Characterization of adult patients with status migrainosus in a tertiary hospital in Colombia, 2019-2021

Abstract text (incl. figure legends and references)

Objective: To describe demographic and clinical characteristics, treatment strategies, use of diagnostic tests, evolution in hospitalization and readmissions of patients with status migrainosus (SM) who required inpatient management.

Methods: Retrospective and observational study analysing patients who presented SM between 2019 and 2021 at a tertiary hospital in Colombia.

Results: We identified 170 SM in 135 subjects. 91% were women with a median age of 34 years. 79,9% had migraine without aura. 79,9% had episodic migraine. 22,9% were taken prophylactic medication. The median duration of headache before admission to emergency department (ED) was 120 hours. 96,5% with level pain ≥7/10. Pulsatile headache (86,5%), worsening of pain with physical activity (87,1%), photophobia (94,7%) and nausea (90%) were the most common symptoms. Pregnancy was present in 8,9%. It was more probable that pregnant women received opioids for their treatment (p=0,0002). 18,2% had prior medication overuse; subjects with medication overuse were less probable to improve with the first line of treatment at ED (p=0.02). Only 34,1% of SM improved with treatment at ED. 81% of SM who improved at ED required at least three medications. Improvement with treatment at ED was less probable if subjects had received opioids before admission (p=0,002). All participants treated by neurologists received a combination of drugs. 52% of them required at least 2 lines of treatment. The most used medications by neurology were magnesium sulfate, ketorolac and triptans. 68,2% received at least one diagnostic test and 94,8% of them were normal. Median length of hospital stay was 1,96 days. 69,4% were discharged pain-free. 12,3% were readmitted to ED due to headache within the next week.

Conclusion: SM is a disabling condition. SM requires to be treated with drug combinations with synergic mechanisms of action, which can lead to freedom of pain in most patients. Opioids should be avoided in the treatment of SM.