Status migraine symptoms. Migraine, what is its danger? Alternative methods of help

Most migraines follow a specific pattern. It usually includes: changes in consciousness, the appearance of an aura or visual disturbances, headache, with an increase and then a gradual decrease in pain. From mild nonspecific pain to a typical migraine it can take 0.5-2 hours. And the condition that occurs with status migraine is a more severe and long-lasting form of headache than regular migraine.

However, conventional strategies for stopping headaches, including rest and taking painkillers, often don't work. In 50% of migraine cases, the duration of pain was 5-24 hours. In this condition, a person’s headache lasts not a few hours, but 72 hours (or 3 days) or even longer.

Pathogenesis

Presumably caused by inflammation of the intracranial blood vessels involved in the migraine process. Dilation of blood vessels and the release of vasoactive neuropeptides, as well as other active peptides that are involved in neurogenic inflammation, lead to activation of the trigeminal neurovascular system.

The constant activation and release of neuropeptides impairs the regulation of serotonergic receptors and reduces endorphin production. Weakness of blood vessels leads to the discharge of blood into the venous system, after which pain syndrome transforms into a pressing type of cephalalgia (headache).

Over time or after taking anti-migraine drugs, vascular tone is restored and the migraine attack stops. However, in the case of status migraine, vascular changes persist for a very long time.

Causes

Any of the following factors can trigger a migraine attack:

hormonal imbalance;
stress;
overuse medications such as painkillers and narcotic drugs, used to treat headaches (this can cause so-called "rebound headaches");
changes in medications, especially hormonal medications such as birth control pills;
hormone therapy during menopause or taking antidepressants;
weather changes;
head injuries;
lack of sleep;
missed breakfast, lunch or dinner;
dehydration;
surgery of sinuses, teeth or jaws;
an infection such as the flu or sinus infection;
meningitis (very rare);
brain tumor (very rare).

Symptoms

Status migraine is not necessarily different from a typical migraine, except for its duration and severity. People who experience this condition claim that the pain is the same as a regular migraine, but it lasts much longer. However, for some people, the pain and nausea are so debilitating that they need to be hospitalized.

The patient's condition often includes the following symptoms:

Changes in consciousness. Some may have difficulty concentrating, drowsiness, nervousness, or brain fog.
Aura. This is a neurological disorder in which a person sees unusual patterns, flashes, or spots before the eyes.
Headache . The pain can be intense and is usually localized to one side of the head. Sometimes it can spread to the other side of the head.
Intense pulsation in the head. Unlike tension headaches, migraine pain is more severe and head massage does not help relieve it.
Nausea. Usually this feeling is accompanied by general weakness, and complete absence appetite.
Weakness in the body, or tingling in the arms, hands, or feet.
Emotional despair and, less frequently, depression, sometimes with suicidal ideation.

A doctor diagnoses status migraine if the headache lasts longer than 72 hours. In this case, the pain may decrease within 12 hours after taking medication or resting, but then returns. The pain must also be so severe that it becomes almost unbearable.

Treatment and prevention tactics in the presence of status migraine

No treatment can cure migraines, and researchers don't yet know exactly how to shorten their duration. Instead, doctors focus on managing symptoms with painkillers.

The first choice when you have status migraine is traditional migraine medications. These include triptans or non-steroidal anti-inflammatory drugs. If these medications don't work, your doctor may suggest a stronger pain reliever such as ketorolac (Toradol).

Other medications such as magnesium sulfate, Benadryl, and lidocaine may also help treat painful sensations. But there is still little evidence to support their effectiveness.

It is extremely important to prevent vomiting, especially if a person is dehydrated. Dehydration can be a trigger for migraines. If vomiting occurs more than 10 times per day, the patient may need anti-nausea medication in the form of a suppository. The presence of migraine status may be a reason for hospital treatment.

Without treatment, complications can be very serious, including stroke. In the hospital, the patient may be given an injection of dihydroergotamine, the anti-depression drug Valproate, or opioid painkillers to alleviate the condition. Oral steroid medications such as Dexamethasone (Decadron) are used to relieve migraine status. One study found that steroids reduced pain in people with migraines.

However, long-term use of steroids may cause side effects, such as weight gain, thinning bones, bone necrosis and sleep problems. People with diabetes cannot take steroids because these medications raise blood sugar levels. The patient may need to remain under medical supervision for one to three days to control the symptoms of the disease. Doctors may try several different migraine medications until they find one that works for a particular person. Some people diagnosed with status migraine are helped by a class of drugs called dopamine receptor antagonists.

Urgent Care

The presence of migraine status requires immediate measures to alleviate the patient’s condition:

First of all, you need to create favorable conditions in the room: close the curtains, eliminate all extraneous noise.
A cold compress should be placed on the patient's head.
If an adult or child over 2 years of age is vomiting, an antiemetic drug, Droperidol or Cerucal, should be given.
If paracetamol or ibuprofen does not help relieve migraine symptoms, children over 2 years of age, adolescents and adults can be given an intramuscular injection of an NSAID (diclofenac, naproxen, ketoprofen) or administered rectally (indomethacin suppository).
To relieve agitation, you can inject diazepam (Seduxen) intramuscularly.

Prevention

Several medications can help prevent migraines when taken regularly. Even if a headache has already begun, it will likely be less severe and shorter if you use one of these drugs.

antidepressants such as amitriptyline;
contraceptives, such as topiramate or valproate;
blood pressure medications such as metoprolol tartrate, propranolol, timolol and verapamil.

Before taking each of the above remedies, consultation with your doctor is required. All of these drugs have serious contraindications and side effects.

It is impossible to completely prevent migraines or status migrainosa. However, many migraine sufferers find that certain triggers, such as odors, allergens, and stress, trigger their headaches.

To prevent migraines, you need to avoid triggers:

Eat small meals throughout the day to avoid getting hungry.
Drink eight or more glasses of water a day to prevent dehydration.
If migraines are caused by insomnia, sleep hygiene techniques can help: airing the bedroom at night, taking a relaxing bath before bed, going to bed at the same time every day.
It is recommended to keep a log of events associated with the presence of migrainous status to help identify triggers and then avoid them as much as possible.

It is also advisable to check if your hormones are in order thyroid gland, since hormonal imbalance often provokes migraines.

Severe migraine paroxysm or a continuous series of migraine attacks lasting more than 3 days. It is characterized by pronounced pain intensity, repeated vomiting, weakness, hyperesthesia, and adynamia. Diagnosed based on clinical criteria after exclusion organic disease brain using Echo-EG, EEG, REG, cerebral CT/MRI, cerebrospinal fluid analysis. Requires emergency therapy, including glucocorticosteroids, ergot pharmaceuticals, antiemetics, psychotropic drugs, and blockade methods.

ICD-10

G43.2

General information

Symptoms of status migraine

The basis of the clinical picture is intense diffuse aching cephalgia. Periods of more than severe pain(cephalgic attacks), interspersed with a temporary decrease in pain. The headache persists for more than three days and does not disappear after sleep or taking analgesic and anti-migraine drugs. Characterized by severe general weakness, adynamia, and pallor. Severe cephalgia is accompanied by repeated vomiting, as a result of which patients cannot take food or medications. The body loses fluid and electrolytes, and dehydration develops.

The patient's condition is serious. There is increased sensitivity to light (photophobia), sounds (hyperacusis), and smells. Possible convulsions, meningeal syndrome, cerebral symptoms, changes in consciousness, transient visual disturbances (decreased visual acuity, blurring, flickering).

Complications

Migraine status is dangerous for the development of ischemic stroke. Migraine stroke accounts for 13.7% of ischemic cerebral lesions of young people. It proceeds hidden, like a lacunar infarction. Its development can be suspected when it appears in clinical picture“pulsating” (appearing and disappearing) focal neurological symptoms (hemianopsia, hypoesthesia, paresis facial nerve). In patients with migraine with aura, the symptoms repeat the manifestations of aura.

Diagnostics

According to the criteria of the International Headache Society, the diagnosis of “status migraine” is eligible if the following criteria are met:

The clinical picture of an attack of cephalgia corresponds to previous migraine attacks and is longer lasting.
Headache is characterized by significant intensity, lasting over 72 hours.
Cephalgia is not a consequence of other diseases.

In order to confirm/refute the third criterion, it is necessary additional examination patient, including:

Examination by a neurologist. Does not reveal focal neurological deficit. The presence of focal symptoms indicates the development of a migraine stroke or another organic brain pathology.
Echoencephalography carried out to exclude a volumetric process in the brain. Does not detect pathological changes.
Electroencephalography. Diffuse dysrhythmia of a nonspecific nature is determined, epileptogenic activity is absent.
Rheoencephalography can diagnose asymmetric blood filling of cerebral vessels, decreased tone of the carotid artery.
Ophthalmoscopy. Performed by an ophthalmologist. During the status period, narrowing of the arteries and dilation of the veins of the retina are determined.
Cerebrospinal fluid examination. Does not detect changes. Makes it possible to exclude inflammatory damage to the central nervous system and hemorrhage.
CT, MRI of the brain. Helps ensure there is no organic damage CNS: intracerebral hematoma, brain abscess, cerebral cyst, tumor process. When migraine persists for many years, foci of atrophy, dilation of the ventricles, and an increase in the subarachnoid space are visualized. The presence of an area of ischemia of brain tissue makes it possible to diagnose a migraine stroke.
MRI of cerebral vessels performed to exclude aneurysm, arteriovenous malformation of the brain.

It is necessary to differentiate migraine status from meningitis, meningoencephalitis, subarachnoid hemorrhage. Intense cephalgia with inflammatory diseases accompanied by fever, general intoxication syndrome, changes in clinical blood test (increased ESR, leukocytosis), cerebrospinal fluid. Subarachnoid hemorrhage is characterized by a sharp headache with increasing confusion and the presence of blood in the cerebrospinal fluid.

Treatment of status migraine

Urgent hospitalization to the neurology department is indicated. The status is stopped by a combination of several of the following methods:

Administration of glucocorticosteroids. It is carried out intravenously using dexamethasone and prednisolone. Corticosteroids have a pronounced anti-inflammatory and anti-edematous effect.
Use of ergot preparations(ergotamine). An intravenous drip is given. Pharmaceuticals in this group eliminate dilatation of cerebral vessels, block neurogenic inflammation, and have a dopaminergic effect.
Administration of psychotropic pharmaceuticals. It is necessary to normalize the patient’s mental sphere. In accordance with clinical manifestations antidepressants, antipsychotics, and tranquilizers are prescribed.
Stopping vomiting. Achieved with the help of antiemetics (metoclopramide), which block the gag reflex.
Periosteal blockades. They are performed at trigger points of the cranial vault, back of the head, temporal region, and cervical vertebrae. Normalize venous drainage, restore local microcirculation, reduce the excitability of local vegetative nodes, have an anti-edematous, anti-inflammatory, analgesic effect.
Intraosseous blockades. Performed when the periosteal effect is insufficient. The injection is carried out into the zygomatic bones, spinous processes of the vertebrae cervical spine. The effect is based on switching off intraosseous receptors from the mechanism of formation of angiospastic and pain components of an attack. Thanks to the developed venous network, the injected drugs easily spread into the surrounding tissues, which ensures a rapid therapeutic effect.

Prognosis and prevention

Timely emergency therapy can stop migraine status. Lack of treatment and incorrect therapy lead to a long course of the status, exhausting the patient, the development of stroke, and dehydration. In the best way prevention is adequate treatment of migraine, including inter-attack therapy. Patients suffering from migraine are recommended to always have medications that relieve paroxysm with them and use them at the first signs of an impending attack.

Migrainous status. Migraine infarction. Migraine treatment.

Complications of migraine are status migraine and cerebral infarction.

Migrainous status is defined as a migraine attack lasting more than 72 hours despite treatment. In this case, light intervals lasting several hours may be observed (sleep is not taken into account). Migraine status is severe: with nausea, repeated vomiting, which prevents the intake of fluids and food, making it impossible to administer medications orally. Due to repeated vomiting, patients may experience excessive chloride loss.

Migraine infarction- a condition in which one or more symptoms of a migraine aura do not disappear within seven days; a heart attack is confirmed by examination using CT and MRI.

Migraine treatment

A patient with migraine must avoid any factors that provoke an attack, including overwork, sleep deprivation, psycho-emotional stress. A distinction is made between therapy for migraine attacks and so-called preventive treatment aimed at preventing migraine attacks.

To remove acute migraine attack aspirin itself is used or in combination with caffeine - askofen or sedalgin (which also includes codeine), as well as phenobarbital, pentalgin, spasmoveralgin; ergot alkaloids: 0.1% solution of ergotamine hydrogen tartrate (15-20 drops) or in tablets, which can also be combined with caffeine (caffeamine). Regitamine, containing 0.001 g of ergotamine hydrotartrate (taken under the tongue), just like digidergot spray, acts quickly and effectively. Recently, to relieve an attack, they began to use clotam - tolfenamic acid in a dose of 200-400 mg, and in particular the serotonin receptor stimulator - sumatriptan (imigran), which has the greatest therapeutic effect. Doses used: 100 mg orally or 6 mg subcutaneously or as a spray. Other drugs that have a stimulating effect on serotonin receptors are also used, in particular naratriptan (Naramig).

For migraine status the patient must be hospitalized. Among the reasons for this migraine complications are called conflict situations with the development of depression, long-term use of oral contraceptives, hypertensive crises, excessive (long-term) use of ergotamine. In the latter case, the administration of ergotamine to relieve an attack is contraindicated! Sedatives, tranquilizers, antidepressants and dehydration agents should be used. One of the best combinations is phenobarbital 0.05-0.1 g orally, diazepam (Seduxen, Relanium) 10 mg into a vein slowly in 20 ml of 40% glucose solution, imizin (melipramine) 25 mg orally or 1.25% solution intramuscularly . In other cases, the use of ergot preparations is indicated. In the most severe cases, their combination with analgesics such as pentazocine is acceptable - 1-2 ml (30-60 mg) subcutaneously or intramuscularly. According to the latest data, repeated administration of sumatriptan is recommended - up to 300 mg orally or up to 18 mg subcutaneously during the day. Our clinic also uses intravenous injection 20 ml of 10% sodium hydroxybutyrate solution, 400 ml of poly- or rheopolyglucin intravenously, 2 ml of 1% Lasix solution.

In some cases of migraine attack It can be stopped by injecting the external temporal area with a solution of novocaine. In case of uncontrollable vomiting, in addition to antihistamines injections of 1-2 ml of 0.5% haloperidol solution, 0.25% trisedyl solution, 1 ml (6.5 mg) of triethylperazine (Torekan), etc. are used.

Migraine has recently become a very common disease. This may be due to the presence large quantity stress factors in modern life. However, headaches can become even more unpleasant pathological condition− migraine status. Let's take a closer look at this disease.

What is status migraine

Causes

The main factor in the appearance of migraine status is not sufficiently considered effective treatment ordinary migraine. In this case, the disease gradually develops into chronic form. In the absence of proper therapy, it develops into a more severe disease - status migraine. However, there are other reasons that contribute to the occurrence of pathology:

active hormonal changes;
therapy with potent medications;
sudden change in meteorological conditions;
chronic lack of sleep;
the course of infectious processes;
malignant tumor.

Above is a list of the main reasons. There may be other conditions that contribute to the formation of the disease.

Pathogenesis

The pathogenesis of status migraine has not yet been fully established. We can only say with certainty that there is a disruption in the harmonious functioning of neurons and elements of cardio-vascular system. As a result, a stable change in vascular tone is formed. This is especially true for the cerebral cortex area. When dilated nearby vessels are stretched under the pressure of blood, severe headaches occur. When it is impossible to stop them for more than three days, we can talk about the presence of migraine status.

Symptoms of status migraine

The main sign of the pathology is protracted, most often concentrated on one side. In addition, during an attack appear additional symptoms. Let's list the most common ones:

Distracted consciousness. The patient's memory and concentration decrease, and it is difficult for him to concentrate.
Nauseous sensation and vomiting. It is not possible to get rid of such conditions with the help of antiemetics or enzymes.
Involuntary muscle contraction. The victim may experience convulsive seizures.
Weakness. Even with minor movements it appears extreme fatigue.
Deterioration in the functioning of the sensory organs. A person's outlines of objects become blurred, and strange sounds appear in the ear canals.
Unreasonable aggression, decadent mood, unwillingness to live.

Symptoms of status migraine vary from person to person. It is not necessary to show all the signs at once. It all depends on the complexity of the disease.

How to determine if you have status migraine

In order to correctly and effectively treat the pathology, it will be necessary to establish that headaches are precisely a manifestation of migraine status. This can only be done in a healthcare facility. First you need to visit a neurologist. He will conduct an examination and a detailed interview of the patient, then refer him to undergo diagnostic procedures.

Important! At the stage of conversation with the doctor, much depends on the patient’s testimony. You should tell everything in the smallest detail and not miss the slightest detail. The further success of treatment depends on this.

To the main diagnostic measures When identifying the disease in question, they include:

Encephalogram of the cerebral cortex.
Ultrasound of vascular elements.
MRI, CT scan of the head region.
X-ray.
Ophthalmological procedures.
Laboratory tests of blood and urine.

If difficulties arise in making a diagnosis, medical professionals may prescribe additional procedures.

Emergency care for migraine status

If migraine status occurs, you will need to call immediately ambulance. Medical workers They will take the necessary measures and relieve the attack, and a call card will also be issued.

Before specialists arrive, the patient will need emergency care. Let's consider what needs to be done while waiting for medical workers:

Place the victim in bed, turn off the lights, and eliminate sources of noise.
Moisten a clean cloth in clean water and apply it to the patient’s forehead.
Give a painkiller tablet, for example, Tempalgin.
You will need to open the windows wide, thereby ensuring the flow of oxygen.
If the patient is cold, you need to cover him with a warm blanket.

After taking the above measures, you will need to reassure the patient and wait for the arrival of qualified medical workers.

Treatment methods for status migraine

Treatment of the disease is carried out in a hospital setting under the supervision of the attending doctor. The patient's condition in the pathology is so severe that the methods traditional medicine or physical therapy rarely bring positive results. These methods can be used, but only as complementary therapy. Therefore, the treatment course is usually based on the use of medications. Both tablet forms and injections are used. We list the most effective medicines:

Methysergide;
Carbamazepine;
Sedalgin;
Ergotamine;
Imigran;
Metoclopramide;
Magnesium sulfate.

When migraine status is eliminated, the attending doctor will give recommendations to the patient on lifestyle changes. A preventive course of medication will also be prescribed.

Possible consequences

Under no circumstances should the occurrence of migraine status be ignored. An advanced disease often transforms into a more dangerous forms. For example, in a migraine stroke. With this disease, painful symptoms are more pronounced. The patient feels very bad. Characteristic feature is a partial loss of some functions of the cerebral cortex, as well as a decrease in mental activity. Moreover, these processes are irreversible. The patient will forever lose the ability to live a full life.

The next complication is the appearance of unconscious muscle contractions. This leads to the fact that during migraine attacks a person can fall backward and convulse for a long time.

Preventive measures

To prevent migraines from developing into serious illnesses, you can take note and take effective preventive measures:

Go to the hospital if migraine attacks occur.
Changing your diet. Refusal of fried, fatty, salty foods, canned food.
Avoid drinking alcoholic beverages and smoking tobacco.
Minimizing psycho-emotional stress, conflict situations, and showdowns.
Inclusion of moderate physical activity.
Complete rest. It will be necessary to reduce mental stress, especially when it comes to the work process.
Sufficient drinking regime. An adult needs at least two liters of clean water per day.
Daily walks lasting from forty minutes to an hour.
Eight hours sleep. In the evening, it is necessary to ventilate your home well, especially in the bedroom.

Forecast

Modern treatment methods can eliminate painful symptoms. However, the patient will need to take specialized medications on an ongoing basis. medications. In addition, he must have them with him at all times. This will avoid adverse consequences if a headache occurs unexpectedly, at the most inopportune moment. In addition to using medicines, you will need to follow the preventive measures discussed above. Moreover, if the condition improves, you cannot return to your usual lifestyle.

Migraine attack - dangerous condition. The most important thing you can do to help your health or the health of your loved ones is to contact medical institution for help. It is impossible to cope with the disease on your own. Under the supervision of a doctor, the patient has a good chance of recovery.

Migraine status is a serious condition in which a severe pain attack for a long time doesn't stop. Migraine attacks last more than 72 hours and are accompanied by a number of typical symptoms, including nausea, weakness, and hyperesthesia.

What is status migraine

The presence of migraine status is determined by a continuous attack with a series of pain attacks. A serious condition lasts more than 3 days, therefore it is important to diagnose in time and carry out the necessary treatment measures. Without rendering emergency care there is a risk of complications in the form of a migraine stroke.

For diagnostic purposes, a number of studies are carried out to exclude organic pathologies of the brain. The treatment is complex and includes taking psychotropic drugs, glucocorticoids, antiemetics and other symptomatic drugs.

Causes

The disease is based on dysfunction of neurotransmitter systems with improper regulation of cerebral vessels. Status migraine is the result of intractable migraine attacks.

The main causes of the disease are:

lack of treatment in the early period of an attack;
ineffectiveness of drugs;
addiction to a particular drug.

Often the cause of a severe attack is self-medication, when the patient does not seek help from a specialist. It is difficult to choose treatment remedies on your own, since they will be different for each form of the disease.

Risk factors for developing status migraine:

reception hormonal drugs and antidepressants;
lack of sleep, dehydration;
suffered severe infections;
change in weather conditions;
strict diet, feeling hungry;
hormonal imbalances in the body, which often happens during pregnancy;
traumatic head injuries.

The reason may be a sudden change in medications. In this regard, it is not recommended to independently make a decision about stopping medications and switching to others.

Pathogenesis

A migraine attack has several stages. First, the vasoconstrictor mechanism is launched, followed by headache. A decrease in vascular tone leads to the discharge of blood into the venous system, which becomes a factor in pulsating cephalgia.

Under the influence of drugs, the reverse process occurs. The blood vessels are restored and the attack stops completely. In the case when vascular changes continue for more than 3 days, the paroxysm develops into migraine status. Without timely assistance, there is a risk of stroke.

Symptoms of status migraine

The manifestations of status migraine are not much different from a regular attack. Patients experience the same accompanying symptoms - nausea, vomiting, dizziness. The main distinguishing symptoms are the duration and severity of pain. It becomes unbearable, is not relieved by the usual medications and does not stop on its own, as happens with a typical migraine.

The main symptom of status migraine is a prolonged headache that cannot be relieved with painkillers.

With status migraine, the following manifestations may occur:

aura - a number of symptoms preceding an attack, the patient sees spots before the eyes, patterns, vision becomes blurred;
drowsiness, problems concentrating, confusion, which makes it impossible to carry out even everyday activities;
increased pain on one side of the head, less often the pain is symmetrical, and can radiate to the other side;
severe nausea, it becomes impossible to eat, appetite is completely lost;
weakness in the muscles, a feeling that all the bones are aching;
tingling of the skin and a feeling of goosebumps;
depression, suicidal thoughts may appear;
pulsation in the head of varying intensity, which is not eliminated by medications and massage, like a regular headache.

The condition of status migraine is severe. Patients experience increased sensitivity to smells, sounds and light. In some cases, convulsions appear, consciousness changes, which is accompanied by visual impairment.

Over a long period of an attack, periods with the greatest intensity of pain are observed, which are defined as cephalgic attacks. After them, it seems that the condition has improved, but the pain remains the same strength as before.

The patient loses his appetite and refuses to drink, which leads to dehydration. This further aggravates the serious condition. Repeated vomiting interferes with normal intake of food and fluids, so one of the primary tasks will be its elimination.

How to determine if you have status migraine

Status migraine can be diagnosed 72 hours after the onset of an attack. For such a diagnosis, the pain must be unbearable, otherwise you need to look for the cause in another disease. A neurologist diagnoses pathology.

Migraine status meets the following criteria:

The symptoms are identical to previous attacks, the only difference being the duration.
The pain is severe and lasts more than 72 hours.
Cephalgia is not a consequence of other pathologies.

Differential diagnosis is carried out with meningitis, stroke, meningoencephalitis.

To confirm the diagnosis, a number of studies are carried out, including:

neurological examination - if focal symptoms are present, the doctor will prescribe tests to look for another brain disease;
electroencephalography - diffuse rhythm disturbance is determined;
ophthalmoscopy - dilation of the retinal veins is observed;
echoencephalography - allows you to exclude volumetric processes in the brain;
magnetic resonance and computed tomography- show in detail the condition of the brain and blood vessels, allow you to identify the smallest pathological foci of soft tissue (MRI) and bones (CT);
rheoencephalography - shows a violation of vascular tone.

In case of migraine status, hospitalization is carried out. Before the ambulance arrives, the patient needs to be helped to cope with his serious condition.

What you need to do to provide first aid:

Move the patient to a quiet room without bright lighting.
Apply a cold compress to your forehead.
Give a drug from the triptan group in an increased dose.
If vomiting, give an antiemetic.

Treatment methods for status migraine

After urgent hospitalization, the patient is placed in the neurological department, and treatment begins immediately. There are several methods for reducing status.

For migraine status, hospitalization is required

Therapeutic measures for migraine:

Administration of ergot preparations by intravenous drip. The drugs in this group cope with dilatation of cerebral vessels, eliminating inflammation and providing a dopaminergic effect.
Administration of glucocorticosteroids. Drugs based on prednisolone and dexamethasone are delivered intravenously. They have an anti-edematous and pronounced anti-inflammatory effect.
Taking antiemetics. Metoclopramide medications are prescribed to block the gag reflex.
Introduction of psychotropics. Tranquilizers, antidepressants, antipsychotics are used, depending on mental state sick.
Intraosseous blockades. The drugs are injected into the spinous processes of the spine and zygomatic bones. The action is explained by the switching off of intraosseous receptors from the system of formation of a pain attack.
Periosteal blockades. They are carried out more often, prescribed first, and if they are ineffective, intraosseous ones are performed. Periosteal blockades involve administering the drug to trigger points in the neck, back of the head, and temple. The procedure normalizes blood flow, relieves swelling, relieves pain and inflammation.

Possible consequences

The main danger of migraine status is the risk of developing ischemic stroke. In young people, this complication can occur latently, like a lacunar infarction. Migraine stroke accounts for about 14% of ischemic brain lesions.

Warning signs will be throbbing pain and the presence of focal symptoms. It includes hyperesthesia, facial nerve paresis and partial blindness (hemianopia).

Preventive measures

In the case of migraine status, the doctor makes a decision on inclusion in the main treatment prophylactic drugs. These may be beta blockers, antidepressants, anticonvulsants, contraceptives and antihypertensives. Only a doctor can prescribe medications for prevention, taking into account the clinical picture and examination results.

Status migraine can be prevented by taking medications in a timely manner when a typical attack occurs. It is also important to avoid triggers. It is necessary to exclude such risk factors as hunger, thirst, severe fatigue, and nervous tension.

Hunger and stress can cause status migraine

Migraine status cannot be guaranteed to be prevented, but compliance preventive measures will reduce its likelihood.

Forecast

Timely medical assistance relieves an attack and allows the patient’s condition to normalize. The further prognosis will depend on the choice of drugs for treatment and on compliance with preventive measures. People with migraines are advised to always carry medications prescribed by their doctor with them, which will improve the prognosis. The faster the attack is stopped, the lower the risk of migraine status.

Migraine status: what it is and how it manifests itself

Most migraines follow a specific pattern. Typically it includes: changes in consciousness, the appearance of an aura or visual disturbances, headache, with an increase and then a gradual decrease in pain. From mild nonspecific pain to a typical migraine it can take 0.5-2 hours. And the condition that occurs with status migraine is a more severe and long-lasting form of headache than regular migraine.

Pathogenesis

The constant activation and release of neuropeptides impairs the regulation of serotonergic receptors and reduces endorphin production. Vascular weakness leads to the discharge of blood into the venous system, after which the pain syndrome is transformed into a pressing type of cephalalgia (headache).

Over time or after taking anti-migraine drugs, vascular tone is restored and the migraine attack stops. However, in the case of status migraine, vascular changes persist for a very long time.

Causes

Any of the following factors can trigger a migraine attack:

hormonal imbalance;
stress;
overuse of medications such as painkillers and narcotics used to treat headaches (this can cause what are called "rebound headaches");
changes in your medications, especially hormonal medications such as birth control pills;
hormone therapy for menopause or taking antidepressants;
weather changes;
head injuries;
lack of sleep;
missed breakfast, lunch or dinner;
dehydration;
surgery of sinuses, teeth or jaws;
an infection such as the flu or sinus infection;
meningitis (very rare);
brain tumor (very rare).

Symptoms

The patient's condition often includes the following symptoms:

Changes in consciousness. Some may have difficulty concentrating, drowsiness, nervousness, or brain fog.
Aura. This is a neurological disorder in which a person sees unusual patterns, flashes, or spots before the eyes.
Headache. The pain can be intense and is usually localized to one side of the head. Sometimes it can spread to the other side of the head.
Intense pulsation in the head. Unlike tension headaches, migraine pain is more severe and head massage does not help relieve it.
Nausea. Usually this feeling is accompanied by general weakness and a complete lack of appetite.
Weakness in the body, or tingling in the arms, hands, or feet.
Emotional despair and, less frequently, depression, sometimes with suicidal ideation.

Treatment and prevention tactics in the presence of status migraine

No treatment can cure migraines, and researchers don't yet know exactly how to shorten their duration. Instead, doctors focus on managing symptoms with painkillers.

Other medications such as magnesium sulfate, Benadryl, and lidocaine may also help relieve pain. But there is still little evidence to support their effectiveness.

However, long-term use of steroids can cause side effects such as weight gain, bone thinning, bone necrosis, and sleep problems. People with diabetes cannot take steroids because these medications raise blood sugar levels. The patient may need to remain under medical supervision for one to three days to control the symptoms of the disease. Doctors may try several different migraine medications until they find one that works for a particular person. Some people diagnosed with status migraine are helped by a class of drugs called dopamine receptor antagonists.

Urgent Care

The presence of migraine status requires immediate measures to alleviate the patient’s condition:

First of all, you need to create favorable conditions in the room: close the curtains, eliminate all extraneous noise.
A cold compress should be placed on the patient's head.
If an adult or child over 2 years of age is vomiting, an antiemetic drug - Droperidol or Cerucal - should be given.
If paracetamol or ibuprofen does not help relieve migraine symptoms, children over 2 years of age, adolescents and adults can be given an intramuscular injection of an NSAID (diclofenac, naproxen, ketoprofen) or administered rectally (indomethacin suppository).
To relieve agitation, you can inject diazepam (Seduxen) intramuscularly.

Prevention

Several medications can help prevent migraines when taken regularly. Even if a headache has already begun, it will likely be less severe and shorter if you use one of these drugs.

antidepressants such as amitriptyline;
birth control medications such as topiramate or valproate;
blood pressure medications such as metoprolol tartrate, propranolol, timolol and verapamil.

Before taking each of the above remedies, consultation with your doctor is required. All of these drugs have serious contraindications and side effects.

It is impossible to completely prevent migraines or status migrainosa. However, many migraine sufferers find that certain triggers, such as odors, allergens, and stress, trigger their headaches.

To prevent migraines, you need to avoid triggers:

Eat small meals throughout the day to avoid getting hungry.
Drink eight or more glasses of water a day to prevent dehydration.
If migraines are caused by insomnia, sleep hygiene techniques can help: airing the bedroom at night, taking a relaxing bath before bed, going to bed at the same time every day.
It is recommended to keep a log of events associated with the presence of migrainous status to help identify triggers and then avoid them as much as possible.

It is also advisable to check whether your thyroid hormones are in order, since hormonal imbalance often triggers migraines.

Migrainous status

Ivan Drozdov 03/30/2018 0 Comments

Migraine status is one continuous intense migraine attack or a series of pain attacks, accompanied by severe neurological symptoms and not going away for more than 3 days. In case of migraine status, timely medical assistance to the patient is important, otherwise the attack may become extremely severe. severe form complications - migraine stroke.

Symptoms of status migraine

An attack of status migraine begins with a bursting headache, the intensity of which steadily increases with the appearance of the following aggravating symptoms:

repeated vomiting, in which it is impossible to take painkillers and antiemetics orally;
dehydration as a result of repeated vomiting;
short-term visual disturbances - the appearance of bright flickering glare, a significant decrease in vision in one eye;
muscle weakness, difficulty moving;
emotional depression, apathy to what is happening;
the appearance of seizures as a sign of impaired brain activity - cerebral edema and oxygen deficiency;
clouding and loss of consciousness.

The appearance of the latter signs indicates serious disturbances in brain structures and the risk of developing stroke as a complication. In this case, the symptoms typical for migraine status are supplemented by signs of an aura, which is flickering in nature, periodically appearing and disappearing.

Treatment of status migraine

A condition with such severe symptoms is unacceptable self-treatment. If migraine status is suspected, the patient must be taken to the hospital to take prompt medication measures to reduce the intensity of the attack and prevent the development of ischemic stroke.

Depending on the severity of the pain syndrome and neurological symptoms, the patient may be prescribed conservative treatment the following drugs:

Medicines from the triptan group to relieve pain: an increased dose of Zolmitriptan or Sumatriptan (orally or nasally), which can be repeated after 4 hours.
Antiemetic drugs to reduce nausea and vomiting: intravenous injection of Metoclopramide followed by a drip of Dihydroergotamine.
Magnesium sulfate, diluted in physiological solution, is used in the form of droppers to prevent intoxication and dehydration during prolonged vomiting.
Antihistamines with sedative action: for a prolonged pain attack that is not relieved by anti-migraine drugs, Promethazine can be prescribed orally or intramuscularly.
Neurotics with antiemetic action: Chlorpromazine is prescribed in the form intravenous injections with preliminary injection of saline solution into the vein.
Glucocorticoids: Dexamethasone in the form of intravenous or intramuscular injections indicated for symptoms indicating swelling and hypoxia of brain structures.

The described drugs can be used as monotherapy or in combination as prescribed by the treating doctor, depending on the stage of the attack and the likelihood of developing the risks of complications. Treatment is carried out in a hospital under the strict supervision of specialized specialists, so that if the condition worsens, promptly respond and take resuscitation measures.

Emergency care for migraine status

With severe symptoms of migraine status, hospitalization in a hospital is necessary. Before the doctors arrive, the patient needs to be provided with urgent and effective assistance:

Place the patient in a room with dim lighting and maximum isolation from noise.
Place a damp towel on your head.
Children aged 2 to 16 years, if there is no effect from taking tableted Ibuprofen or Paracetamol, are given an intramuscular injection of Indomethacin or Diclofenac. To relieve seizures and nervous excitement, as well as maintain brain activity, Diazepam and Prednisolone can be used.
Adults during an acute attack should be given an increased dose of one of the triptan drugs. In special cases, it is possible to take Tramadol or other narcotic analgesics.
In case of painful vomiting, the patient needs to take an antiemetic in the form of tablets or spray - Metoclopramide, Droperidol or Validol.

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The described measures will alleviate the excruciating pain syndrome until doctors appear and will prevent complications of the attack in the form of a migraine heart attack or ischemic stroke.

Migraine – protocol for providing assistance at the EMS stage

G43.9 Migraine, unspecified

G43.2 Migrainous status

Main clinical symptoms

Migraine, unspecified

Cephalgia of moderate or severe intensity, beating, pulsating, in 60% of cases - unilateral, localized in the frontal, periorbital, temporal regions or hemicrania, aggravated by movement;
Nausea, vomiting;
Light and sound fear;
Vegetative disorders are possible.

Migrainous status

Migraine attack lasting more than 72 hours (light intervals lasting several hours are possible (excluding sleep).

Diagnostic measures

Taking anamnesis (simultaneously with diagnostic and therapeutic measures);
Examination by an ambulance doctor (paramedic) medical care or a doctor from a visiting emergency medical team of the appropriate profile;
General thermometry;
Registration of an electrocardiogram, interpretation, description and interpretation of electrocardiographic data.

Therapeutic measures

Migraine

In the presence of nausea, vomiting

Metoclopramide -10 mg IM (slow IV bolus);

In the presence of psychomotor excitement and vomiting:

With pronounced neuroticism patient:

Medical evacuation according to indications (see “General tactical measures”).

Migrainous status

Providing a medical and protective regime;
Horizontal position with an elevated position of the upper half of the body;
Aspirin -500 mg (crushed) orally (sublingually) or, and

NSAIDs IM (slow IV bolus) or, and

Catheterization of the cubital or other peripheral veins;
Dexamethasone - 16 mg IV drip or, and

Magnesium sulfate - 2500 mg IV drip or infusion pump, at a rate of 30 mg/kg/hour on site and during medical evacuation;

In the presence of vomiting:

Metoclopramide -10 mg IV bolus slowly;

In the presence of psychomotor excitement and vomiting:

Droperidol - 1.25-2.5 mg IV bolus slowly;

With pronounced neuroticism patient:

Diazepam -10 mg IM (slow IV bolus);

Medical evacuation (see “General tactical measures”).

General tactical measures

Migraine

If there is a history of migraine, the duration of pain is less than 72 hours, the usual (for this patient) nature of the headache, the effectiveness of the therapy, or the patient or his legal representative refuses hospitalization:

For teams of all profiles:

Carry out therapy;
If you refuse medical evacuation:

Fill out a refusal of medical evacuation in the EMS call card;

Give recommendations:

bed rest (at least 2 hours);
elimination of stress: physical and sensory;
consultation with a neurologist;

Offer an active call to the local therapist;
If the patient or his legal representative agrees to actively call the local therapist:

transfer an active call to the clinic through a nurse (paramedic) to receive calls and transfer them to field teams.

From public places and for social reasons:

For teams of all profiles:

Carry out therapy;

For first-time headaches or if the pain lasts more than 72 hours or the nature of the headache is unusual (for this patient) or if there is no effect of the therapy:

For teams of all profiles:

Carry out therapy;
Perform medical evacuation.

Migrainous status

For teams of all profiles:

Provide therapy;
Perform medical evacuation.

Migraine. Migrainous status

Migraine. Migrainous status.

Migraine- a disease caused by hereditarily determined dysfunction of vasomotor regulation, manifested in the form of periodically recurring attacks of headache, usually in one half of the head.

Clinically characterized by throbbing pain, usually covering half of the head and accompanied by nausea, vomiting, as well as poor tolerance to sounds and bright light. The duration of the attack varies from 4 hours to 3 days. The pain reaches its maximum within a few minutes or hours. Aura at classic migraine occurs in the form of short-term visual, motor, sensory and mental disorders, which usually last several minutes, preceding or combined with a headache.

It is often possible to determine provoking factors, which include stress, hunger, fatigue, lack or excess sleep, physical exertion, bright light, alcohol consumption, pregnancy, menstruation, taking oral contraceptives, certain types of food and nutritional supplements. Migraines predominantly affect women; The first attack occurs before the age of 30.

The diagnosis of migraine should be based on the following:

onset of the disease in prepuberty, puberty and adolescence;
an indication of the hereditary-familial nature of the disease;
paroxysmal nature and frequency of headaches;
attacks of headaches have a unilateral, predominantly frontotemporo-parietal localization, often accompanied by peculiar transient visual, vestibular, sensory, motor or vegetovisceral manifestations;
good health of patients in pauses between attacks, absence of any pronounced symptoms of organic damage to the nervous system;
presence of signs of vegetative-vascular dystonia;
beneficial effects of ergot preparations.

Migrainous status is a severe variant of the attack, in which painful attacks occur one after another, with periods of less intense pain between individual attacks. The clinical picture is dominated by adynamia, pallor, meningeal and cerebral symptoms, disturbances of consciousness or mental disorders, uncontrollable vomiting and increased body temperature.

Treatment. Therapeutic measures for migraine are based on three directions: 1) relief of a single painful attack; 2) treatment of status migraine; 3) preventive treatment in the interictal period.

There is no single scheme in the treatment of migraine. The most effective and pathogenetically substantiated means for relieving a pain attack are ergot preparations, having a vasoconstrictor effect: ergotamine hydrotartate 0.001 g under the tongue (after 20 minutes you can repeat the dose, but no more than three tablets per day); 0.2% solution dihydroergotamine or 0.1% solution dihydroergotoxin 15-20 drops inside; redergin one tablet 3 times a day; ditamine 25 drops 2-3 times a day or 1 tablet 2 times a day.

Since caffeine enhances the resorption of ergotamine and smoothes it side effect(nausea and abdominal pain) complex preparations containing caffeine and ergotamine are currently used ( caffeamine, cofergot, rigetamine, ankofen). At the beginning of an attack, take 1-2 tablets of any of the drugs in this group, and if the attack does not stop, the drug is repeated, but not more than 6 tablets per day. A serotonin analogue can be used in treatment - sumatriptan 100 mg, repeated after 2 hours at the same dose.

Migrainous status is a direct indication for hospitalization of the patient in a hospital (neurological department) for emergency diagnostic and therapeutic measures. In the hospital, a spinal puncture should be performed with the slow removal of 4-5 ml of cerebrospinal fluid. In addition, prednisolone is administered intravenously (at a dose of 60-120 mg), drip ergotamine, dehydrating agents, antipsychotics(more often aminazine), tranquilizers (Relanium) to relieve excitement. Well proven intravenous administration medicinal mixture (in a lying position) consisting of 1 ml of caffeine + 4 ml of Relanium + 60 mg of prednisolone + isotonic sodium chloride solution 3-13 ml. If there is no effect, the administration of the specified medicinal mixture is repeated (after 2-3 hours). Intractable status migraine within 12 hours requires resuscitation measures(intravenous administration of drugs for anesthesia).

17.Observation and care of the patient during

Observation is a set of measures aimed at dynamic monitoring of the patient’s condition and the results of laboratory and instrumental studies.

The surveillance system is installed from the moment of the initial medical examination. At the site of first aid and during transport of the patient to the hospital, observation is limited to recording changes in the degree of disturbance of consciousness, pulse, blood pressure, breathing pattern, as well as the defining neurological symptom - changes in the pupils.

Unlike other patients, patients with impaired consciousness require constant monitoring directly by the staff on duty. This is dictated by two reasons:

The most important indicators of the dynamics of the condition of such patients - changes in the level of depression of consciousness and changes in the pupils - cannot be controlled by hardware and can only be detected by specially trained personnel.
Patients with sudden and prolonged changes in consciousness (delirium, delirium) can commit actions that are dangerous for themselves and for others.

It follows from this that this category of patients should be located in premises where on-duty personnel are constantly located. The observation system includes two categories of closely interrelated activities: intensive care and special patient care.

Intensive care measures include vital correction important functions(breathing, blood circulation); pathogenetic treatment, systematic monitoring of the state of consciousness and pupils; control and maintenance of fluid, electrolyte balance, as well as blood gas composition and acid-base balance at an optimal level; adequate nutrition; prevention (early recognition) of complications of the underlying disease.

Special care. This includes general hygiene measures (sanitation of the oral cavity, prevention of aspiration of saliva and vomit, prevention of infection and trophic changes in the conjunctiva and cornea, treatment skin); creating the necessary position for the patient in bed; maintaining the constant functioning of infusion systems and probes; regular administration of necessary medications; control of diuresis and bowel function.

The effectiveness of the listed comprehensive measures, primarily the possibility of immediate registration of life-threatening deterioration of the patient’s condition, is ensured by a certain regime and regular implementation of individual components of the observation system (Table 22).

Regulation of surveillance regimes in the process

intensive care and nursing

with a depressed consciousness ( B.S. Vilensky, 1986)