Epidemiology and Characteristics of Status Migrainosus in a Tertiary Headache Clinic: A Retrospective Cohort Study
Objective:
Assess epidemiology and characteristics of status migrainosus (SM) in a patient cohort within tertiary care headache clinic to identify the prevalence, 1-year incidence, attack features, treatments, and healthcare utilization for SM.
Background:
Status migrainosus (SM) is a debilitating migraine attack lasting at least 72 hours according to the International Classification of Headache Disorders 3rd edition (ICHD-3). SM has been poorly characterized.
Design/Methods:
Retrospective observational cohort study evaluating SM in a subspecialty headache center using chart review from electronic health records (EHR) for patients seen in 2022. Primary endpoint was prevalence and 1-year incidence of reported SM attacks. Wilson score intervals calculated 95% confidence intervals for all proportions. Secondary outcomes assessed clinical features and treatments utilized during SM, using descriptive statistics from those with sufficient detail in EHR.
Results:
1184 patients seen in 2022 were screened, of which 1043 (88.1%) were diagnosed with migraine, 458 with any lifetime episode of SM, and 373 meeting inclusion criteria. Median age was 47 (IQR 38, 57) and 87.7% were female (327/373). Nearly 50% reported baseline migraine aura, however prolonged aura during SM was rare. SM prevalence 43.9% (458/1043; 95% CI 40.9%, 46.9%) within the migraine-only population. The 2022 SM incidence in patients with migraine was 21.5% (187/869; 95% CI 18.9%, 24.4%). The median midpoint SM severity was 8/10 (IQR 7-9) with median SM attack duration of 10 days (IQR 4-30, range 3-330 days). SM treatments: migraine specific 48.3% (175/362), nerve blocks 28.8% (68/362), butalbital-containing 1.7% (6/362). 17.7% (64/351) with a recorded emergency department visit and 6.4% (23/360) with a recorded admission.
Conclusions:
SM is prevalent within tertiary headache population, affecting ~50% of migraine patients during their lifetime and 1/5 within one year. In this population, patients with SM present as chronic migraine with high rates of aura. This study highlights needs for improved diagnostic consistency and treatment.
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