attending support groups or psychotherapy may be beneficial for pain management and anxiety.
Treating status migrainosus can be difficult since an aspect of this headache is that a person's usual migraine remedies do not work.
No treatment can cure migraines, and researchers do not yet know of a way to shorten the length of status migrainosus. Instead, doctors focus on relieving symptoms with pain medications.
Steroid medications, such as prednisone, can be helpful. Some people also find relief from anti-inflammatory drugs.
Anti-nausea medications can reduce the nausea, dizziness, and confusion some people feel. Other drugs, such as magnesium sulfate, Benadryl, and lidocaine may help, but evidence to support their use is limited.
It is crucial to prevent excessive vomiting, particularly if a person is dehydrated. Dehydration can be a trigger for migraines. When vomiting is severe, a person may need an anti-nausea medication in suppository form.
Medication given into a vein to rehydrate the body can prevent a headache from getting worse and fight dehydration.
Coping with status migrainosus
Living with migraines, and particularly with status migrainosus headaches, can be difficult.
Treatment should focus not only on the immediate pain of a migraine, but also on its long-term psychological effects. The fear of another migraine, frustration with not being able to carry out plans, plus other challenges can all make life with migraines difficult.
Some people find that support groups help them cope while offering useful suggestions for managing the pain.
Psychotherapy can also help people deal with the psychological effects of pain and the anxiety that often comes with a chronic medical condition.
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 their headaches.
People should keep a log of events surrounding each migraine to help them figure out triggers, and then avoid those triggers, as much as possible.
The most common triggers for status migrainosus include:
- hormonal imbalances
- changes in medication, such as antidepressants or birth control pills
- injuries to the neck or head
- changes in sleeping or eating patterns
- weather changes
- infections, such as a cold or the flu
- surgery on the head or face
Remaining hydrated and getting plenty of rest on a regular schedule can reduce the frequency of migraines. People should aim to drink at least 60–80 ounces of water per day.
Migraines are a neurological disorder, and it is important for people to be checked for underlying neurological issues that may be causing them.
Neurological conditions, such as multiple sclerosis can sometimes cause migraine headaches. This is not a likely cause, but it is one that a migraine specialist should investigate.
Status migrainosus can be frightening and painful. Understanding what causes the pain can ease a person's mind and help them avoid future attacks.
Once the attack relents, a person should ask a doctor for a referral to a neurologist who specializes in migraines.
A specialized treatment plan may help prevent or reduce the severity of the next attack and offer insight into potential triggers that can be avoided.