Status Migrainosus

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Nicola Tambasco - One of the best experts on this subject based on the ideXlab platform.

Tomor Harnod - One of the best experts on this subject based on the ideXlab platform.

  • Risk and Predisposing Factors for Suicide Attempts in Patients with Migraine and Status Migrainosus: A Nationwide Population-Based Study
    Journal of Clinical Medicine, 2018
    Co-Authors: Tomor Harnod
    Abstract:

    Objective: To investigate the risk and risk factors for suicide attempt by patients with regular migraines (RM) and Status Migrainosus (SM) in Taiwan. Methods: We analyzed a subset of the National Health Insurance Research Database of Taiwan and enrolled patients (≥20 years old) who had ever received a diagnosis of RM or SM between 2000 and 2012 in the RM and SM cohort. The SM cohort included 13,605 patients, the RM cohort had 21,485 patients, and the comparison cohort contained approximately four times that many patients. We calculated the adjusted hazard ratios and 95% confidence intervals (CI) for suicide attempts after adjusting for age, sex, monthly income, urbanization level, occupation, and comorbidities. Results: The SM cohort had a 1.81-fold risk of attempting suicide (95% CI = 1.14–2.89) compared to the comparison cohort. Other factors that predispose patients with SM to attempt suicide include the following: female sex, relatively young age (

  • risk and predisposing factors for suicide attempts in patients with migraine and Status Migrainosus a nationwide population based study
    Journal of Clinical Medicine, 2018
    Co-Authors: Tomor Harnod
    Abstract:

    Objective: To investigate the risk and risk factors for suicide attempt by patients with regular migraines (RM) and Status Migrainosus (SM) in Taiwan. Methods: We analyzed a subset of the National Health Insurance Research Database of Taiwan and enrolled patients (≥20 years old) who had ever received a diagnosis of RM or SM between 2000 and 2012 in the RM and SM cohort. The SM cohort included 13,605 patients, the RM cohort had 21,485 patients, and the comparison cohort contained approximately four times that many patients. We calculated the adjusted hazard ratios and 95% confidence intervals (CI) for suicide attempts after adjusting for age, sex, monthly income, urbanization level, occupation, and comorbidities. Results: The SM cohort had a 1.81-fold risk of attempting suicide (95% CI = 1.14–2.89) compared to the comparison cohort. Other factors that predispose patients with SM to attempt suicide include the following: female sex, relatively young age (<50 years old), and low monthly income (<15,000 New Taiwan Dollars, approximately equivalent to 495 US Dollars). Additionally, the risk of attempting suicide only increased in patients who had been diagnosed with SM for longer than five years. Conclusion: SM is associated with a higher risk for suicide attempt in migraineurs in Taiwan. This finding is important to clinicians and government officials seeking to prevent patients from attempting suicide in Taiwan and other similar East Asian countries.

  • Survival outcome and mortality rate in patients with migraine: a population-based cohort study
    Journal of Headache and Pain, 2018
    Co-Authors: Tomor Harnod
    Abstract:

    Whether the patients with migraine have an elevated mortality risk in Taiwan is unclear. We analyzed a subset of the National Health Insurance Research Database of Taiwan and enrolled patients (≥20 years old) who received a diagnosis of migraine between 2000 and 2012. The migraine cohort was further divided into the ones ever with Status Migrainosus (SM) and non-Status migraine (NM) subcohort and compared with a 1:4 age-, sex-, comorbidity-, and index date-matched comparison cohort. We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for subsequent mortality risk after adjustment for age, sex, and comorbidities. Compared with the comparison cohort, the corresponding aHRs for mortality were 0.81 (95% CI = 0.76–0.87), 0.89 (95% CI = 0.80–0.98), and 0.78 (95% CI = 0.72–0.84) in the total migraine, SM, and NM cohorts, respectively. SM, male sex, comorbid alcohol-related illness, depression, and mental disorders were identified as risk factors for subsequent mortality. Comorbid alcohol-related illness significantly increased the mortality risk in patients with migraine. Taiwanese patients with migraine require comprehensive and universal medical care. These patients would benefit from controlling their migraines and reducing the subsequent mortality.

Marielle A Kabbouche - One of the best experts on this subject based on the ideXlab platform.

  • the profile and prognosis of youth with Status Migrainosus results from an observational study
    Headache, 2020
    Co-Authors: Abigail Turner, Marielle A Kabbouche, Paul S Horn, Hope L Obrien, Joanne Kacperski, Susan L Lecates
    Abstract:

    OBJECTIVE: To characterize the clinical features of a large sample of children, adolescents, and young adults with a history of Status Migrainosus (SM) and to describe their short-term prognosis. BACKGROUND: Data on the clinical characteristics of children and adolescents with SM are sparse and little is known about the prognosis of this population. METHODS: This was a retrospective clinical cohort study that included patients from the Cincinnati Children's Headache Center if they had a diagnosis of migraine and data available for a 1-3 months follow-up interval. Data extracted from the initial interval visit (visit A) included: age, sex, race, migraine diagnosis, SM history, chronic migraine, medication overuse headache (MOH), body mass index (BMI), headache frequency, headache severity, disability, allodynia and lifestyle habits: caffeine intake, meal skipping, sleep duration, exercise frequency, and fluid intake. Data extracted from the initial consultation visit included: months with headache at initial consultation visit, patient endorsing "feeling depressed" and anxiety symptoms. Headache frequency and visit type were also measured at the second visit (visit B) in the follow-up interval. A multivariate logistic regression model with a backward elimination procedure was created to model the odds of having a diagnosis of SM using the cross-sectional predictor variables above. Second, chi-square tests were used to compare the proportion of patients with SM to the proportion of patients without SM who had each of the following outcomes in the short-term follow-up window: treatment response (50% or greater reduction in headache frequency), overall reduction in headache frequency (reduction of 1 or more headache days/month), minimal change in headache frequency (increase in 0-3 headache days/month), and clinical worsening (increase in 4 or more headache days/month). RESULTS: A total of 5316 youth with migraine were included and 559 (10.5%) had a history of SM. In the multivariate logistic regression model, predictors significantly associated with SM were: older age (OR = 1.13, 95% CI = 1.09-1.17, P < .0001), migraine with aura (MWA) (OR = 1.30, 95% CI = 1.03-1.65, P = .03), MOH (OR = 1.72, 95% CI = 1.30-2.28, P = .0001), headache frequency (OR = 0.99, 95% CI = 0.97-0.99, P = .030), higher headache severity (OR = 1.08, 95% CI = 1.02-1.15, P = .009), months with headache at initial consultation (OR = 1.00, 95% CI = 1.00-1.01, P = .042), and admission to infusion center at visit B (OR = 2.27, 95% CI = 1.38-3.72, P = .001). Patients with a history of SM were more likely to experience an increase in 4 or more headache days per month at follow-up: 15.2% as compared to 11.1% of those without SM, chi(2) (1, n = 5316) = 8.172, P = .0043. CONCLUSIONS: Youth with SM represent a distinct subgroup of the migraine population and have an unfavorable short-term prognosis.

  • Predictors of Short-Term Prognosis While in Pediatric Headache Care: An Observational Study.
    Headache, 2019
    Co-Authors: Abigail Turner, Marielle A Kabbouche, Paul S Horn, Joanne Kacperski, Susan L Lecates, Hope L. O’brien, Shannon White, Jessica Weberding, Mimi N. Miller
    Abstract:

    To characterize the short-term prognosis of a clinical population of pediatric and young adult patients with migraine and explore predictors of clinical worsening while in care. This was a retrospective study of all migraine patients seen at the Cincinnati Children's Hospital Headache Center from 09/01/2006 to 12/31/2017, who had at least 1 follow-up visit within 1-3 months of the index visit analyzed. Included data were: age, sex, race, primary ICHD diagnosis, chronic migraine, medication overuse, history of Status Migrainosus, BMI percentile, headache frequency, headache severity, PedMIDAS score, allodynia, preventive treatment type, lifestyle habits, disease duration, depressive and anxiety symptoms. Clinical worsening was defined as an increase in 4 or more headache days per month between the index visit and the follow-up visit. Data for 13,160 visit pairs (index and follow-up), from 5316 patients, were analyzed. Clinical worsening occurred in only 14.5% (1908/13,160), whereas a reduction in headache frequency was observed in 56.8% of visit intervals (7475/13,160), with 34.8% of the intervals (4580/13,160) showing a reduction of 50% or greater. The change in headache frequency was minimal (increase in 0-3 headaches/month) in 28.7% of intervals (3737/13,160). In the multivariable model, the odds of worsening were significantly higher with increasing age, female sex, chronic migraine, Status Migrainosus, depressive symptoms, higher PedMIDAS scores, and use of nutraceuticals, whereas the odds of worsening were lower for summer visits, caffeine drinkers, higher headache frequencies, and use of pharmaceuticals. The majority of pediatric patients who receive multimodal interdisciplinary care for migraine improve over time. Our findings highlight a set of clinical features that may help in identifying specific factors that may contribute to an unfavorable short-term prognosis. © 2019 American Headache Society.

  • The optimal management of headaches in children and adolescents
    Therapeutic Advances in Neurological Disorders, 2015
    Co-Authors: Joanne Kacperski, Marielle A Kabbouche, Hope L. O’brien, Jessica Weberding
    Abstract:

    The recognition of the diagnosis of migraine in children is increasing. Early and aggressive treatment of migraine in this population with the use of over-the-counter medications has proven effective. The off-label use of many migraine-specific medications is often accepted in the absence of sufficient evidenced-based trials. Mild to severe cases of migraine should be treated with nonsteroidal anti-inflammatory drugs, with triptans used in moderate to severe headaches unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine [DHE] should be used for Status Migrainosus, preferably in the hospital setting. Antiemetics that have antidopaminergic properties can be helpful in patients with associated symptoms of nausea and vomiting through their action on central migraine generation. Furthermore, patients and families should be educated on nonpharmacologic management such as lifestyle modification and avoidance of triggers that can prevent episodic migraine.

  • Pediatric Inpatient Headache Therapy: What is Available.
    Headache, 2015
    Co-Authors: Marielle A Kabbouche
    Abstract:

    Status Migrainosus is defined by the international classification of headache disorders (ICHD) criteria as a debilitating migraine lasting more then 72 hours. The epidemiology of Status Migrainosus is still unknown in adult and children, and frequently underdiagnosed. Children and adolescents often end up in the emergency room with an intractable headache that failed outpatient therapy. Six to seven percent of these children do not respond to acute infusion therapy and require hospitalization. It is imperative that more aggressive therapy is considered when patients are affected by a severe intractable headache to prevent further disability and returning the child to baseline activity. Multiple therapies are available for adults and children. Studies for acute therapy in the emergency room are available in adults and pediatric groups. Small studies are available for inpatient therapy in children and, along with available therapies for children and adolescents, are described in this review. A review of the literature shows growing evidence regarding the use of dihydroergotamine intravenously once patients are hospitalized. Effectiveness and safety have been proven in the last decades in adults and small studies in the pediatric populations.

  • Management of Pediatric Migraine Headache in the Emergency Room and Infusion Center
    Headache, 2015
    Co-Authors: Marielle A Kabbouche
    Abstract:

    Migraine is a common disorder that starts at an early age and takes a variable pattern from intermittent to chronic headache with several exacerbations throughout a lifetime. Children and adolescents are significantly affected. If an acute headache is not aborted by outpatient migraine therapy, it often causes severe disability, preventing the child from attending school and social events. Treating the acute severe headache aggressively helps prevent prolonged disability as well as possible chronification. Multiple medications are available, mostly for the outpatient management of an attack and include the use of over-the-counter anti-inflammatory medications as well as prescribed medications in the triptan group. These therapies do sometime fail and the exacerbation can last from days to weeks. If the headache lasts 72 hours or longer it will fall in the category of Status Migrainosus. Status Migrainosus is described as a severe disabling headache lasting 72 hours or more by the ICHD3 criteria. Disability is a major issue in children and adolescents and aggressive acute measures are to be taken to control it as soon as possible. Early aggressive intravenous therapy can be very effective in breaking the attack and allowing the child to be quickly back to normal functioning. This article reviews what is available for the treatment of pediatric primary headaches in the emergency room.

Giuseppe Nappi - One of the best experts on this subject based on the ideXlab platform.

  • estradiol supplementation modulates neuroendocrine response to m chlorophenylpiperazine in menstrual Status Migrainosus triggered by oral contraception free interval
    Human Reproduction, 2005
    Co-Authors: R E Nappi, Grazia Sances, Benedetta Brundu, S De Taddei, Arianna Sommacal, Natascia Ghiotto, Franco Polatti, Giuseppe Nappi
    Abstract:

    Background: Migraine triggered by oral contraception (OC)-free interval is very common and may be extremely severe long-lasting and poorly responsive to analgesics (Status Migrainosus). The serotoninergic (5-HT) system is crucially involved in pain threshold and it is sensitive to estradiol (E(-2)). Therefore we aimed to assess neuroendocrine correlates of OC Status Migrainosus in response to the direct central 5-HT agonist meta-chlorophenylpiperazine (m-CPP) and to test the effect of transdermal E(-2) supplementation of the OC-free interval. Methods: Clinical investigative protocol single-blinded placebo-controlled treatment. Oral m-CPP (0.5 mg/kg body weight) challenge test was performed in 10 patients with Status Migrainosus occurring within 48 h of the discontinuation of a monophasic pill (30 µg of ethinyl estradiol and 150 µg of desogestrel) and in six healthy women assuming the same OC as controls. In a consecutive menstrual cycle patients with OC Status Migrainosus underwent to the same test after they were blindly treated with 2.0 g of percutaneous E(-2) gel or placebo daily during the pill-free interval. Plasma prolactin and cortisol levels and clinical characteristics of migraine attacks were evaluated. Results: Women with OC-Status Migrainosus showed a derangement of prolactin release (F = 4.8; P < 0.01) and a lack of cortisol response (F = 5.8; P < 0.001) after m-CPP in comparison with controls. Transdermal E(-2) during the pill-free interval significantly restored prolactin (F = 2.8; P < 0.01) and cortisol responses (F = 18.9; P < 0.001) against placebo and positively affected the duration (P < 0.001) the number of hours in which pain intensity prohibits daily activity (P < 0.001) the episodes of vomiting (P < 0.001) and the consumption of analgesics (P < 0.001). Conclusions: Status Migrainosus triggered by OC-free interval is associated with impaired prolactin and cortisol responses following m-CPP challenge. Transdermal E(-2) supplementation is able to restore neuroendocrine response to this specific 5-HT agent exerting a positive clinical effect on the course of menstrually related migraine. (authors)

  • neuroendocrine response to the serotonin agonist m chlorophenylpiperazine in women with menstrual Status Migrainosus
    Neuroendocrinology, 2003
    Co-Authors: Rossella E Nappi, Grazia Sances, Benedetta Brundu, Natascia Ghiotto, Franco Polatti, Silvia Detaddei, Caterina Biancardi, Giuseppe Nappi
    Abstract:

    To assess the neuroendocrine correlates of menstrual Status Migrainosus (MSM) and menstrual migraine (MM), we evaluated the prolactin (PRL) and cortisol responses to the direct central serotoninergic

Mandip S. Dhamoon - One of the best experts on this subject based on the ideXlab platform.

  • Impact of Aura and Status Migrainosus on Readmissions for Vascular Events After Migraine Admission
    Headache, 2018
    Co-Authors: Lili Velickovic Ostojic, John W. Liang, Huma U. Sheikh, Mandip S. Dhamoon
    Abstract:

    -To estimate readmission rates for acute ischemic stroke (AIS), transient ischemic attack (TIA), subarachnoid hemorrhage, and intracerebral hemorrhage after an index admission for migraine, using nationally representative data. -The Nationwide Readmissions Database was designed to analyze readmissions for all payers and uninsured, with data on >14 million US admissions in 2013. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify index migraine admissions with and without aura or Status Migrainosus, and readmissions for cerebrovascular events. Cox proportional hazards regression was performed for each outcome with aura and Status Migrainosus as main predictors, adjusting for age and vascular risk factors. -Out of 12,448 index admissions for migraine, 9972 (80.1%) were women, mean age was 45.5 ± 14.8 years, aura was present in 3038 (24.41%), and Status Migrainosus in 1798 (14.44%). The 30-day readmission rate (per 100,000 index admissions) was 154 for ischemic stroke, 86 for TIA, 42 for subarachnoid hemorrhage, and 17 for intracranial hemorrhage. In unadjusted models, aura was significantly associated with TIA (hazard ratio 2.43, 95% CI 1.39-4.24), but not AIS (1.26, 0.73-2.18), intracranial hemorrhage (1.86, 0.45-7.79) or subarachnoid hemorrhage (1.85, 0.44-7.75). When adjusting for age and vascular risk factors, aura remained significantly associated with TIA (2.13, 1.22-3.74). Status, in adjusted models, was significantly associated with subarachnoid hemorrhage readmission (4.83, 1.09-21.42). -In this large, nationally representative retrospective cohort study, migraine admission with aura was independently associated with TIA readmission, and Status Migrainosus was independently associated with subarachnoid hemorrhage. Further research would clarify the role of misdiagnosis and causal relationships underlying these strong associations. © 2018 American Headache Society.

  • abstract tmp49 impact of aura and Status Migrainosus on readmissions for vascular events after migraine admission
    Stroke, 2018
    Co-Authors: Lili Velickovic Ostojic, John W. Liang, Huma U. Sheikh, Mandip S. Dhamoon
    Abstract:

    Background: Multiple studies have identified migraine as a risk factor for stroke. The conclusions have often been contradictory and differ between subpopulations of migraine patients. No studies t...

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