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"Status Migraine" is a term every migraineur ought to know. Yet few have ever heard of it. What is it, and why is this condition so potentially-dangerous?

Every migraineur should know the term "Status Migraine", although very few do. Status Migraine is something you must discuss with your doctor, as it is a potential medical emergency that could cause life-threatening complications.

What is Status Migraine

Status Migraine (also called "Status Migrainosus", or "Status Migrainous") is a migraine that lasts for more than 72 hours.

In order to be diagnosed as Status Migrainosus, the International Headache Society says the following factors must be present [see links]:

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...duration and severity
C. Both of the following characteristics:

  • 1. unremitting for >72 hr1
    2. ...debilitating2

D. Not better accounted for by another ICHD-3 diagnosis.

If the patient has remission for up to 12 hours, due to sleep or pain medication, the diagnosis is still Status Migrainosus.

Symptoms of Status Migraine

The symptoms of Status Migraine are similar to the symptoms of migraine. However, due to prolonged pain and vomiting, you are more likely to experience effects such as insomnia and dehydration. These may make mental effects more likely and more pronounced.

Dehydration could also lead to dizziness, heart palpitations, general weakness, and impaired kidney function.

But what does Status Migraine feel like?

For those who have never had a Status Migraine (or even a migraine, you lucky devils), this is how it feels:

First, imagine the worst migraine (or headache) you've ever had. Double it. Triple it. Double it again. You're approaching the pain level.

Remove your ability to think (you can't think; you certainly can't grasp any abstract concept).

Imagine you've been vomiting, constantly, for seventy-two hours, with no end in sight. You're weak with dehydration and your throat hurts. Every smell that wafts by your nose (a cigarette, the cat's food, someone's meatball sub wafting through an open window) makes you feel like you're going to be sick again (osmophobia).

The light doesn't just burn your eyes (photophobia), it physically hurts them. Even with sunglasses, the light sears. Every whisper is like a shout (phonophobia). Even people talking in the same room has you retreating to a cool, silent, dark room (the only environment where you can find any comfort at all).

This is migraine. And Status Migraine feels like it will never end.

What to do about Status Migraine

If you have Status Migraine, you need to see a doctor.

The longer migraine is present, the harder it is to treat. It also becomes more likely that allodynia will occur; this is where your body can become so sensitive that lightly touching your hair or skin with a finger or bedsheets is so painful that you can cry.

You may require:

  • Suppository, IV or injection therapy, as prolonged migraine can cause gastric stasis and stop your stomach absorbing medications.
    • IV fluids will usually be given to treat dehydration
    • Anti-nausea medications such as metoclopramide may be given to speed up the gastric passage and fight nausea
    • Dihydroergotamine or a triptan may be given to halt the migraine
  • Corticosteroids can be used to relieve Status Migraine
If your migraines change in nature or severity, always discuss it with your doctor.
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