Status Migrainosus – Stroke, Definition, Treatment and More

Status Migrainosus – Stroke, Definition, Treatment and More

By: shubham

If you haven’t heard of Status Migrainosus (aka Status Migraine aka Status Migraine aka Intractable Migraine aka Pernicious Migraine), then I don’t prefer you ever get to hear about it.  Here is a brief information about what status Migrainosus is and how to do its treatment – protocol and hospitals.

What is a Status Migraine?

Definition of Status Migraine

  • Status Migraine is a medical term for a certain type of Migraine which lasts for around 72 hours or more and gives a headache of severe intensity. Even though at the beginning, you might not actually get to diagnose Status Migraine, if not diagnosed, it might result into very unbearable headache and even tougher situation or stage of migraine.
  • According to the definition of Status Migraine at several website, Status Migrainosus is not something that is generally known to a lot of people and is often misunderstood as normal headache of severe intensity.
  • Status Migrainosus is also known as Status Migraine, Intractable Migraine and Pernicious Migraine.
  • Status Migrainosus or Status Migraine is categorized as a migraine without aura.
what is migraine and status migraine definition

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Types of Migraine

There are basically two types of Migraine categorized on the basis of Migraine aura.

  1. Migraine with aura

    Many a times, migraine has some visual or sensory signs which differentiates it from general headache related disease and therefore is a little easier to be diagnosed on the basis of symptoms. These migraine situations are categorized as Migraine with aura. Migraine Prodrome or Migraine aura is the term for those visual or sensory signs of migraine’s presence.

  2. Migraine without aura

    Migraine without aura is term used for those migraine situations in which there is lesser or no visual or sensory signs of Migraine present which makes it tougher to diagnose on the basis of symptoms. Those who suffer from the Migraine without aura do not experience such sensation of presence of migraine and often mistake it as general headache or related problems.

Can migraine cause stroke?

  • There are many situations where presence of migraine may result in stroke and the main reason for which often is the blood clotting.
  • Because of the hormones, women seem to have a higher chace of Status migraine strokes.
  • Men seem to have lesser chance of Status migraine strokes.
  • Some migraine aura or migraine symptoms give a sign of stroke as it comes.
  • Some patients of status migraine, though it is a migraine without aura, might get strokes after some flashlight visuals.
status migraine stroke, symptom and treatment

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Status Migraine treatment

Reference – Please check the following guide for full detailed information about migraine treatment –

About the treatment of Status Migraine

  1. Lysine acetylsalicylate (aspirin).  – A few studies have shown intravenous aspirin to be an effective treatment for acute migraine attacks but only one has examined its use in an inpatient setting, given primarily for medication withdrawal headache. In this retrospective review of 91 patients with migraine, one gram of intravenous aspirin had a moderate effect in 62% and good effect in 27%. Intravenous aspirin was well tolerated, with only minor adverse events reported. Of note, of 21 patients with a history of upper gastrointestinal problems or NSAID intolerance, only 3 (14%) reported nausea or abdominal pain with intravenous aspirin.
  2. Valproate. One uncontrolled study showed that eight (80%) of ten patients with chronic migraine treated with a loading dose of 15 mg/Kg followed by 5 mg/Kg every 8 hours of intravenous valproate every eight hours had improvement of the pain. 57% was pain free. Intravenous valproate may also be effective for acute migraine in the emergency department and outpatient settings.
  3. Lidocaine. Two retrospective reviews have examined the use of intravenous lidocaine for chronic migraine. Of 71 patients with chronic daily headache (90% with migraine) and medication overuse treated with lidocaine infusion at 2mg/min for seven to ten days, 90% noted improvement in headache by discharge, with 60% achieving headache freedom. Six months  later, headache was absent in 51% and improved in an additional 20%. Of 68 patients with chronic daily headache (60% with migraine) treated with between 1mg/min to 4mg/min of lidocaine for a mean of 8.5 days, 57% had some improvement and 25% achieved headache freedom. Most patients had received intravenous DHE, neuroleptics or corticosteroids during the hospitalization prior to lidocaine. Side effects were generally mild, including nausea, hypotension, and arrhythmia, and did not lead to treatment discontinuation. However, hallucinations and other psychiatric side effects are not uncommon.
  4. Magnesium. The data available regarding the use of intravenous magnesium for the treatment of headache in adults is conflicting, most reports focusing on its use in the emergency setting rather than in patient and for the treatment of migraine headaches. Bigal et al. assessed the effect of 1 g intravenous magnesium sulphate on the pain and associated symptoms (nausea, photophobia and phonophobia) in patients with migraine without aura and migraine with aura compared to placebo. In the migraine without aura group there was no statistically significant difference in the patients who received magnesium sulphate vs. placebo in pain relief. In the migraine with aura group though patients receiving magnesium sulphate presented a statistically significant improvement of pain and of all associated symptoms compared with controls. Data supports use of magnesium sulphate for the treatment of all symptoms in migraine with aura, or as an adjuvant therapy for associated symptoms in patients with migraine without aura. In a randomized, single-blind, placebo controlled trial 15 patients received 1 g intravenous magnesium sulfate given and were compared to 15 patients who received 10 mL of 0.9% saline  intravenously. Magnesium sulfate was found to be superior to placebo with a pain-free rate of 87% for magnesium sulfate compared to 0% for placebo. Frank et al. published a randomized double-blind placebo-controlled trial comparing 2 g of IV magnesium versus placebo for the treatment of 42 patients (21 in each treatment group) with acute benign headache who presented to the EDs of two teaching hospitals. Authors found no benefit of IV magnesium compared to placebo. A meta-analysis of trials including 295 patients treated with intravenous magnesium for acute migraine failed to demonstrate a beneficial effect in terms of reduction in pain and decrease for rescue medication. It also showed that patients treated with magnesium were significantly more likely to report adverse events. In one study metoclopramide was more effective than magnesium with statistically significan  differences. In another study comparing a neuroleptic agent (prochlorperazine) and magnesium, the results were not statistically significant. A small case series reviewed the effect of intravenous magnesium therapy for 20 adolescent patients (range 13–18 years old): 5 with migraine, 4 tension-type headache, and 11 with status migrainosus. Although the treatment showed good tolerability there was no clear efficacy, although the study was limited by small sample size, multiple potential confounders, and lack of controls. There are no available controlled studies in the pediatric population.
  5. Diphenhydramine. The role of histamine in the pathophysiology of migraine is still under investigation but studies suggest benefits from intravenous administration. A study by Somerville reported that the administration of an acetaminophen-codeine combination plus the antihistamine doxylamine significantly relieved acute migraine attacks compared with  placebo. Swidan and colleagues compared the efficacy of intravenous diphenhydramine with dihydroergotamine mesylate (DHE) in the treatment of severe, refractory, migraine headache in eighty patients divided into two groups of 40 patients each. Comparison was made between nine doses of diphenhydramine (25 to 75 mg administered intravenously three times daily) and nine doses of DHE (0.25 to 1.0 mg administered intravenously approximately every 8 hours) during a 3-day period. Patients receiving DHE also received 10 to 15 mg of metoclopramide administered orally or intravenously approximately 30 minutes before the DHE for nausea prophylaxis. Intravenous diphenhydramine was noted to reduce pain levels more effectively than DHE immediately after its administration although overall DHE was associated with greater reduction in head pain level after the full nine doses (pre- and post protocol pain scores were compared). Despite the study’s limitations authors concluded that diphenhydramine could be effective in the treatment of some patients with intractable chronic migraine.
  6. Antiemetics. The majority of available data available mostly focus on outcome of treatment in the emergency department or infusion settings. According to a systematic review from the Canadian Headache Society, intravenous prochlorperazine is strongly recommended at a dose of 10 mg as high quality evidence for acute treatment of migraine. Multiple clinical trials have showed superior effect compared to placebo, SC sumatriptan and sodium valproate. Intravenous droperidol is effective in status migranosus and more effective than placebo in controlled trials for acute migraine. Multiple studies also support the use of chlorpromazine, haloperidol, and metoclopramide with or in conjunction with DHE treatment. EKG monitoring is recommended for drugs which may prolong QT interval.
  7. Propofol. Intravenous propofol in both subanesthetic and sedating doses has been reported to be effective for acute migraine in outpatient and emergency department settings. In a small study conducted in an inpatient setting for airway monitoring, 18 patients with chronic daily headache (14 with chronic migraine) were treated with repetitive boluses of propofol with a mean total dose of 234mg. Six achieved headache freedom and 11 reported reduced headache intensity with a mean decrease of 4.2 points on a 10 point scale. There were no adverse events other than drowsiness, and in fact patients who slept between boluses had more pain relief.

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