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Updated: Mar 29, 2026

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Redefining status migrainosus: A narrative review.

Jennifer Robblee1, Jonathan H Smith2, Sarah Ahmad3

  • 1Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.

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|March 28, 2026
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Summary

The current definition of status migrainosus (SM) needs revision. A new definition should focus on functional impairment and treatment response, not just a 72-hour duration, for better clinical use.

Keywords:
diagnosisemergency departmentmigrainerefractory migrainestatus Migrainosus

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Area of Science:

  • Neurology
  • Headache Medicine
  • Clinical Diagnostics

Background:

  • The International Classification of Headache Disorders, 3rd edition (ICHD-3) defines status migrainosus (SM) as a migraine attack lasting over 72 hours.
  • This duration-based definition lacks empirical validation and clinical utility for guiding treatment decisions.
  • The current criteria may not adequately capture the full spectrum of prolonged, debilitating migraine attacks.

Purpose of the Study:

  • To critically evaluate the ICHD-3 definition of SM.
  • To assess its adequacy for clinical practice and research needs.
  • To explore additional dimensions for a more patient-centric definition of SM.

Main Methods:

  • A narrative review structured around key questions regarding SM diagnostic criteria.
  • Literature searches were conducted in PubMed for relevant studies.
  • Data extraction and analysis were performed by reviewers assigned to specific questions.

Main Results:

  • The 72-hour threshold for SM lacks clear justification and is misaligned with clinical practice.
  • Functional impairment and treatment refractoriness are crucial aspects of SM not currently defined.
  • Current criteria fail to account for the heterogeneity of prolonged attacks and the impact of non-headache phases.

Conclusions:

  • A revised definition of SM is needed, moving beyond a rigid 72-hour duration.
  • Greater emphasis should be placed on functional impairment and treatment response.
  • Clearer guidelines are required for defining attack duration, including non-headache phases.