Status migrainosus is a migraine attack that lasts longer than 72 hours. Learn about symptoms and treatment options.
For most people living with migraine, the timeline of an attack is 4-5 hours. But some people get attacks that can last 72 hours or more. And the name fits the description. Status migrainosus is a headache that doesn’t respond to usual treatment or lasts longer than 72 hours. It is a relentless migraine attack that can require medical attention and sometimes a visit to the hospital. Thankfully, most of the time, treatment options are available to stop the pain and help you recover.
How is this disease different from other types of migraine?
What sets status migrainosus apart from other types of migraine or headache is the length of the headache. Unlike chronic migraine, which is marked by 15 or more headache days per month, status migrainosus is a continuous migraine attack with a headache phase that lasts 72 hours or longer.
What triggers status migrainosus?
Status migrainosus is a migraine attack that spins out of control and becomes difficult to treat. The reason why an individual attack of migraine develops into this is not exactly known. A trigger—or a combination of triggers—could cause a migraine attack to develop into status migrainosus, including:
- Changes in medication
- Skipping meals
- Lack of sleep
The best way to reduce the chance of a migraine attack developing into status migrainosus is by beginning treatment at the first signs of an attack. Recognizing your prodrome, or “preheadache,” symptoms can help alert you to take your prescribed acute treatment. The earlier you treat your attack, the more likely you are to stop it in its tracks or prevent it from getting out of control.
It’s important to remember that migraine attacks are not anyone’s fault. Migraine attacks can be spontaneous, meaning they can still occur even if you’ve carefully followed every step of your treatment and management plan.
Status migrainosus symptoms are often the same as those of a typical migraine attack, such as:
- Throbbing pain on one or both sides of the head
- Sensitivity to light or sound
- Nausea or vomiting
- Difficulty concentrating or communicating
Status migrainosus can cause sleep loss and severe dehydration due to nausea and vomiting. If a headache persists for more than 72 hours, it’s critical to seek care or use the plan you and your headache provider have developed.
How is status migrainosus diagnosed?
To diagnose someone with status migrainosus, doctors will examine the patient’s previous diagnoses, medical history and symptoms to rule out the possibility of other types of headache, such as:
- Hemicrania continua (hemicrania means one side of the head and continua means continuous)
- New daily persistent headache
- Post-traumatic headaches
- Medication overuse headache
They will also check for “red flag” symptoms to ensure that the patient isn’t experiencing a more serious condition than migraine, such as a stroke. Some signs they’ll look for include:
- Sudden vision changes or double vision
- Sudden numbness or weakness
- Changes in speech
Once the diagnosis is confirmed, doctors can develop a treatment plan.
How to Treat Status Migrainosus
If you’re experiencing status migrainosus, your doctor may first prescribe migraine medications or a combination of medications. If things are getting worse or you are unable to stay hydrated, you may need to consider a visit to an urgent care center or the emergency room to treat serious dehydration and relieve the pain. There, a doctor may prescribe a combination of treatments, typically administered through an IV. Treatment may be unique to every patient but can include:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Triptans or dihydroergotamine
- Anti-nausea medications
- Nerve blocks
Doctors will monitor your condition and may provide multiple doses or a continuous infusion over several days. If you’re prone to status migrainosus, your doctor may prescribe a combination of medications to be taken at home or refer you to an infusion clinic. Having these options could prevent you from needing to visit the hospital in the future.
When treating this disease, it’s also important to identify contributing factors. This may be a combination of stopping or starting medications, identifying lifestyle triggers (irregular sleeping or eating patterns, lack of exercise, etc.) and introducing new therapies that help regain control over triggers.
Status migrainosus is often more difficult to treat than a migraine attack. But options are available to ease symptoms and help you feel better. Treating and preventing prolonged migraine attacks requires a combined effort of you and your headache provider. However, with the help of your doctor and support system, finding relief is possible.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.
Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.