Practically all migraine attacks are not considered life-threatening and can be cared for with migraine treatments. One of a few exceptions is status migrainosus, which is a type of migraine that is considered dangerous and requires emergency medical care.

Status migrainosus refers to a migraine attack that lasts longer than 72 hours. It is more serious than a regular migraine because the prolonged symptoms, like vomiting, can cause a patient to get dangerously dehydrated. Hospital treatment is required for powerful medications to stop the migraine, and to receive intravenous fluids to combat dehydration.

Status migrainosus is generally preventable. A typical migraine can become status migrainosus if a person:

  • Does not receive proper treatment.
  • Does not receive treatment early in the migraine attack cycle.
  • Takes too much headache medicine in the hopes of alleviating migraine pain.

The symptoms associated with status migrainosus are the same as the symptoms associated with any migraine, but they last longer. These symptoms include:

  • Changes in vision
  • Difficulty concentrating
  • Nausea
  • Vomiting

The symptoms associated with status migrainosus are the same as the symptoms associated with any migraine, but they last longer. These symptoms include:

  • Pain located on one or both sides of the head. The pain is typically moderate to severe and described as pulsating or throbbing. Also, the pain worsens with activity and impairs your ability to function normally.
  • Changes in vision, typically referred to as an aura. An aura typically occurs before the onset of the migraine headache and can last anywhere from 15 minutes to 1 hour. Auras can have many different manifestations, such as zig-zag patterns, blind spots, blurry vision, temporary loss of vision, flashes of light or double vision (diplopia). Occasionally, auras can affect the senses and lead to ringing in the ears (tinnitus) or changes in smell, taste or touch.
  • Nausea and vomiting. This represents an uneasiness of the stomach accompanied by loss of appetite. It can be extremely difficult to treat or tolerate and lead to one of the most serious complications of status migrainosus—life-threatening dehydration.
  • Sensitivity to light (photophobia) as well sensitivity to sound (phonophobia). Many migraineurs just want to retreat to a dark, quiet room in their apartment or home.
  • Changes in consciousness. Individuals with status migrainosus may have difficulty concentrating, feel confused, have extreme fatigue/sleepiness, or struggle to communicate.
  • Weakness in a part of the body. This symptom can often be confused with a stroke, and medical imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) can differentiate between the two conditions.
  • Tingling (“pins and needles”) sensation in the arms, hands or legs.

When does a migraine start to become be dangerous?

Migraines are typically benign, or non-life threatening, but this is not the case with status migrainosus. Due to its relentless and never ending nature (> 72 hours), status migrainosus has the potential to become and is considered, in most instances, an emergency medical situation. The longer the condition persist, the more serious it can become. Indeed, status migrainosus can be life threatening, inducing conditions such as dehydration, stroke, aneurysm, permanent vision loss, serious dental problems, coma and even death. In the long-term, it can lead to psychological problems such as anxiety and depression, which increases the risk of suicide.

How is status migrainosus treated?

Status migrainosus requires a trip to the emergency room and potentially a stay in the hospital for treatment. Treatment targets the underlying migraine, along with the dangerous symptoms, like vomiting, which can cause life-threatening dehydration.

To help stop the migraine, many standard migraine drugs will be be administered by IV, nasal spray or suppository. This is because most patients with status migrainosus have severe vomiting and pills cannot be kept down and absorbed. Other medications will be given to treat the symptoms of the migraine, including pain, nausea and vomiting. Steroids are sometimes used to treat status migrainosus. All patients will also receive fluids through an IV, to treat the most serious complication of status migrainosus: dehydration.

Like any migraine, there is no surefire solution to treat status migrainosus. Instead, doctors may try a number of treatments to help a patient minimize status migrainosus and the accompanying symptoms.

Additionally, many emergency room and hospital status migrainosus treatments are designed to deliver instant relief, often not addressing the root causes of migraine symptoms. Status migrainosus patients may receive temporary migraine relief from these medications, but they may not treat prolonged migraines in the future.

What should I do if my migraine lasts more than 72 hours?

When it comes to status migrainosus, diligence is key. If a person has a migraine for over 72 hours, this individual has status migrainosus and must receive immediate medical attention. After an emergency room or hospital visit, a status migrainosus patient should follow up with their neurologist to ensure they are receiving the best medical treatment to prevent future attacks. Patients who have experienced status migrainosus generally suffer from chronic migraines, and should visit The Migraine Institute to find out if they qualify for long-lasting Botox or surgery treatment..

Dr. Jonathan Cabin of The Migraine Institute is committed to helping patients identify long-term solutions to migraines, like status migrainosus. As a board-certified head and neck surgeon with dual-subspecialty training in facial plastic and reconstructive surgery, Dr. Cabin provides two interventional treatments to help migraine patients achieve long-lasting relief:

  1. Botox for migraines involves the use of Botox injections to reduce or eliminate nerve irritability that can trigger painful migraines.
  2. Minimally Invasive Migraine Surgery helps remove faulty nerve signals that can cause migraines.

During a consultation, Dr. Cabin will learn about an individual’s migraine symptoms and gather critical information about the patient’s migraine history. Then, Dr. Cabin will provide personalized interventional migraine treatment recommendations.

Coping with Status Migrainosus

Living with migraine headaches, and particularly with intermittent status migrainosus, can be extremely difficult. The fear of the possibility of having another episode and frustration with not being able to live a “normal” life can take a large toll. As status migrainosus is a debilitating, extremely painful and chronic illness, coexisting psychiatric diagnoses, such as depression and anxiety, are not uncommon. As a result, psychotherapy and support groups along with antidepressant and/or anti-anxiety medications may be able to provide a reprieve from the relentless pain and disruption of daily activities and quality of life. As stress can be a factor in the development of status migrainosus, natural anti-stress measures such as mindfulness meditation, yoga, Pilates, essential oils, mood boosting supplements and acupuncture may prove useful in dealing with this chronic illness. Besides stress, other potential triggers to avoid include alcohol, smoking, caffeine, food additives (e.g., nitrates and monosodium glutamate [MSG]), skipping meals and sleep deprivation. Every migraineur is unique, and it may take some trial and error to find what works for you.

There is no need to let migraine symptoms linger for an extended period of time. By scheduling a consultation with Dr. Cabin, migraine sufferers can take the first step to reducing migraine suffering.

To set up a migraine consultation, please call us today at 310.461.0303 or fill out our online form.

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