If the attack won't end
If the headache phase of a migraine attack lasts longer than 72 hours despite treatment, it is called status migrainosus. Status migrainosus usually only occurs after a prolonged, multi-year migraine illness combined with ongoing medication overuse. Before consulting a doctor, the patient has typically experienced at least three days of pronounced nausea, vomiting, and very intense headaches. Self-medication, usually involving a diverse mix of various substances and combination preparations, has proven ineffective during this period.
I would like to describe to you what the doctor can do in such a case, so that you – should you ever be affected yourself – can assess the treatment:
In such cases, the doctor may consider inpatient treatment. The patient should then be admitted immediately
- 1000 mg lysine acetyl salicylate in combination
with
- 10 mg Metoclopramide
Received intravenously.
Subsequently, sedation is administered using medication. This may involve..
- Levomepromazine 3 x 25 mg per os
or
- Diazepam 3 x 10 mg
Administer over 2 days with a gradual dose reduction.
As a further step, the additional administration of anti-inflammatory medication can accelerate the improvement of status migrainosus. This can include, for example, the use of..
- Dexamethasone (intravenous), initially 24 mg with subsequent single doses of 6 mg at six-hour intervals for 3 to 4 days,
This will take place. In individual cases, there are also other treatment strategies, which cannot be discussed in detail here.
So that it doesn't happen again
After the status migrainosus subsides, a particularly thorough analysis of the patient's migraine history and previous treatment is necessary. This usually reveals suboptimal migraine prophylaxis and inappropriate medication use. In such cases, a hospital stay without medication is generally advisable, as is medication prophylaxis for headache disorders.
In addition, the patient must receive thorough advice and be instructed in the use of non-drug therapies.