Everything You Need to Know About Migrainosus (Intractable Migraines)
Status migrainosus is every migraineur’s nightmare – a migraine that refuses to let up or back down, shifting the condition from debilitating to dangerous.
Knowledge is power. Understanding the background, symptoms, and what to do will give you some peace of mind. In this post for status migrainosus, we’ll look at the:
- Diagnostic criteria
- Common Treatments
- Prevention Measures
The History of Status Migrainosus
Status migrainosus, which is also referred to as intractable or pernicious migraine, is defined as a migraine attack that lasts for more than 72 hours, with or without an aura. It’s not usually associated with any other disorder or condition and is accompanied by severely disabling symptoms.
The term “status migrainosus” was first coined in 1978 by David Taverner, who described the attacks as “severe and prolonged, or frequently repeated migraine.” The attack can occur in any migraineur.
Diagnostic Criteria for Status Migrainosus
The third edition (2013) of the International Classification of Headache Disorders states the following about status migrainosus:
A debilitating migraine attack lasting more than 72 hours.
- A headache attack fulfilling criteria B and C
- Occurring in a patient with 1.1 Migraine without aura and/or2 Migraine with aura, and typical of previous attacks except for its duration and severity
- Both of the following characteristics:
- unremitting for >72 hr
- pain and/or associated symptoms are debilitating
- Not better accounted for by another ICHD-3 diagnosis.
The International Headache Society has a separate diagnosis for migraines that are caused by medication overuse, a chronic problem in our society. Finding ways to reduce the use of medications is essential to your well-being, especially if your intractable migraines are due to their overuse.
For the most part, intractable migraines have the same basic symptoms as regular migraines, including:
- Intense, throbbing pain in the head, usually on one side, but can occur on both sides
- Sensitivity to light and sound
- Dizziness or light-headedness
- Nausea and vomiting
- Electrolyte imbalance
- Numbness and tingling
The most notable difference between the two conditions is in the duration and treatment response. Intractable migraines last longer than 72 hours, whereas regular migraines are usually well under that. Status migrainosus symptoms may go away for a brief period, but they always come right back, and they don’t usually respond to medication as regular migraines do.
Treatment and Prevention for Status Migrainosus
Nailing down one set treatment for this population is impossible. Status migrainosus doesn’t respond to medications in the same way that regular migraines do, so they are often treated in the emergency room and include measures like:
- IV fluid hydration
- Anti-nausea and anti-emetic medications such as Compazine and Reglan
- Anti-seizure medications
- Strong pain relievers
ER doctors and migraine specialists have found that the longer the migraine is present in a status migrainosus event, the less likely it is to respond to drug therapy.
So, what gives? What can you do to heal the intractable migraines? First thing is first: Determine the cause or trigger to your migraines, then plan your attack to avoid those triggers or treat any underlying causes. Some options to start with include:
- Start a daily migraine diary to track symptoms, foods, drinks, environment, and stress levels
- Determine if you have any food sensitivities that are linked to the migraines. You can do this through the Elimination Diet.
- Drink more water. No matter how much you’re drinking (unless it’s more than half your weight in ounces a day), then drink more. Start with a half glass more, then a glass, and again.
- Get better sleep. Here are some ideas for how to restore your sleep.
- Don’t overuse any medications. They shouldn’t only be the last resort.
You’ll notice I didn’t go anywhere near the causes of migraines. For more information about what causes and triggers migraine attacks, you can browse through my blog, or check out my post, The Most Common Reasons for Migraine. It’s far too complicated to pinpoint an exact cause because every patient is different; therefore, this article should serve as good background information for your research.
If this post makes you nod your head in familiarity, then it’s time to talk to your doctor about treatment and prevention measures. Remember, make sure your doctor is the right doctor for your needs.
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