Objective:

To evaluate olanzapine’s effectiveness in treating status migrainosus and identify common dosing regimens.

Background:

Status migrainosus, a debilitating condition marked by migraines lasting over 72 hours, has led researchers to explore new treatments. Given dopamine's role in migraine pathophysiology, olanzapine, an atypical antipsychotic, shows promise as an abortive treatment. This study assesses olanzapine's efficacy and tolerability for status migrainosus in adults.

Design/Methods:

A retrospective chart review was conducted at the AHN Headache Center from January 1, 2020, to January 1, 2023. Inclusion criteria included adults over 18 diagnosed with migraine who received olanzapine. Exclusion criteria involved patients prescribed olanzapine for chronic use or indications other than acute migraine treatment. Data were analyzed for patient demographics, olanzapine dosing, efficacy, and safety. Efficacy was defined as a patient-reported reduction of migraine symptoms by more than 50%, or complete resolution immediately following treatment, or no additional treatment needed to abort the migraine attack.

Results:

From an initial query of 1626 patients, 1230 met inclusion criteria after excluding those with psychiatric disorders. A total of 59 patients with status migrainosus were treated with olanzapine, with the following dosing outcomes: 42 patients received 2.5 mg, 5 received 5 mg, 3 received 7.5 mg, and 1 received 10 mg. Efficacy was noted in 29 of 42 patients (69%) on 2.5 mg, 10 of 12 (83%) on 5 mg, and 3 of 5 (60%) on doses greater than 5 mg. Comparatively, olanzapine demonstrated effectiveness in 16 of 18 patients (89%) when compared to initial treatments like IV steroids and migraine cocktails, which showed effectiveness in 26 of 41 patients (63%).

Conclusions:

Olanzapine was effective to abort status migrainosus in 42/59 (71%) of patients, with a favorable safety profile, especially at lower doses. Further research with a larger sample size may provide deeper insights into the dose-response relationship and long-term tolerability.