ICHD-3 diagnostic criteria – status migrainosus

1.4.1 Status migrainosus – a debilitating migraine attack lasting for more than 72 hours.^{[IHS, 2018]}
A. A headache attack fulfilling criteria B and C.
B. Occurring in a patient with 1.1 ‘Migraine without aura’ and/or 1.2 ‘Migraine with aura’, and typical of previous attacks except for its duration and severity.
C.Both of the following characteristics:

1. unremitting for >72 hours1.^a
2. pain and/or associated symptoms are debilitating.1.^b

D. Not better accounted for by another ICHD-3 diagnosis.

^aRemissions of up to 12 hours due to medication or sleep are accepted.
^bMilder cases, not meeting criterion C2, are coded 1.5.1 ‘Probable migraine without aura’.
Comment: Headache with the features of ‘1.4.1 Status migrainosus’ may often be caused by medication overuse. When headache in these circumstances meets the criteria for ‘8.2 Medication-overuse headache’, code for this disorder and the relevant type or subtype of migraine but not for ‘1.4.1 Status migrainosus’. When overuse of medication is of shorter duration than three months, code for the appropriate migraine type or subtype(s) only.

Reference:
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3^rd edition. Cephalalgia 2018; 38 (1): 1–211.

Other references used on slide:
Iljazi A, Chua A, Rich-Fiondella R, et al. Unrecognized challenges of treating status migrainosus: an observational study. Cephalalgia 2020; 40 (8): 818–827.
The Migraine Institute website. https://www.themigraineinstitute.com/status-migrainosus-migraines/. Accessed May 2020.