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Status Migrainosus

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Migraines are a type of headache that tend to cause more than just head pain. The symptoms often include nausea and vision problems.

A migraine headache can last for a few hours a day to several hours. But a migraine attack that lasts for more than 72 hours is called status migrainosus. This may require hospital treatment to relieve the pain and treat dehydration from vomiting.

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Migraines are a type of headache that cause severe, throbbing pain, often accompanied by nausea, vomiting, and sensitivity to light (photophobia) or sound (phonophobia). Migraine headaches generally last between four and 72 hours. Many people experience certain symptoms prior to the onset of the head pain. Symptoms that precede and herald an upcoming headache are referred to as an "aura," and usually last under an hour. Symptoms of an aura include: Changes in your vision (even brief blindness) ...

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A typical migraine can sometimes turn into status migrainosus if:

  • The migraine isn't treated early in the course of the attack.
  • The migraine isn't treated correctly.
  • Headache medication is overused.

 

Symptoms of Status Migrainosus

The symptoms of status migrainosus are similar to symptoms of a typical migraine. Along with pain in the head, common symptoms include:

  • Sensation of sparkling lights or other vision changes (aura)
  • Nausea and vomiting
  • Difficulty thinking properly

Because status migrainosus lasts for at least three days, prolonged vomiting and pain can lead to:

  • Dehydration
  • Fatigue due to sleep loss

Treatment for Status Migrainosus

If you have to go to an emergency room or you are admitted to the hospital because of status migrainosus, doctors may need to treat the complications of the migraine as well as the migraine itself.

In the hospital, doctors may administer drugs through an IV to control pain. They will treat dehydration by administering fluids through an IV.

Drugs used to end vomiting include:

A commonly used medicine for halting status migrainosus is dihydroergotamine (DHE-45, Migranal). This is a migraine treatment that dates back to the 1940s. The drug may be taken as a nasal spray or through an injection.

Another drug that can halt status migrainosus is sumatriptan. It is given as an injection, nasal spray, pill, or skin patch.

However, people with blood vessel disease should avoid these drugs.

The corticosteroids dexamethasone (Decadron, Dexamethasone Intensol, Dexpak) and prednisolone can also relieve status migrainosus.

Preventing Migraines

If you have frequent migraines you may want to take medicines to prevent them. These may not completely prevent migraines. But they may reduce the number or severity of attacks that can turn into status migrainosus.

These medications include:

  • Beta-blockers. These drugs, which are also used for reducing blood pressure, are a common preventive treatment for people with frequent migraines. They include atenolol (Tenormin), metoprolol (Lopressor, Toprol), nadolol (Corgard), and propranolol (Inderal, InnoPran, Pronol).
  • Calcium channel blockers, which are also used for high blood pressure.
  • Types of antidepressants known as tricyclics (such as amitriptyline) and SNRIs (such as venlafaxine).
  • Anti-seizure medicines such as valproate and topiramate.
  • Botox. Though better known as a treatment for wrinkles, Botox has been approved by the FDA to prevent chronic migraines.
  • Natural therapies such as magnesium. More research is needed though to see which of these treatments are effective.

 

WebMD Medical Reference

Reviewed by Melinda Ratini, DO, MS on November 21, 2014
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