Stratus migrainosus is an uncommon type of migraine that involves intense pain and lasts for more than three days. Over-the-counter and prescription medications can help. In rare cases, you may need to seek medical treatment.
Migraines are severe headaches that cause throbbing pain, nausea, and sensitivity to light and sound. Status migrainosus is an especially severe and long-lasting form of migraine headache. It’s also called an intractable migraine.
Status migrainosus headaches affect less than 1 percent of people with migraines. However, they’re intense and they stick around for longer than 72 hours. Even treatment with traditional migraine medicines like triptans and ergots often won’t cut through the pain of a status migraine. The pain and nausea can be severe enough to require a hospital visit for treatment.
Status migraines have the same basic symptoms as a regular migraine:
- throbbing pain on one or both sides of your head
- nausea and vomiting
- sensitivity to light and sounds
Regular migraine vs. status migrainosus
The difference is in the duration and the response to treatment. A regular migraine attack usually lasts between 4 and 72 hours. Treatments like triptan drugs and pain relievers can often relieve migraine pain and other symptoms.
Status migraine symptoms last for longer than 72 hours, even with treatment. The headache might go away for a few hours, but it keeps coming back.
Symptoms of a status migraine can be severe enough to disrupt your life. Vomiting can also lead to dehydration and an electrolyte imbalance.
People with status migraines should see a primary care doctor or neurologist for treatment. The doctor will look for any health issues or lifestyle factors (such as stress) that might trigger your headaches. They’ll recommend treatments based on this information.
You might first try a traditional migraine medicine. These include triptans, ergots, or nonsteroidal anti-inflammatory drugs. If these medicines don’t work, ask your doctor about trying a stronger pain reliever, such as ketorolac (Toradol). You might also need an antinausea medicine, which you can take as a suppository.
If your pain doesn’t improve or if you become dehydrated, you may need to be treated in a hospital. There you can get fluids and medicines intravenously. Migraine treatments you might get in the hospital include:
- dihydroergotamine injection or nasal spray
- antinausea medicine such as ondansetron (Zofran) or metoclopramide (Reglan)
- the anti-seizure drug valproate (Depakote)
- opioid pain relievers
Hospitals also treat status migraines with steroid medicines such as dexamethasone (Decadron) that you take by mouth. One small study found that steroids improved pain in people with status migraines. Your doctor will probably only prescribe steroids for a few days to treat your migraine. Long-term steroid use can cause side effects like weight gain, weakened bones, bone death (necrosis), and trouble sleeping. People with diabetes may not be able to take steroids as they can cause high blood sugar.
You may need to stay in the hospital for one to three days to control your symptoms. The doctors can try a few different migraine drugs until they find one that works for you. A class of drugs called dopamine receptor antagonists may also help with status migraines.
A few medicines can help prevent migraine headaches if you take them on a regular basis. Even if you do get a headache, it’s likely to be less severe and shorter if you take one of these drugs.
- antidepressants like amitriptyline (Elavil)
- anti-seizure drugs such as topiramate (Topamax) or valproate (Depakote)
- blood pressure medicines, such as metoprolol tartrate (Lopressor), propranolol (Inderal LA, Innopran XL), timolol (Betimol), and verapamil (Calan, Verelan)
- CGRP antagonists such as erenumab (Aimovig)
To prevent status migraines, avoid the triggers that set them off. The following suggestions may help:
- Eat small meals throughout the day, so you don’t get hungry.
- Drink eight or more glasses of water per day to prevent dehydration.
- If you can’t sleep at night, try sleep-hygiene techniques. Keep your bedroom cool, quiet, and dark. Go to sleep at the same time each night. Do something relaxing before bed. Take a warm bath or read a book. If you still can’t get to sleep, ask your doctor about taking a sleep aid.
- Try stress-relieving techniques such as deep breathing or meditation.
- Only take migraine pain relievers when you need them. Don’t overuse them.
All of these factors can trigger status migraines:
- hormone imbalances
- overuse of medicines such as pain relievers and narcotic drugs used to treat headaches (these can cause what are called rebound headaches)
- changes to medicines you take, especially hormone treatments like birth control pills, hormone therapy for menopause, or antidepressants
- changes in weather
- head injuries
- lack of sleep
- skipped meals
- surgery to the sinuses, teeth, or jaw
- an infection, such as the flu or a sinus infection
- meningitis (very rare)
- brain tumor (very rare)
Status migraines are more difficult to treat than regular migraines, but there are treatment options available. Your doctor might need to adjust the dose of a medicine you already take, or they may put you on a new drug. If the treatments you have at home don’t relieve your headaches, visit a hospital for treatment.