The Incidence of and Difficulties in Defining Status Migrainosus: Rashmi Halker Singh, MD, FAHS, FAAN

WATCH TIME: 3 minutes

“There’s a lot of conversation happening, actually, at this meeting itself in terms of how we define status migrainosus. Is it different when someone has episodic migraine and then has a bout of status migrainosus? Can someone who has chronic migraine also have status migrainosus? And, do we treat that differently?”

Status migrainosus, defined by the International Classification of Headache Disorders, Third Edition, as a debilitating migraine attack lasting for more than 72 hours, has been a challenge for physicians and patients.1 There currently are no evidence-based treatment guidelines for the condition, nor any rational-driven assessments with successful treatment outcomes. Findings from a 2020 observational study by Iljazi et al in Cephalagia,¹ suggest that current treatment approaches to terminating status migrainosus are not satisfactory, pointing to a critical for a refined approach to define treatment response.

On top of this lack of standardized approach, there is limited epidemiological knowledge available. At the 2022 American Headache Society (AHS) Annual Scientific Meeting, June 9-11, in Denver, Colorado, a group of investigators including Rashmi Halker Singh, MD, FAHS, FAAN, associate professor of neurology, Mayo Clinic, and member, board of directors, AHS, presented data from their attempt to add to this lack of information, using the Rochester Epidemiology Project to identify incident cases of status migrainosus in Olmsted County, Minnesota between January 1, 2012, and December 31, 2017.²

All told, the study identified an age- and sex-adjusted incidence rate of 26.60 per 100,000 (95% CI, 23.21-29.97). Those with status migrainosus reported a median age of 35 years (IQR, 26-47), and 88.6% (n = 210) of the individuals were women. Chronic migraine was recorded in 36.3% (n = 82) of people and aura in 35.7% (n = 76). At the time of presentation, the medication reconciliation reported involved triptan or ergotamine in 129 (55.4%) people and/or an opioid-containing analgesic in 43 (18.5%).

The median duration of attack was 5 days (IQR, 4-9), and the most frequently recorded triggers were stress (16.9%; n = 40) and too much/too little sleep (11.4%; n = 27). Recurrence occurred in 35 people (14.8%) at a median of 58 days (IQR, 23-130) following the initial attack. Notably, too much/too little sleep was associated with 12-month risk of recurrence (adjusted odds ratio, 3.59; 95% CI, 1.58-8.14; P = .0022).

To find out the clinical implications of these data and about the difficulties in treating status migrainosus, NeurologyLive^® sat down with Halker Singh while on-site at AHS. She offered her perspective on the importance of collecting more information on status migrainosus and the need to develop a better approach and definition.

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REFERENCES
1. Iljazi A, Chua A, Rich-Fiondella R, et al. Unrecognized challenges of treating status migrainosus: An observational study. Cephalalgia. 2020;40(8):818-827. doi:10.1177/0333102420911461
2. VanderPluym J, Mangipudi K, Mbonde A, et al. Incidence of status migrainosus in Olmsted County, Minnesota, United States: Characterization and predictors of recurrence. Presented at: AHS Annual Scientific Meeting; June 9-11, 2022; Denver, CO. OR-17