Clinical Features of Children Diagnosed With Status Migrainosus

Children, adolescents, and young adults with status migrainosus have distinct clinical features and an unfavorable short-term prognosis, according to study results published in Headache.  

The aim of this retrospective, clinical cohort study was to characterize clinical features and assess the short-term prognosis of children, adolescents, and young adults with a diagnosis of status migrainosus. Patients were included in this study if they had ≥1 short-term follow-up appointment between 1 to 3 months after initial visit for migraine at the Cincinnati Children’s Headache Center. Data included demographic information, primary International Classification of Headache Disorders diagnosis, clinical records, and lifestyle habits. Depression and anxiety symptoms were assessed at the follow-up appointment. Status migrainosus was defined as a migraine lasting ≥72 hours.

Of the 5316 patients included in this study, 10.5% were diagnosed with status migrainosus. Based on multivariate logistic regression, the odds of having a history of status migrainosus were greater for older children than younger children (odds ratio [OR], 1.13; 95% CI, 1.09-1.17; P <.0001), greater for having migraine with aura than without (OR, 1.30; 95% CI, 1.03-1.65; P =.03), greater for having a medication overuse headache at appointment 1 than not having a medication overuse headache (OR, 1.72; 95% CI, 1.30-2.28; P =.0001), and greater for patients with higher severity of headaches (OR, 1.08; 95% CI, 1.02-1.15; P =.009). Analyzing the outcomes of diagnoses, at the follow-up appointment, 15.2% of patients who had a history of status migrainosus and 11.1% of patients without that diagnosis experienced an increase in the number of headaches to ≥4 per month (P =.004).

Limitations of this study include the inability to assess the timing and causation of the migraines, potential errors in the coding of the diagnosis in database, and the lack of external validity.

“It appears likely that patients with [status migrainosus] represent not only a distinct subgroup from a phenotypic standpoint, but that they also may differ from the general migraine population from a biological standpoint,” researchers concluded. They also suggested that further characterization of this population is needed to better understand disease biology and treatment algorithms.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Orr SL, Turner A, Kabbouche MA, et al. The profile and prognosis of youth with status migrainosus: results from an observational study [published online February 7, 2020]. Headache. doi: 10.1111/head.13767