Definition of Status Migrainosus
Status migrainosus is a severe, debilitating migraine attack that persists continuously for more than 72 hours with minimal or no relief, causing significant functional disability and often requiring emergency medical intervention. 1
Formal Diagnostic Criteria
The International Classification of Headache Disorders (ICHD) formally defines status migrainosus as a migraine attack lasting more than 72 hours that remains debilitating throughout its entire course. 1 This distinguishes it from typical migraine attacks, which last 4-72 hours in adults when untreated. 1
Key Defining Characteristics
Duration: The headache must exceed 72 hours of continuous, unremitting pain. 1
Treatment resistance: The condition is marked by minimal or no response to usual acute migraine treatments. 1
Functional impact: The attack must remain debilitating throughout its course, leading to significant functional disability. 2
Patient population: Status migrainosus is recognized as a complication of migraine with or without aura in patients with a previously established migraine diagnosis. 2, 3
Clinical Presentation
The headache phenotype in status migrainosus typically mirrors standard migraine characteristics:
Location: Usually unilateral, though approximately 40% of cases present with bilateral pain. 1
Quality: Pulsating in nature. 1
Intensity: Moderate to severe. 1
Aggravating factors: Routine physical activity worsens the headache. 1
Associated symptoms: Nausea or vomiting, photophobia, and phonophobia commonly accompany the headache. 1
Important Clinical Distinctions
Status migrainosus requires distinct management approaches beyond standard acute migraine protocols and is explicitly excluded from guidelines addressing typical episodic migraine treatment. 1 The condition represents a medical emergency requiring parenteral pharmacotherapy due to its severity and treatment resistance. 3