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Unrecognized challenges of treating status migrainosus: An observational study
Afrim Iljazi1,2, Abigail Chua3,4, Raymond Rich-Fiondella3
1Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Cephalalgia : an International Journal of Headache
|March 13, 2020
Summary
Current treatments for status migrainosus show low success rates. Further research is needed to develop better strategies for this prolonged migraine condition.
Area of Science:
- Neurology
- Clinical Medicine
Background:
- Status migrainosus is a prolonged migraine attack with limited epidemiological data.
- There is a lack of evidence-based guidelines and defined outcomes for successful treatment.
Purpose of the Study:
- To prospectively evaluate the effectiveness of common treatments for status migrainosus.
- To document treatment outcomes in a tertiary headache clinic setting.
Main Methods:
- A prospective observational study was conducted.
- Patients received dexamethasone, ketorolac, nerve blocks, or naratriptan.
- Headache intensity was monitored hourly and daily using headache diaries.
Main Results:
- Success rates for pain freedom within 24 hours varied: dexamethasone (31%), nerve blocks (24%), ketorolac (11%), and naratriptan (11%).
- Longer time to remission correlated with a higher likelihood of achieving and maintaining pain-free status.
- Overall treatment effectiveness for terminating status migrainosus was found to be unsatisfactory.
Conclusions:
- Current treatment approaches for status migrainosus are not satisfactory.
- There is a critical need for a more scientific approach to define treatment response in status migrainosus.
