Status migrainosus: an underrecognized and undertreated condition in the emergency department

Abstract

Status Migrainosus: An Underrecognized and Undertreated Condition in the Emergency Department

INTRODUCTION: Status migrainosus is a severe, debilitating condition that, if left untreated, can lead to serious complications such as ischemic stroke, dehydration, and electrolyte imbalances. This condition's inflammatory nature can progress to vasculitis of small and medium cerebral vessels, causing ischemic stroke. OBJECTIVE: To describe the importance of recognizing status migrainosus for prompt and appropriate treatment to alleviate pain and prevent further complications. CASE REPORT: A 45-year-old female industrial worker from Campina Grande with a history of migraine since the age of 12 presented to the emergency department for the fourth time in seven days. She experienced severe, continuous, pulsatile hemicranial headache associated with intense nausea, vomiting, phonophobia, and photophobia. Intravenous analgesics, anti-inflammatory drugs, oral triptans, and opioids were prescribed during each visit, but her symptoms persisted, consistent with a migraine. Physical examination revealed poor general condition, dehydration, hypoactivity, intense photophobia, and multiple episodes of uncontrollable vomiting. Neurological examination, cranial CT scan, and cerebrospinal fluid analysis were normal. A diagnosis of status migrainosus was made, prompting urgent investigation and treatment. The patient received intravenous hydration, antiemetics, electrolyte replacement, a high-dose corticosteroid, an antipsychotic, simple analgesics, and a triptan. She showed significant improvement within 36 hours, and scheduled for re-evaluation in 15 days. CONCLUSION: Status migrainosus represents a severe and debilitating form of migraine that requires immediate medical attention. Recognizing this condition is crucial to ensure patients receive timely and appropriate treatment, preventing complications and improving their quality of life.