Status Migrainosus

Medically Reviewed by Carmelita Swiner, MD on January 04, 2023
3 min read

Migraines are a type of headache that tend to cause other symptoms, too, such as nausea and vision problems. They can last for a few hours to a few days. But a migraine that lasts for more than 72 hours is called status migrainosus.

A typical migraine can sometimes turn into status migrainosus if:

  • You don’t get treatment early enough after the attack starts.
  • You don’t get the right treatment.
  • You use too much headache medicine.

The warning signs of status migrainosus are similar to those of a typical migraine. Along with pain in your head, you might also feel:

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

Because the condition lasts for at least 3 days, you’re also at risk for dehydration and sleep loss because of prolonged vomiting and pain.

If you need to seek urgent treatment for status migrainosus, doctors may need to treat other problems the migraine causes as well as the migraine itself. Doctors treat dehydration by giving you fluids through an IV. They may give you drugs through an IV to control pain, as well as medications for other symptoms.

Drugs that stop vomiting include:

  • Chlorpromazine
  • Metoclopramide (Metozolv, Reglan)
  • Prochlorperazine (Compro, Procomp)

A common medicine for halting status migrainosus is dihydroergotamine (DHE-45, Migranal). You can take it as a nasal spray or through a shot. Another drug, sumatriptan (Imitrex, Onzetra, Sumavel DosePro, Zecuity), comes as a shot, nasal spray, pill, or skin patch. Valproate, given by vein, can also be used.

People with certain medical problems should avoid these medicines though.

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

If you don’t respond to other treatments and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You take these regularly to make the headaches less frequent or less severe. These include seizure medicines, blood pressure medicines (like beta-blockers and calcium channel blockers), and some antidepressants. CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines don’t help.

Botox, though better known as a treatment for wrinkles, has also been approved by the FDA to prevent recurring migraines. Natural options such as magnesium may work, but we need more research to know which of these treatments are effective.

There are a couple of devices designed to interrupt abnormal electrical activity in the brain associated with migraine. A device called SpringTMS or eNeura sTMS uses a technique called transcranial magnetic stimulation (TMS). Place it on the back of your head for about a minute, and it releases a pulse of magnetic energy. Similarly, Cefaly uses transcutaneous supraorbital nerve stimulation and is worn as a band on the forehead and turned on daily for 20 minutes to prevent migraine from developing. There is also a noninvasive vagus nerve stimulator called gammaCore. When placed over the vagus nerve in the neck, it releases mild electrical stimulation to the nerve's fibers to relieve pain