Treatment Of Status Migrainosus Research Articles

Status migrainosus inpatient treatment with eptinezumab (SMITE): study protocol for a randomised controlled trial

IntroductionStatus migrainosus is a disabling complication of migraine, which frequently results in hospitalisation. For patients who fail to respond to simple analgesia, triptans and intravenous prochlorperazine or chlorpromazine, there are...

The Association Between Hospital Length of Stay and Treatment With IV Magnesium in Patients With Status Migrainosus.

Status migrainosus (SM) is a subtype of migraine defined by migraine lasting >72 hours and is difficult to treat in clinical practice. Magnesium is commonly used in the treatment of migraine. We conducted a retrospective cohort study to determine if length of admission was associated with IV magnesium therapy in patients with SM. We reviewed the charts of all patients admitted to a large military treatment facility from October 2013 to December 2018 with the admission diagnosis of migraine. There were 333 patients that were reviewed and 141 met the inclusion criteria. Nearly half of patients received IV magnesium therapy with routine care (46.8%, n = 66). IV magnesium therapy was not associated with length of admission (58 hours (IQR 25.5, 86) compared to 42 hours (IQR 25.5, 80.5) respectively, p = 0.47). Of the cases without Neurology consultation, patients who received magnesium therapy (n = 5) had numerically shorter admission but this difference did not meet statistical significance (n = 12) (17 hours (IQR 13.75, 31.25) versus 24.5 hours (IQR 15.25, 58.75), p = 0.0534). This study contributes to the limited pool of available data on the treatment of SM. Prospective research is needed to study magnesium therapy in patients with prolonged migraine.

Treatment of Status Migrainosus with Oral Dexamethasone in an Outpatient Setting (P1.160)

Treatment of Status Migrainosus with Oral Dexamethasone in an Outpatient Setting (P1.160)

Use of Dopamine Antagonists in Treatment of Migraine

Dopamine antagonists are indicated for treatment of nausea or psychosis and have an established role in the treatment of migraine. Neuroleptics, including antipsychotics, act as antagonists at the dopamine D2 receptor type. These medications also have variable activity as antihistamines and anticholinergics, and they block alpha-adrenergic and some serotonin receptor types, but their actions on dopamine are likely the reason for their efficacy in treating nausea, psychosis, and acute migraine. Neuroleptics are first-line agents in the emergency room setting for migraine, especially for patients with nausea and vomiting. In the setting of a clear prodrome, antiemetics may prevent migraine when taken before an attack. They are also indicated in clinical situations such as patients who are pregnant or have contraindications to migraine-specific medications or NSAIDs. Recent developments suggest that dopamine is particularly important in chronic pain, and we most commonly use neuroleptic medications in the treatment of status migrainosus or medication-overuse headache. Clinicians may avoid dopamine antagonists because of unfamiliarity and a lack of large, controlled clinical trials. Their use requires special care to avoid adverse events such as sedation, akathisia or dystonic reactions, neuroleptic malignant syndrome, or movement disorders with long-term use. Some newer atypical neuroleptic agents appear promising for both acute and prophylactic migraine treatment with a lower risk of adverse events.

43 Status Migrainosus in Children: A 3 Year Experience with Prochlorperazine

There is limited evidence suggesting that prochlorperazine is effective and safe in the treatment of status migrainosus in children. Evidence in adults suggests that the prevalence of akathisia is high. To describe the use of prochlorperazine in the treatment of status migrainosus in children. From Jan/00 to Dec/02 all patients presenting to a pediatric emergency department (PED) diagnosed with status migrainosus and treated with prochlorperazine were followed prospectively 24 hours after discharge with a standardized telephone questionnaire in order to access the efficacy and side effects of the treatment. Our protocol recommends IV prochlorperazine 0.15 mg/kg (max 10 mg) with IV diphenhydramine 0.5 mg/kg (max 25 mg). The subjective part of an akathisia scale (0 to 9) was used to evaluate this side effect: a score of =2 was considered positive. Parents were asked to rate the pain associated with the migraine on a 0 to 10 scale on presentation to the PED, at discharge, and if a relapse occurred after discharge. Over a three year period 51 patients (29 female/22 male) aged 12±3 years were treated with prochlorperazine. The pain associated with the migraine on presentation was 8.4±1.3 while at discharge it was 1.5±1.8. Out of 51 patients, 18 (35%) had a relapse 14±12 hours after discharge with reported pain level at 4.3±2.4. Three parents reported their child as having abnormal movements described as shaking or tic: it was quantified in one case as mild and occasional. Six patients were reported as being restless: four mild and occasional, one severe and occasional. Nine patients were reported as being unable to stand or sit still: two as occasional, one as severe and occasional. Five patients were reported as being unable to keep their legs still: one as mild and frequent, one as severe and occasional. On the akathisia scale, 13 patients had a score =1 point. However only six (12%) patients could be said to have had akathisia with a score of 2 in four patients and of 3 and 6 in one patient each. Prochlorperazine appears to be effective in the treatment of status migrainosus in children. Even with the use of diphenhydramine as prophylaxis, it is associated with some extrapyramidal side effects. The prevalence of akathisia appears to be lower than reported in adults; however more objective and subjective assessment is needed.