Symptoms and Treatment of Status Migrainosus

Signs and Therapy for This Long, Severe Migraine

Symptoms and Treatment of Status Migrainosus

Status migrainosus is a debilitating and severely painful migraine attack that lasts longer than a usual migraine — commonly sending a person to the emergency room.

Let's learn more about what a status migrainosus feels like, and how it's commonly treated.

Symptoms of Status Migrainosus

The symptoms of status migrainosus are similar to whatever your "typical" migraine symptoms may be — this includes either migraine with aura or migraine without aura.

The main difference is that in status migraines the symptoms are continuous for more than 72 hours. In a regular migraine with aura or migraine without aura, the headache lasts between 4 and 72 hours. In status migrainosus, there may be periods of relative relief that last up to 12 hours — these are usually due to sleep or medications.

According to the third edition of the International Classification of Headache Disorders, symptoms of a migraine include:

  • Unilateral location (one side)
  • Throbbing character
  • Worsening pain with normal physical activity like walking
  • Moderate to severe intensity

In addition, patients must have at least one of the following:

Treating Status Migrainosus

Nearly all patients with status migrainosus will tell you their regular migraine treatments are not helping. Besides trying to "break" the headache, treatment of status migrainosus includes managing all of the "extra" problems, like nausea and vomiting or dehydration.

Many times status migraines are treated in the emergency room and the usual treatment includes intravenous (IV) fluids and medications to control nausea and vomiting, like metoclopramide (Reglan) and prochlorperazine (Compazine).

Medications used to abort a status migraine may include one of the triptans, especially subcutaneous sumatriptan, or DHE, followed by an intravenous NSAID, like ketorolac (Toradol).

Sometimes, steroids like dexamethasone are used. Intravenous sodium valproate, an anti-seizure medication, can be considered but may not be as effective as ketorolac (Toradol) or metoclopramide (Reglan)  and should be used with caution in women of child-bearing years.

What Will the ER Give Me for My Migraine?

What Should I Do?

As with all headaches, try to notice if you are having new symptoms or symptoms that are more severe than usual. Be sure to be familiar with headache warning signs, or reasons for alarm. Also, be sure to notify your health care provider if you have a migraine that lasts long enough to be considered a status migraine.


Friedman BW, Garber L, Yoon A, Solorzano C, Wollowitz A, Esses D et al. Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine. Neurology. 2014 Mar 18;82(11):976-83.

Gelfand AA & Goadsby PJ. A Neurologist's Guide to Acute Migraine Therapy in the Emergency Room. Neurohospitalist. 2012 Apr; 2(2): 51–59.

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Morley, Sharon Scott. "Guidelines on Migraine: Part 3. Recommendations for Individual Drugs.” Am Fam Phys. 2000; 62:2145-52.

Continue Reading