Sometimes people experience abnormal migraine complications, which might be more painful and/or harder to treat than typical migraine attacks. This includes:
- Status migraine / status migrainosus
- Persistent aura symptoms
- Migraine-induced stroke
- Seizure triggered by aura symptoms
Migraine complications should be investigated by your neurologist, to understand if it is caused by an underlying condition.
Status Migraine / Status Migrainosus
A status migraine or status migrainosus refers to a debilitating migraine attack, either with or without aura, that lasts over 72 hours. The head pain has the same symptoms as a typical migraine attack (throbbing pain, nausea, sensitivity to light and sounds), however the unrelenting nature of the headache makes it much more difficult to manage. During status migrainosus, a person’s usual migraine treatments may be ineffectual or less effective, with symptoms returning a few hours after taking medication. In severe cases, people may need to be treated at hospital during the attack – they might need a cannula in their arm to administer fluids or stronger pain medication. The best way to manage status migrainosus is to manage known triggers, discuss preventative medications with your doctor and have a plan if a migraine attack is unresponsive to your usual initial treatment.
Persistent aura without infarction (tissue death in the brain)
For some people with migraine, aura symptoms are experienced continuously for over a week. Aura symptoms may be visual, sensory, affecting speech/language, impeding strength (i.e., hemiplegic migraine), related to brainstem function, or any combination of these. Persistent aura without infarction means that despite the persistence of symptoms, neuroimaging shows there has been no tissue death in the brain. While this is a rare complication of migraine, there have been cases of persistent aura reported that have lasted for months.
Migrainous infarction (migraine-induced stroke)
When aura symptoms persist for over 60 minutes, this could be a result of migraine-induced stroke (migrainous infarction). A stroke is a result of lack of blood to a certain area of the brain, leading to brain cell death and resulting in persistent or permanent aura symptoms. The area of brain tissue affected by stroke can be confirmed by neuroimaging.
Migraine aura-triggered seizure
A seizure occurring during, or in the hour following, a migraine attack is referred to as a migraine aura-triggered seizure. The seizure is thought to occur due to electrical changes in the brain associated with a person’s aura symptoms. Both migraine aura and seizures/epilepsy are complex but common neurological disorders and can usually be well managed with medications. The treating doctor may use the same medication to treat both conditions.
Migraine complications happen for several reasons. There may be an underlying condition triggered by your migraine attack, or a negative reaction to medication. See the following articles for more information on migraine and related conditions/headache types that could cause complications.
Migraine – a common and distressing disorder – a detailed introduction and overview of migraine
Treatment Options – general treatment options for migraine
Stroke – Brain Foundation
Medication Overuse Headache – brief definition
Medication Overuse Headache – article from Migraine & Headache Awareness Week 2019