Real Life Approach to Outpatient Treatment of Status Migrainosus: A Survey Study
Jennifer Robblee1, Yulia Orlova2, Andrew Ahn3, Ashhar Ali4, Laur Marius Birlea5, Larry Charleston6, Niranjan Singh7, Marcio Nattan8
1Lewis Headache Center, Neurology, Barrow Neurological Institute, 2University of Forida, 3Teva Pharmaceuticals, 4Henry Ford, 5University of Colorado, 6Michigan State University College of Human Medicine, 7University of Missouri, 8University of São Paulo
Objective:
Identify how the American Headache Society (AHS) membership manages status migrainosus as an outpatient.
Background:
Status migrainosus (SM), a common migraine complication, is defined as a severe attack lasting for more than 72 hours. There is no standard of care for SM, including whether 72 hours is requisite to treat as SM.
Design/Methods:
The “Refractory, Inpatient, Emergency care” Special Interest Group from AHS developed a 4 question survey distributed to AHS membership: 1) if they treat severe refractory migraine attacks the same as SM regardless of duration, 2) what their first step in SM management is, 3) what are the top 3 medications they use for SM, and 4) if they are UCNS certified. The survey was administered January 2022. Descriptive statistics and qualitative analysis were performed.
Results:
Responses were received from 196 of the 1859 AHS members. 64.29% are UCNS certified in headache. 69.39% (136/196) treat a severe refractory migraine attack as SM before 72 hours. 76.02% (149/196) of respondents chose “Treat remotely using outpatient medications at home” as the first step, while 11.22% (22/196) preferred procedures, 6.12% (12/196) favored an infusion center, 6.12% (12/196) sent to the emergency department or urgent care, and 0.51% (1/196) prefer direct admission. The preferred medications included the following categories: 71.4% (140/196) steroids, 50.5% (99/196) NSAIDs, 46.9% (92/196) neuroleptics, 30.6% (60/196) triptans, 21.4% (42/196) DHE, 11.7% (23/196) antihistamines, 10.7% (21/196) gepants, 10.2% (20/196) anti-epileptics, and 6.1% (12/196) muscle relaxants.
Conclusions:
Healthcare professionals with expertise in headache medicine treat SM early and do not wait the 72 hours required to fulfill diagnostic criteria. Outpatient management with one or more medications for home use was preferred by majority of responders while very few opt for the emergency department. Finally, steroids, NSAIDs, neuroleptics, triptans, and DHE were the top 5 preferred for home SM management.