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Migraine status
Last reviewed: 23.04.2024
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Migraine status - more pronounced and prolonged in comparison with the usual attack of migraine symptoms.
The development of migraine is due to a hereditary predisposition to inadequate regulation of the tone of the vessels of the brain (spasm and subsequent vasodilation) in response to the action of various factors of the external and internal environment. In the genesis of the attack, the leading role is played by such neuropeptides as serotonin and dopamine, which activates the release of inflammatory cytokines by endothelial cells, thrombocytes, etc., which is accompanied by vasodilation and perivascular reaction.
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Symptoms of migraineal status
Migraine status is characterized by such symptoms: severe headache, nausea, vomiting, photophobia, temporary visual impairment, hyperesthesia of the senses. Aura is detected in less than 20% of cases.
Where does it hurt?
What's bothering you?
Diagnosis of migraineal status
Many hours of headache, unlike a normal migraine attack, does not stop after sleep. Vomiting has a debilitating nature and appears regardless of the time of day against a background of headache. There are photopsy, blurred vision, amblyopia. The duration of visual impairment is several tens of minutes.
What do need to examine?
Who to contact?
Emergency medical care with migraine status
The patient is placed in a darkened room isolated from the noise. In some cases, pain relief is achieved by cold compresses on the head. For cupping migrenoznogo status with ineffectiveness of paracetamol or ibuprofen in children over 2 years and adolescents use NSAID intramuscularly (diclofenac, naproxen, ketoprofen) or per rectum (indomethacin), as well as antihistamines. Teenagers may prescribe ketorolac or tramadol. When excited intramuscularly administered diazepam (seduxen). Possible use of prednisolone and furosemide (Lasix) for dehydration of the brain. When vomiting in children older than 2 years and adolescents appoint prochlorperasin (compassin), metoclopramide (cerucal) or droperidol.
In adolescents, the use of selective 5-HT1 receptor agonists such as sumatriptan, zolmitriptan, noratriptan, and rizatriptany eletriptan (rilpax) may be used to increase the activity of the serotonergic system (which is accompanied by the normalization of the vascular tone of the brain). These medicines, as well as ergot preparations (ergometrine tartrate, etc.) are not prescribed for children.
Children with migraine status, in contrast to patients with normal migraine attacks, should be hospitalized in the neurological department. Prevention of migraine attacks in these patients is carried out with valproic acid (depakin) or sodium divalpsex (a combination of sodium valproate and valproic acid). In addition, for this purpose, the use of antidepressants and beta-blockers, or metisergid. Limit the frequency and duration of migraine attacks clonidine and calcium channel blockers (nimodipine verapamil, nifedepine).