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Status Migrainosus in Children and Adults

According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), status migrainosus (SM) is “a debilitating migraine attack lasting for more than 72 hours.” Analogous to the term “status epilepticus,” “status migrainosus” was coined by Taverner in 1975, used by Lance in 1978, and was first added to the International Classification of Headache Disorders (ICHD-1) in 1988. The condition occurs in those with migraine with or without aura and, aside from increased duration and severity, has features similar to the individual's prior migraine attacks. While attacks should last greater than 72 hours to fulfill the diagnostic criteria for SM (Table 1), short periods of remission (less than 12 hours) due to medication or sleep are accepted. CASE HISTORY This is a 31-year-old woman with a history of migraine without aura for 5 years occurring twice a month lasting 1-2 hours after taking 10 mg of rizatriptan. She presented to the office with an exactly similar nonmenstrual headache continuously occurring for 5 days associated with increased stress and lack of sleep. The headache is described as a generalized, especially bifrontal-temporal, throbbing pain associated with nausea, light and noise sensitivity but no vomiting or aura. Pain intensity was initially 3/10 and since onset has been ranging from 3-8/10; at presentation to the office, her headache severity was 7/10. She had tried rizatriptan, ibuprofen, and a combination of acetaminophen (APAP) /aspirin/caffeine for the past 4 days without help. Past medical history was negative. Neurological exam was normal and she denied any recent illness, trauma, or change in medications. She was given bilateral greater occipital nerve (GON) blocks with 3 cc each and bilateral auriculotemporal, supraorbital, and supratrochlear nerve blocks with 0.5 cc each of 1% lidocaine, as well as diclofenac sodium 50 mg oral solution with resolution of the headache.