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Migraine status
Medical expert of the article
Last reviewed: 07.07.2025
Migraine status - more pronounced and prolonged migraine symptoms compared to a normal attack.
The development of migraine is caused by a hereditary predisposition to inadequate regulation of the tone of the brain vessels (spasm and subsequent vasodilation) in response to various factors of the external and internal environment. In the genesis of an attack, the leading role is given to such neuropeptides as serotonin and dopamine, activating the release of inflammatory cytokines by endothelial cells, platelets, etc., which is accompanied by vasodilation and perivascular reaction.
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Symptoms of Status Migrainosus
Migraine status is characterized by the following symptoms: severe headache, nausea, vomiting, photophobia, temporary visual impairment, hyperesthesia of the sense organs. Aura is detected in less than 20% of cases.
Where does it hurt?
What's bothering you?
Diagnosis of migraine status
A headache that lasts for many hours, unlike a regular migraine attack, does not stop after sleep. Vomiting is debilitating and occurs regardless of the time of day against the background of a headache. There are photopsies, blurred vision, amblyopia. The duration of visual impairment is several tens of minutes.
What do need to examine?
Who to contact?
Emergency medical care for status migrainosus
The patient is placed in a darkened room isolated from noise. In some cases, pain relief is achieved by cold compresses on the head. To relieve migraine status if paracetamol or ibuprofen are ineffective in children over 2 years of age and adolescents, NSAIDs are used intramuscularly (diclofenac, naproxen, ketoprofen) or per rectum (indomethacin), as well as antihistamines. In adolescents, ketorolac or tramadol may be prescribed. In case of agitation, diazepam (seduxen) is administered intramuscularly. Prednisolone and furosemide (lasix) may be used to dehydrate the brain. Prochlorperazine (compazine), metoclopramide (cerucal), or droperidol are prescribed for vomiting in children over 2 years of age and adolescents.
In adolescents, selective 5-HT1 receptor agonists such as sumatriptan, zolmitriptan, noratriptan, rizatriptan, or eletriptan (Relpax) may be used to increase the activity of the serotonergic system (which is accompanied by normalization of cerebral vascular tone). These drugs, as well as ergot preparations (ergometrine tartrate, etc.), are not prescribed to children.
Children with migraine status, unlike patients with regular migraine attacks, should be hospitalized in a neurological department. Prevention of migraine attacks in such patients is carried out using valproic acid (depakine) or sodium divalprex (a combination of sodium valproate and valproic acid). In addition, antidepressants and beta-blockers, or methysergide, can be used for this purpose. Clonidine and calcium channel blockers (nimodipine, verapamil, nifedipine) limit the frequency and duration of migraine attacks.
More information of the treatment