Status Migrainosus: Causative and Therapeutic Aspects


  • James R. Couch Jr. M.D., Ph.D.,

  • Seymour Diamond M.D.



Because of the scarcity of information on Status Migrainosus (SM), the members of the AASH were surveyed as to (1) precipitating factors; (2) criteria to hospitalize patients; and (3) initial, (4) second-line, (5) adjunct, and (6) follow-up modes of therapy for SM. SM was defined as a disabling migraine headache of 72 hours duration that was refractory to usual treatment. Of 540 AASH members polled, 126 responses were received from physicians. As to precipitating events, psychiatric factors, medication abuse and withdrawal, diet, and changes in estrogen levels were mentioned most often and in that order. The major criteria to hospitalize included intense pain, nausea, vomiting, psychiatric factors, and suspicion of neurologic disease. While the therapeutic approach to SM varied; antiemetics, narcotics, prophylactic agents, ergot compounds, steroids and sedation were most often mentioned. Responses regarding follow-up measures listed prophylactic medication, supportive psychotherapy, patient education, and rapid symptomatic therapy as the major means to prevent recurrence.