If the attack doesn't want to end

If the headache phase of a migraine attack lasts longer than 72 hours despite treatment, this is referred to as status migraenosus. Status migraenosus usually only occurs after a long-term migraine illness lasting several years in conjunction with ongoing medication overuse. Before consulting the doctor, the patient has then experienced at least 3 days of severe nausea, vomiting and very severe headache intensity. Self-help medication, usually with a colorful mix of different substances and combination preparations, was not successful during this time.

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. Then the patient should immediately

  • 1000 mg lysine acetyl salicylate in combination


  • 10 mg metoclopramide

received intravenously.

Immobilization (sedation) using medication is then initiated. This can be done

  • Levomepromazine 3 x 25 mg per os


  • Diazepam 3 x 10 mg

administered over 2 days with gradual dose reduction.

As a further step, the additional administration of anti-inflammatory medications can accelerate the improvement of status migraenosus. This can be done, for example, by using

  • Dexamethasone (intravenous), 24 mg initially with subsequent single doses of 6 mg at six hour intervals for 3 to 4 days,

take place. In individual cases there are also other therapeutic strategies, but these cannot be explained in more detail here.

So that it doesn't happen again

After the status migraenosus has subsided, a particularly in-depth analysis of the migraine history and previous treatment is required. This usually results in suboptimal migraine prophylaxis and incorrect use of medication. In such cases, an inpatient medication break is usually useful, as is medication-based prophylaxis for headache disorders.

In addition, the patient must be advised in detail and instructed in the use of non-drug therapy methods.