Epidemiology and characteristics of status migrainosus in a tertiary headache clinic: A retrospective cohort study

Assess the epidemiology and characteristics of status migrainosus (SM) in a cohort of patients from a tertiary care headache clinic to identify the prevalence, 1-year incidence, attack features, treatments, and healthcare utilization for SM.

SM is a debilitating migraine attack lasting at least 72 h according to the International Classification of Headache Disorders, 3rd edition. SM has not been well characterized.

This retrospective observational cohort study evaluated SM in a subspecialty headache center in Arizona using chart review from electronic health records for patients seen in 2022. The primary endpoints were clinic-observed lifetime prevalence and 1-year incidence (January 1 to December 31, 2022) of SM. Secondary outcomes assessed the clinical features and treatments tried for the SM attacks using descriptive statistics from those with sufficient detail available in electronic health records.

A total of 1184 patients seen in 2022 were screened; of those, 1043 (88.1%) had a diagnosis of migraine, including 458 patients with any lifetime episode of SM, with 373 meeting inclusion criteria. The median age was 47.0 years (interquartile range [IQR] 38.0, 57.0) and 87.7% were female (327/373). The majority had chronic migraine and nearly half reported a history of aura. The clinic-observed SM prevalence was 43.9% (458/1043; 95% confidence interval 40.9%, 46.9%) within the migraine-only population. The 2022 clinic-observed SM incidence in patients with migraine was 24.2% (187/772; 95% confidence interval 21.3%, 27.4%). The median midpoint SM severity was 8.0/10.0 (IQR 7.0-9.0) with median SM attack duration of 10.0 days (IQR 4.0-30.0, range 3.0-330.0 days). SM treatments included: 48.3% (175/362) migraine-specific, 40.1% (145/362) NSAIDs, 37.8% (137/362) steroids, 21.3% (77/362) anti-dopaminergic drugs, 18.8% (68/362) nerve blocks, 23.2% (84/362) new preventive, 4.4% (16/362) opioids, and 1.7% (6/362) butalbital-containing medications. There were 17.7% (64/361) with a recorded emergency department visit and 6.4% (23/360) with a recorded admission for the SM episode.

SM is common in a tertiary headache population, affecting nearly half of specialty clinic patients with migraine over their lifetime and one in five in a single year. In this population, patients with SM tend to have chronic migraine with high rates of aura. This study highlights the need for improved diagnostic consistency and treatment.