Abstract Details

Title Status Migrainosus in Pediatric Populations: A Systematic Evidence Synthesis

Topic Headache

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 15-011

Objective To systematically review the literature on status migrainosus (SM) in children and adolescents, focusing on clinical characteristics, treatment strategies, response predictors, and prognosis.

Background SM, described as a migraine attack lasting >72 hours, poses a significant challenge in pediatric populations. Evidence to guide management, prognostication, and prevention remains limited and fragmented.

Design/Methods This PRISMA-compliant review (Prospectively-registered PROSPERO ID: CRD420251088970) searched CENTRAL, MEDLINE, PubMed, Scopus, and MedRxiv using (“Status migrainosus” OR “status migrain*”) from inception to July 2025. Eligible studies included RCTs, cohorts, or case series (≥5 patients) reporting SM in individuals ≤21 years. Two independent reviewers conducted screening, extraction, and quality assessment(QA) using the Newcastle–Ottawa checklist.

Results Seventeen studies, encompassing 1,857 pediatric patients with SM (Total sample: 7,161), were included after screening 658 studies. Most were single-center and retrospective, limiting generalizability. Females constituted the majority (typically 70-80%), with mean ages clustering at 13-16 years. Chronic migraine(CM) at baseline was common, and psychiatric comorbidities (anxiety/depression) were frequent. Lidocaine infusions demonstrated faster pain relief than valproate but required intensive monitoring. Dihydroergotamine was effective in many cohorts, but was associated with nausea/vomiting. Nerve-blocks displayed promising short-term efficacy with fewer systemic side effects. Preventive strategies (nutraceuticals) are ineffective against recurrence. Across studies, no intervention significantly reduced short-term recurrence. Psychiatric comorbidities, ADHD, older age, medication-overuse headache, and greater baseline severity predicted poor response. Stress was a recurrent trigger for SM onset. Prognosis was guarded: two large studies reported clinical worsening after SM, and in one long-term cohort, 83% of children with episodic SM progressed to CM over 8 years. AHRQ-based-QA classified nine studies as "good", while others were "fair".

Conclusions Pediatric SM is characterized by female predominance, high comorbidity burden, and no unanimous treatment consensus. Predictors such as comorbidities and age highlight the need for tailored prevention. Standardized pediatric-specific protocols and randomized, controlled trials to guide management are warranted.

Authors/Disclosures
Nsser Abdelall, MD (LSU Health Sciences - CALS Bldg) PRESENTER	Dr. Abdelall has nothing to disclose.
Mohamed Ibrahim A. Mohamed, MD	Mr. Mohamed has nothing to disclose.
Michael Salib, MD	Dr. Salib has nothing to disclose.
Aya K. Hegazy, Medical student	Ms. Hegazy has nothing to disclose.
Rana S. Abdelhafiz	Miss Abdelhafiz has nothing to disclose.
Basmalla A. Mostafa, Medical student	Ms. Mostafa has nothing to disclose.
Hagar Amer, MBBS	Dr. Amer has nothing to disclose.
Mona Nada, MD	Prof. Nada has nothing to disclose.

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