Abstract Details

Title Real Life Approach to Outpatient Treatment of Status Migrainosus: A Survey Study

Topic Headache

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 2-012

Objective Identify how the American Headache Society (AHS) membership manages status migrainosus as an outpatient.

Background

Status migrainosus (SM), a common migraine complication, is defined as a severe attack lasting for more than 72 hours. There is no standard of care for SM, including whether 72 hours is requisite to treat as SM.

Design/Methods

The “Refractory, Inpatient, Emergency care” Special Interest Group from AHS developed a 4 question survey distributed to AHS membership: 1) if they treat severe refractory migraine attacks the same as SM regardless of duration, 2) what their first step in SM management is, 3) what are the top 3 medications they use for SM, and 4) if they are UCNS certified. The survey was administered January 2022. Descriptive statistics and qualitative analysis were performed.

Results Responses were received from 196 of the 1859 AHS members. 64.29% are UCNS certified in headache. 69.39% (136/196) treat a severe refractory migraine attack as SM before 72 hours. 76.02% (149/196) of respondents chose “Treat remotely using outpatient medications at home” as the first step, while 11.22% (22/196) preferred procedures, 6.12% (12/196) favored an infusion center, 6.12% (12/196) sent to the emergency department or urgent care, and 0.51% (1/196) prefer direct admission. The preferred medications included the following categories: 71.4% (140/196) steroids, 50.5% (99/196) NSAIDs, 46.9% (92/196) neuroleptics, 30.6% (60/196) triptans, 21.4% (42/196) DHE, 11.7% (23/196) antihistamines, 10.7% (21/196) gepants, 10.2% (20/196) anti-epileptics, and 6.1% (12/196) muscle relaxants.

Conclusions Healthcare professionals with expertise in headache medicine treat SM early and do not wait the 72 hours required to fulfill diagnostic criteria. Outpatient management with one or more medications for home use was preferred by majority of responders while very few opt for the emergency department. Finally, steroids, NSAIDs, neuroleptics, triptans, and DHE were the top 5 preferred for home SM management.

Authors/Disclosures
Jennifer V. Robblee, MD (Barrow Neurological Institute) PRESENTER	Dr. Robblee has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Impel. Dr. Robblee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Robblee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tonix. An immediate family member of Dr. Robblee has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Scottsdale Providence. The institution of Dr. Robblee has received research support from Eli Lilly. The institution of Dr. Robblee has received research support from AbbVie. The institution of Dr. Robblee has received research support from Barrow Neurological Institute. Dr. Robblee has received publishing royalties from a publication relating to health care. Dr. Robblee has received publishing royalties from a publication relating to health care.
Yulia Y. Orlova, MD, PhD (Mayo Clinic)	Dr. Orlova has nothing to disclose.
Andrew H. Ahn, MD, PhD (Alnylam Pharmaceuticals)	Dr. Ahn has received personal compensation for serving as an employee of Teva Pharmaceuticals.
Ashhar Ali, DO, FAAN (Henry Ford Health)	Dr. Ali has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Ali has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Ebsco.
Laur Marius Birlea, MD, FAAN	Dr. Birlea has nothing to disclose.
Larry "LC" Charleston IV, MD, MSc, FAHS, FANA, FAAN (A NeuRaye Of Sunshine Publishing, LLC)	Dr. Charleston has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AbbVie. Dr. Charleston has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amneal Pharmaceuticals. Dr. Charleston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Satsuma Pharmaceuticals. Dr. Charleston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LinPharma. Dr. Charleston has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Haleon. Dr. Charleston has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Pfizer. The institution of Dr. Charleston has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Axsome. Dr. Charleston has or had stock in Mi-Helper Inc..Dr. Charleston has a non-compensated relationship as a Associate Editor with Headache Journal: The Journal of Head and Face Pain that is relevant to AAN interests or activities. Dr. Charleston has a non-compensated relationship as a Board Member with Clinical Neurological Society of America that is relevant to AAN interests or activities. Dr. Charleston has a non-compensated relationship as a Chair, EDI Advisory Committee (Non-voting Board Member) with American Headache Society that is relevant to AAN interests or activities.
Niranjan N. Singh, MD, FAAN	Dr. Singh has nothing to disclose.
Marcio N. Souza, MD (MRNeuro)	Dr. Souza has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Lilly. Dr. Souza has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Novartis. Dr. Souza has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for TEVA. Dr. Souza has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Libbs. Dr. Souza has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Abbvie.

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