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What Is An Intractable Migraine

Intractable Migraine A Migraine Headache That Will Not Go Away

Intractable Migraine

Status migrainosus is an especially severe and long-lasting form of migraine attack. Its also called intractable migraine. Put simply, it is a migraine attack that doesnt go away.

Status migrainosus attacks affect less than;1 per cent of people with migraine. However, theyre intense and they stick around for longer than 72 hours. Treatment with traditional migraine medicines like triptans and even stronger pain killers like codeine often wont cut through a status migraine attack. The pain and nausea can be severe enough to require a hospital visit for treatment.

Status migraine attacks have the same basic symptoms as regular migraine attacks:

  • throbbing pain on one or both sides of your head
  • nausea and vomiting
  • sensitivity to light, sounds and smell

When Does A Migraine Start To Become Be Dangerous

Migraines are typically benign, or non-life threatening, but this is not the case with status migrainosus. Due to its relentless and never ending nature , status migrainosus has the potential to become and is considered, in most instances, an emergency medical situation. The longer the condition persist, the more serious it can become. Indeed, status migrainosus can be life threatening, inducing conditions such as dehydration, stroke, aneurysm, permanent vision loss, serious dental problems, coma and even death. In the long-term, it can lead to psychological problems such as anxiety and depression, which increases the risk of suicide.

Dr Jennifer Robblee Of The Mayo Clinic Walks Us Through The More

Just like the people it affects, not every migraine is the same. One of the most common differences between different types of migraine is how it presents. Some people experience an aura, which are transient sensory changes typically occurring before pain starts . More commonly, however, migraine presents without auraabout 70-75% of migraine patients do not experience aura.

Once known as common migraine, migraine without aura is what patients are more likely to experience. Knowing what migraine without aura is and how it differs from migraine with aura is important for patients to understand when learning about their condition and how best to treat it.

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The Ins And Outs Of Intractable Migraine

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What It Is:Intractable migraine, also called refractory migraine and/or status migrainosus, is the medical term used to describe a persistent migraine that is either 1) difficult to treat or b) fails to respond to standard and/or aggressive treatments. In general, its a migraine that simply doesnt go away, regardless of treatment.

What It Feels Like: Intractable migraine is relentless and seems to never end. You wake up with it. You go to sleep with it. Its there all day. The pain levels associated with it, however, may not be constant. The symptoms generally are not either.

When I had my last intractable migraine, some days would be full of vertigo, nausea, and vision disturbances. Other days would be relatively symptom-free . In general, my pain tended to lessen over night , and increase over the day . When I was blessed with a lesser-pain day , I tended to get sharp ice-pick stabs throughout the day that were significantly more painful than the underlying pain. My disability level ranged from mild to severe, depending on the number of symptoms present and the magnitude of the pain.

As with any other migraine attack, an intractable one will be different for everyone who experiences it. This is one of the reasons they are so difficult to treat. If you have an intractable period, it will likely look very different from mine.

Who Gets It: Any migraineur can theoretically get an intractable attack

What Constitutes A Refractory Migraine

Chronic Intractable Migraine: Its NOT a Headache, Its a ...

In 2008, the Refractory Headache Special Interest Section and the American Headache Society set out to define criteria for refractory chronic migraine.

The criteria include the following:

  • Symptoms must be consistent with those defined by the International Classification of Headache Disorders for migraine or chronic migraine.
  • Headaches need to interfere significantly with function or quality of life despite modification of triggers, lifestyle factors, and adequate trials of acute and preventive medicines with established efficacy.

While accepted by many doctors, others maintain that refractory migraine is no different than chronic migraine.

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What Is Migraine Without Aura

Aura is a phase in the migraine where the person experiences vision changes. This vision change typically takes place in the form of unusual formations in the persons line of vision. An intractable migraine with aura without status migrainosus is not as disturbing to a persons functioning as the one with aura.

But intractable migraine without comes with various phases that are very distressing for the person. They are:

  • Premonitory phase

What Happens During A Migraine

There are four potential migraine stages:

  • Prodrome: Lasting anywhere from a couple of hours to several days, prodrome is the beginning stage of a migraine; common prodrome symptoms include trouble concentrating, food cravings, irritability, nausea and muscle or neck stiffness.
  • Aura: During the aura stage, an individual typically experiences disruptions involving one or more senses; this disruptions may include temporary vision loss or numbness in the face, arms or legs.
  • Migraine Attack: Also referred to as the headache phase, a migraine attack causes throbbing or pulsating pain on one side of the head; this pain may eventually affect both sides of the head, too.
  • Postdrome: The postdrome stage generally results in a hangover-like feeling; at this time, a person may experience body aches, confusion and fatigue, among other physical symptoms.

An individual may experience one or more of the aforementioned migraine stages. Additionally, each migraine stage may vary in severity and length.

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How Is Abdominal Migraine Treated

Once a child is diagnosed with abdominal migraine, treatment generally falls into two categories: relieving symptoms during an episode and preventing future episodes.

While there are few studies on the treatment and management of abdominal migraine, doctors may prescribe the following medications, based on their usefulness in treating migraines:

  • NSAIDs or acetaminophen to relieve the pain.
  • Triptans. This family of drugs is commonly used to treat migraine headaches and, if taken as soon as a migraine starts, can prevent symptoms from progressing.
  • Anti-nausea medication. Anti-nausea drugs act by blocking chemicals in the brain that trigger vomiting.

Some studies have shown evidence to support the use of the following medications in preventing abdominal migraine:

  • Pizotifen, a benzocycloheptene-based drug.

Causes And Diagnosis Of Status Migraine

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Status migraines are believed to share the same causes as regular migraines. The World Health Organization believes that migraines have a genetic basis, and some studies have revealed that 70 percent of migraine sufferers have a family history of migraines.

Migraines have been found to be triggered deep in the brain, releasing inflammatory substances around the nerve and blood vessels of the brain. Why this occurs is still unclear.

Through the use of imaging studies such as MRIs, it has been revealed that changes in cerebral blood flow to the brain occur during ocular migraines and visual auras. But it is still uncertain if this is the cause, and not simply an association.

Migraines commonly affect adults in their 30s and 40s but can start in children during the puberty phase. Women are more commonly affected by migraine headaches compared to men. Approximately 15 to 18 percent of women and six percent of men in the United States are estimated to suffer from migraine headaches.

The diagnosis of status migraines is determined by its severe unremitting intensity, lasting more than 72 hours.

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Risk Factors For Intractable Migraine

Migraines, in general, tend to have triggers things or circumstances that increase the risk of developing an episode. It is best to identify these triggers if you have a tendency for developing intractable migraines, avoiding them as much as possible. The following are common triggers for status migraines, but some may be unique to the individual.

  • Hormonal changes in women due to fluctuations in estrogen
  • Foods aged cheeses, salty foods, skipping meals
  • Food additives such as aspartame sweetener, MSG
  • Drinks alcohol, wine, highly caffeinated beverages
  • Stress increased levels of stress are known to be a trigger
  • Sensory stimuli bright lights, sun glare, loud noises, strong smells
  • Changes in wake-sleep pattern
  • Brain tumor

Options For Drug Therapy

Antiemetics. Dopamine receptor antagonists are assumed to merely treat nausea in patients with migraine; however, they act independently to abort migraine and thus should be considered irrespective of the presence of nausea.

The two most commonly used agents are prochlorperazine and metoclopramide. The American Academy of Neurology guidelines recommend prochlorperazine as first-line therapy for acute migraine. Metoclopramide is rated slightly lower and is considered to have moderate benefit.4 The Canadian Headache Society cites a high level of evidence supporting prochlorperazine and a moderate level of evidence supporting metoclopramide.5 The American Headache Society assessment of parenteral pharmacotherapies gives prochlorperazine and metoclopramide a level B recommendation of should offer .3 Hence, either agent can be used.

To reduce the risk of post-treatment akathisia, diphenhydramine or benztropine may be given before starting a dopamine receptor antagonist. Diphenhydramine may be independently effective in migraine treatment,6,7 but data on this are limited.

Oral naproxen sodium is a possible alternative in patients with cardiovascular disease, as it has been shown to carry a lower cardiovascular risk than other NSAIDs.8

The same concerns in patients with renal dysfunction apply to any NSAID, as the enzyme cyclooxygenase plays a constitutive role in glomerular function.

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How Intractable Pain Is Diagnosed

If you experience chronic pain and traditional pain-relief treatments arent effective, you should seek out a doctors evaluation. Its important to describe your symptoms accurately and with detail.

Diagnosing the cause of your intractable pain can be challenging. If you experience daily, chronic headaches, for example, you may be experiencing migraine or tension-type headaches. The symptoms of migraine-induced intractable pain, however, are like those of other types of headaches. This makes diagnosis difficult and treatment similarly problematic. You may end up being treated improperly for a condition that appears to be the cause of your pain.

Usually, intractable pain is formally diagnosed when, over the course of time, a variety of treatments fail to ease your pain. For example, after failing different non-injectable measures, you get a corticosteroid injection and it doesnt ease your pain. Or your pain doesnt ease even after taking several different types of medications, such as:

  • nonsteroidal anti-inflammatory drugs
  • mild opioids
  • anti-seizure medications

If these or other treatments, such as surgery, exercise, and physical therapy, dont work, your doctor may officially diagnose you with intractable pain.

Who Is At Risk For Abdominal Migraine

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Abdominal migraines mostly affect children, with the first episode occurring between 3 and 10 years old. Most children seem to outgrow the condition, though abdominal migraines in adulthood are just starting to be studied. A child with a family or personal history of migraine headache has an increased chance of developing abdominal migraine.;

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I Know There Is A Purpose In My Pain

I am not a religious person. I do have a relationship with Christ though.;Its that relationship that keeps hopes fire still burning within me.;Was Botox going to be my Godsend or CGRP perhaps? Either way I still had hope. I know there is going to be purpose in my pain. I know how hard it is to imagine that migraine has a purpose in life.;Im sure it will present itself differently in each persons life.; We all differ in what we put our hope and faith into.;I havent come to the point of knowing the purpose in my pain. If you have come to that point in your life Im happy for you.;Purpose may go under the guise of promoting migraine awareness, having support and compassion for other migraine sufferers, or just getting real with yourself and making your health a priority. No matter where I am in the journey with chronic migraine I know I will always have hope. For now that is the purpose in my pain.

Prevention And Tips For Status Migrainosus

Due to the unrelenting presentation of status migraines and treatment difficulty, the best course of action is to prevent status migraine development from occurring in the first place. This will typically come in the form of prescribed medication that will reduce migraines from occurring, and if they do still occur, they will likely be less severe and shorter in duration. These medications include:

  • Antidepressants medication such as amitriptyline
  • Antiseizure medication such as topiramate or valproate
  • Blood pressure medication such as metoprolol tartrate and propranolol

Preventing status migraine development will also require the avoidance of various triggers and lifestyle habits. The following are some helpful suggestions that may prove beneficial:

  • Preventing hunger by eating several small meals throughout the day
  • Preventing dehydration by drinking eight or more glasses of water per day
  • Good sleep hygiene practices
  • Deep breathing and meditation to relieve stress
  • Not over using migraine pain relievers

If you are a known sufferer of status migraines, it may be worth your time to see a neurologist to get a detailed evaluation of your own unique situation. They are the best equipped to diagnose status migraines and to look deeper for any potential causes. Lastly, by adhering to your doctors prescribed treatments and the avoidance of triggers, you can be certain you are doing all you can to avoid this severe form of headache

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Diagnosis Of Migraine Without Aura

According to Dr. Jennifer Robblee, of The Mayo Clinic, migraine without aura is a clinical diagnosis. While there is no surefire test for detecting the presence of migraine, Robblee says there are a number of symptoms and factors that doctors can point to so they can make a diagnosis.

The diagnosis is reached by reviewing the patients personal and family medical history, studying symptoms and conducting an examination. Robblee notes that doctors do not diagnose migraineor any other type of headachebased on imaging.

Less than 1% of all brain imaging has a sinister finding in headache, so generally your imaging is going to look normal, she says. If we see anything, its probably not related to migraine . So there are certain things we need to know and look for to reach an accurate diagnosis.

If there are any atypical features or red flags in a patients history or examination, further testing may be warranted.

What The Future Holds For Pediatric Headache

Status Migrainosus Intractable Migraines and What To Do About Them

One of the biggest hurdles to be overcome in pediatric headache care is the paucity of drugs approved by the Food and Drug Administration . Currently, only rizatriptan is approved for ages 6 years and above, and almotriptan is approved for ages 12 years and above. Despite its widespread use, oral sumatriptan is not FDA approved for pediatric use.

In 2013, sumatriptan in a patch formulation was released for adult use. Since many migraineurs suffer nausea with migraine attacks, this unique delivery system may offer a more tolerable injection-free method of treatment for adults and pediatric patients. However, FDA approval is not likely to be granted in the near future. DHE in an inhaled form is in the final stages of study and will likely soon be available. In many emergency departments, IV DHE is part of the therapy for status migrainosus. Tepper and colleagues have shown that unlike triptans, the efficacy of orally inhaled DHE is not reduced once central sensitization has occurred.110 This difference is quite significant. One could potentially consider using inhaled DHE in the home setting to try and prevent an ER visit for status migrainosus.

Beyond therapies one can hope that in the near future research will provide a better understanding of the relationship between migraine and GI disorders such as inflammatory bowel disease and celiac disease . Other autonomic disorders, such as postural orthostatic tachycardia syndrome , may be involved.

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Coping With Status Migrainosus

Living with migraine headaches, and particularly with intermittent status migrainosus, can be extremely difficult. The fear of the possibility of having another episode and frustration with not being able to live a normal life can take a large toll. As status migrainosus is a debilitating, extremely painful and chronic illness, coexisting psychiatric diagnoses, such as depression and anxiety, are not uncommon. As a result, psychotherapy and support groups along with antidepressant and/or anti-anxiety medications may be able to provide a reprieve from the relentless pain and disruption of daily activities and quality of life. As stress can be a factor in the development of status migrainosus, natural anti-stress measures such as mindfulness meditation, yoga, Pilates, essential oils, mood boosting supplements and acupuncture may prove useful in dealing with this chronic illness. Besides stress, other potential triggers to avoid include alcohol, smoking, caffeine, food additives , skipping meals and sleep deprivation. Every migraineur is unique, and it may take some trial and error to find what works for you.

There is no need to let migraine symptoms linger for an extended period of time. By scheduling a consultation with Dr. Cabin, migraine sufferers can take the first step to reducing migraine suffering.

To set up a migraine consultation, please call us today at 310.461.0303 or fill out our online form.

Articles On Migraine Types

Migraines are a type of headache that tend to cause other symptoms, too, such as nausea and vision problems. They can last for a few hours to a few days. But a migraine that lasts for more than 72 hours is called status migrainosus. To treat it, you may need to go to the hospital to get help relieving the pain and dehydration from vomiting.

A typical migraine can sometimes turn into status migrainosus if:

  • You donât get treatment early enough after the attack starts.
  • You donât get the right treatment.
  • You use too much headache medicine.

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