Migraine status: causes and symptoms, its prevention and treatment

Most migraines follow a pattern. Usually it includes: changes in consciousness, the appearance of an aura or visual disturbances, headache, with an increase and then a gradual extinction of pain. From mild nonspecific pain to typical migraine headaches can resolve 0,5-2 hours. And the condition that occurs with status migraine is a more severe and long-term form of headache than a common migraine.

That being said, conventional strategies for stopping headaches, including rest and taking pain pills, often do not work. In 50% of migraine cases, the duration of pain was 5-24 hours. In this state, a person's headache lasts not for several hours, but for 72 hours (or 3 days) or even longer.

Pathogenesis

Presumably caused by inflammation of the intracranial blood vessels involved in the migraine process. Dilation of blood vessels and release of vasoactive neuropeptides as well as other active peptides that are involved in neurogenic inflammation, lead to the activation of the neurovascular system trigeminal nerve.

Continuous activation and release of neuropeptides impairs the regulation of serotonergic receptors and decreases the production of endorphins. Weakness of the vessels leads to the discharge of blood into the venous system, after which the pain syndrome is transformed into a pressing type of cephalalgia (headache).

After a lapse of time or after taking anti-migraine drugs, the vascular tone is restored and the migraine attack stops. However, in the case of migraine status, vascular changes persist for a very long time.

Causes

Any of the following factors can trigger a migraine attack:

• hormonal imbalance;
• stress;
• Excessive use of medications such as pain relievers and narcotics used to treat headaches (this can cause so-called "rebound headaches");
• changes in your medication, especially hormonal drugs such as birth control pills;
• hormone therapy for menopause or taking antidepressants;
• weather changes;
• head trauma;
• lack of sleep;
• missed breakfast, lunch or dinner;
• dehydration;
• surgery of the sinuses, teeth or jaws;
• an infection such as the flu or sinus infection;
• meningitis (very rare);
• a brain tumor (very rare).

Symptoms

Migraine status does not necessarily differ from a typical migraine, except for its duration and severity. People who experience this condition claim that the pain is the same as for a normal migraine, only it lasts much longer. However, for some people, the pain and nausea are so debilitating that they need to be hospitalized.

The patient's condition often includes the following symptoms:

• Changes in consciousness. Someone may have difficulty concentrating, drowsiness, nervousness, or "head fog".
• Aura. It is a neurological disorder in which a person sees unusual patterns, flashes, or spots in front of the eyes.
• Headache. The pain can be intense and is usually localized to one side of the head. Sometimes it can spread to the other side of the head.
• Intense throbbing in the head. Unlike tension headaches, migraine pains are more acute, and head massage does not help relieve them.
• Nausea. Usually this feeling is accompanied by general weakness, and a complete lack of appetite.
• Weakness in the body, or tingling in the hands, arms, or legs.
• Emotional despair and less often depression, sometimes with suicidal ideation.

The doctor diagnoses status migraine if the headache lasts longer than 72 hours. In this case, the pain may decrease within 12 hours after taking medication or rest, but then it returns. The pain must also be so severe that it becomes almost unbearable.

Tactics of treatment and prevention in the presence of migraine status

No treatment can cure migraines, and researchers don't yet know exactly how to shorten their duration. Instead, doctors focus on relieving symptoms with pain relievers.

Traditional migraine medications are the first choice when you have a migraine status. These include triptans or nonsteroidal anti-inflammatory drugs. If these medications don't work, your doctor may suggest a stronger pain reliever, such as ketorolac (Toradol).

Other medications, such as magnesium sulfate, benadryl, and lidocaine, can also help manage pain. But so far there is little evidence to support their effectiveness.

It is imperative to prevent vomiting, especially if the person is dehydrated. Dehydration can be a trigger for migraines. If vomiting occurs more than 10 times a day, the patient may need medicine for nausea in the form of a suppository. The presence of a migraine status can be a reason for hospital treatment.

Without treatment, complications can be very serious, including stroke. In the hospital, the patient may receive an injection of dihydroergotamine, the drug Valproate for depression, or opioid pain relievers to relieve the patient's condition. Oral steroid medications such as Dexamethasone (Decadron) are used to relieve migraine status. One study found that steroids reduced pain in people with migraines.

However, long-term steroid use can cause side effects such as weight gain, thinning bones, bone necrosis, and trouble sleeping. People with diabetes cannot take steroids because these medications raise blood sugar levels. The patient may need to remain under medical supervision for one to three days in order to control the symptoms of the disease. Doctors may try several different migraine medications until they find one that works for a specific person. Some people who are diagnosed with migraine status are helped by a class of drugs called dopamine receptor antagonists.

Urgent care

The presence of a migraine status requires immediate measures to alleviate the patient's condition:

• First of all, you need to create favorable conditions in the room: curtain curtains, exclude all extraneous noise.
• A cold compress should be put on the patient's head.
• If an adult or a child over 2 years old vomits, an antiemetic drug should be given - Droperidol or Cerucal.
• If acetaminophen or ibuprofen does not help relieve the symptoms of a migraine, children over 2 years of age, adolescents, and adults can make an intramuscular injection of NSAIDs (diclofenac, naproxen, ketoprofen) or enter the drug rectally (suppository with indomethacin).
• Diazepam (Seduxen) can be injected intramuscularly to relieve arousal.

Prophylaxis

Several medicines can help prevent migraines from occurring if taken regularly. Even if the headache has already begun, it is likely to be less severe and shorter with one of these medications.

• antidepressants such as amitriptyline;
• birth control drugs such as topiramate or valproate;
• blood pressure medications such as metoprolol tartrate, propranolol, timolol, and verapamil.

It is impossible to completely prevent migraines or migraine status. However, many migraine sufferers notice that certain triggers such as smells, allergens, and stress cause headaches.

To prevent migraines, triggers should be avoided:

• Eat small meals throughout the day to keep from getting hungry.
• Drink eight or more glasses of water a day to prevent dehydration.
• Sleep hygiene practices can help if migraines are caused by insomnia: airing the bedroom at night, relaxing in the bath before bed, and going to bed at the same time every day.
• It is recommended that you keep a log of migraine-related events to help identify triggers and then avoid them as much as possible.

It is also advisable to check if the thyroid hormones are in order, as hormonal imbalances often provoke migraines.