Background

Status migrainosus is a condition with limited epidemiological knowledge, and no evidence-based treatment guideline or rational-driven assessment of successful treatment outcome. To fill this gap, we performed a prospective observational study in which we documented effectiveness of treatment approaches commonly used in a tertiary headache clinic.

Material and methods

Patients with episodic and chronic migraine who experienced continuous and prolonged attacks for more than 72 hours were treated with dexamethasone (4 mg orally twice daily for 3 days), ketorolac (60 mg intramuscularly), bilateral nerve blocks (1–2% lidocaine, 0.1–0.2 ml for both supraorbital and supratrochlear nerves, 1 ml for both auriculotemporal nerves, and 1 ml for both greater occipital nerves), or naratriptan (2.5 mg twice daily for 5 days). Hourly (for the first 24 hours) and daily (for first 30 days) change in headache intensity was documented using appropriate headache diaries.

Results

Fifty-four patients provided eligible data for 60 treatment attempts. The success rate of rendering patients pain free within 24 hours and maintaining the pain-free status for 48 hours was 4/13 (31%) for dexamethasone, 7/29 (24%) for nerve blocks, 1/9 (11%) for ketorolac and 1/9 (11%) for naratriptan. These success rates depended on time to remission, as the longer we allowed the treatments to begin to work and patients to become pain free (i.e. 2, 12, 24, 48, 72, or 96 hours), the more likely patients were to achieve and maintain a pain-free status for at least 48 hours.

Discussion

These findings suggest that current treatment approaches to terminating status migrainosus are not satisfactory and call attention to the need to develop a more scientific approach to define a treatment response for status migrainosus.

中文翻译：

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治疗偏头痛持续状态的未被认识到的挑战：一项观察性研究。

 背景

偏头痛持续状态是一种流行病学知识有限的疾病，没有循证治疗指南或对成功治疗结果的理性驱动评估。为了填补这一空白，我们进行了一项前瞻性观察研究，记录了三级头痛诊所常用治疗方法的有效性。

 材料与方法

持续、长时间发作超过 72 小时的阵发性和慢性偏头痛患者接受地塞米松（4 mg，口服，每日两次，持续 3 天）、酮咯酸（60 mg 肌肉注射）、双侧神经阻滞（1-2% 利多卡因，0.1 – 眶上神经和滑车上神经均为 0.2 ml，耳颞神经均为 1 ml，枕大神经均为 1 ml），或那拉曲坦（2.5 mg，每天两次，持续 5 天）。使用适当的头痛日记记录每小时（前 24 小时）和每日（前 30 天）头痛强度的变化。

 结果

54 名患者提供了 60 次治疗尝试的合格数据。地塞米松使患者在 24 小时内无痛并维持无痛状态 48 小时的成功率为 4/13（31%），神经阻滞为 7/29（24%），1/9（11%）酮咯酸为 1/9 (11%) 那拉曲坦。这些成功率取决于缓解时间，因为我们允许治疗开始发挥作用并且患者变得无痛的时间越长（即 2、12、24、48、72 或 96 小时），患者实现缓解的可能性就越大。并保持无痛状态至少48小时。

 讨论

这些发现表明，目前终止偏头痛持续状态的治疗方法并不令人满意，并提醒人们注意需要开发更科学的方法来定义偏头痛持续状态的治疗反应。