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 from usual acute treatments, causing significant functional disability and typically 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, distinguishing it from typical migraine attacks which last 4-72 hours in adults when untreated. 1
Key Defining Features
- Duration: Continuous, unremitting headache pain exceeding 72 hours 1
- Treatment resistance: Minimal or no response to usual acute migraine therapies 1, 2
- Functional impact: Severe disability requiring emergency care 1
Clinical Characteristics
Headache Phenotype
- Location: Usually unilateral (approximately 60% of cases), but bilateral pain occurs in about 40% of patients 1
- Quality: Pulsating character 1
- Intensity: Moderate to severe pain 1
- Aggravating factors: Worsened by routine physical activity such as walking or climbing stairs 1
Associated Symptoms
- Nausea and/or vomiting are common 1
- Photophobia (light sensitivity) 1
- Phonophobia (sound sensitivity) 1
Important Clinical Context
Status migrainosus is recognized as a complication of migraine with or without aura. 2 The condition represents a distinct clinical entity that is explicitly excluded from standard acute episodic migraine treatment guidelines, indicating it requires a separate management pathway beyond routine acute migraine protocols. 1
The substantial healthcare burden and individual impact of this condition necessitate prompt recognition and aggressive emergency intervention. 1, 2