Chapter 1, Episode 8: What is Status Migrainosus?


This content has been medically reviewed by Dr. Alyson McGregor.

Status migrainosus is a migraine attack that lasts longer than 72 hours with debilitating pain and/or associated symptoms. It can occur in someone who has migraine with or without aura. This is a challenging form of migraine that does not respond to standard treatments. Status migrainosus may also be called intractable migraine or refractory migraine.

Status migrainosus differs from chronic migraine. With chronic migraine, a person will have 15 or more headache days per month but the attacks do not last more than 72 hours each. A person with chronic migraine can DEVELOP status migrainosus. 

Status Migrainosus generally occurs due to ineffective treatment, an adaptation to medication or when abortive medications are taken too late in the migraine cycle. 

Typical symptoms include: severe head pain, sensitivity to light, vision disturbances, nausea and vomiting, sound sensitivity, dizziness, irritability and inability to concentrate. Prolonged and untreated symptoms can cause low blood sugar, electrolyte imbalances and dehydration. 

A person who has a migraine attack that lasts longer than 72 hours should contact their headache specialist or go to the emergency room. 

Since this condition is very difficult to treat, hospital level treatment may be necessary for pain management and prevention of dehydration due to nausea and vomiting. Emergency department or inpatient care can include intravenous treatments such as dihydroergotamine, steroids, anti-seizure medications, antihistamines, magnesium, anti-inflammatory medications, propofol phenothiazines, anti-nausea medications and electrolytes. 

Outpatient treatment options may include steroids, muscle relaxers, antihistamines and anti-nausea medications. Nerve blocks with lidocaine administered in a doctor’s office may be an effective treatment and a good option for pregnant women. 

Traditional migraine preventive medications may also be prescribed.

Under the supervision of a clinician, a combination of various migraine therapies may be the most beneficial way to treat status migrainosus. Combination therapy may include medications, botulinum toxin, neuromodulation, biofeedback, cognitive behavioral therapy and others.

It is important to follow up with a health care provider within one week of a status migrainosus attack to try to prevent a recurrence.

This video is sponsored in part by Amgen and Teva Pharmaceuticals.

*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.