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Postural Status Migrainosus
Dear Dr,
My close friend is in the hospital with what has been diagnosed as Status Migrainosus. She has a history of Migraines that come around the time of her menstrual cycle. What separates this from the others is that it is intense, (does not go away with meds, she has had Imitrex and another med is is currently on Morphine which is allowing her to sleep) but mostly because it is postural. If she is lying down it is tolerable, the moment she stands or attempts to sit up she has intense pain. The MRI was clear except for a small area which they related to the headache. Do you have any suggestions or ideas for easing her suffering?
Thank you for your help!
My close friend is in the hospital with what has been diagnosed as Status Migrainosus. She has a history of Migraines that come around the time of her menstrual cycle. What separates this from the others is that it is intense, (does not go away with meds, she has had Imitrex and another med is is currently on Morphine which is allowing her to sleep) but mostly because it is postural. If she is lying down it is tolerable, the moment she stands or attempts to sit up she has intense pain. The MRI was clear except for a small area which they related to the headache. Do you have any suggestions or ideas for easing her suffering?
Thank you for your help!
Thank you for your advice and you were spot on. The diagnosis came in as spontaneous cerebrospinal fluid leakage and she will be treated with a patch. Appreciate your help!!! All the Best!!
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
As you have probably already know, status migrainosus is a condition where a migraine last longer then 72 hours without relief from the usual medications. Often times these headaches become very difficult to treat and keep getting worse day after day ultimately forcing a person to go to the hospital.
The key to treating these headaches is to "break" the cycle. They way we usually treat status migrainoses is with IV medications. We usually use a combination of 3 medications, and in hospitals it has been given the term "headache cocktail". The combination most commonly used is intravenous Depacon ( also a seizure medication), Magnesium sulfate plus any other anti nausea medication like Reglan, or compazine. These are usually given together, and if needed repeated a second or third time until the headache breaks.
We usually don't encourage the use of opiods like morphine to treat such headaches, as they just act as a band aid. The effect wears of quickly and the headache returns may be even worse then before, what we call a "rebound" headache.
That said, the fact that it always gets worse when she stands up is of concern. Did she have a recent spinal tap or lumbar puncture?? or any history of trauma??
Usually headaches that get worse with standing up are due to low pressure. There can some times be a fluid leak from around the spinal cord, which can occur spontaneously or after a procedure like a spinal tap, which can decrease the pressure around our brain and spinal cord. When one stands up, everything sags down, resulting in a headache. This would have shown up on an MRI. It is treated with a blood patch ( the patients blood is injected in to the fluid space around the spinal cord, and the blood cells go and clot of the site of the leak).
Obviously when any one is feeling unwell and had a really bad headache, the headache can get worse with any movement. If it completely resolved when lying down, I would strongly consider a low pressure headache as described above.
I hope this helps. Good luck!!
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
As you have probably already know, status migrainosus is a condition where a migraine last longer then 72 hours without relief from the usual medications. Often times these headaches become very difficult to treat and keep getting worse day after day ultimately forcing a person to go to the hospital.
The key to treating these headaches is to "break" the cycle. They way we usually treat status migrainoses is with IV medications. We usually use a combination of 3 medications, and in hospitals it has been given the term "headache cocktail". The combination most commonly used is intravenous Depacon ( also a seizure medication), Magnesium sulfate plus any other anti nausea medication like Reglan, or compazine. These are usually given together, and if needed repeated a second or third time until the headache breaks.
We usually don't encourage the use of opiods like morphine to treat such headaches, as they just act as a band aid. The effect wears of quickly and the headache returns may be even worse then before, what we call a "rebound" headache.
That said, the fact that it always gets worse when she stands up is of concern. Did she have a recent spinal tap or lumbar puncture?? or any history of trauma??
Usually headaches that get worse with standing up are due to low pressure. There can some times be a fluid leak from around the spinal cord, which can occur spontaneously or after a procedure like a spinal tap, which can decrease the pressure around our brain and spinal cord. When one stands up, everything sags down, resulting in a headache. This would have shown up on an MRI. It is treated with a blood patch ( the patients blood is injected in to the fluid space around the spinal cord, and the blood cells go and clot of the site of the leak).
Obviously when any one is feeling unwell and had a really bad headache, the headache can get worse with any movement. If it completely resolved when lying down, I would strongly consider a low pressure headache as described above.
I hope this helps. Good luck!!
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