Intractable Migraine Portrait of AfroAmerican woman hand on forehead blue wall in the background

Everything You Need to Know About Intractable Migraine

The condition is challenging to treat, but there are things that can help.

Migraine headaches are almost as mysterious as they are excruciating. Despite the fact that migraine is a common, chronic, and highly debilitating neurological condition that affects at least 39 million Americans—and one that is being heavily researched—its exact root causes are still not understood. And among the various types of migraine, there’s one that could be called the most mysterious of all: intractable migraine.

Signs and Symptoms of Intractable Migraine

If the name sounds a little sinister to you, rightfully so. Intractable migraine (also referred to as intractable headache, refractory migraine, status migraine, or status migrainosus) refers to a severe headache that just won’t quit—one that’s been throbbing away for at least 72 hours, only letting up for an hour here or there, if at all. Intractable migraines are mysterious not just because they last for much longer than typical migraines, but because they’re resistant to acute medications that people with chronic migraine usually find effective, like NSAIDs (nonsteroidal anti-inflammatory drugs), ergots, and triptans. As if the head pain weren’t enough, intractable migraine usually involves other symptoms as well, like severe nausea, dizziness, and vomiting. With no way to ease relentless and severe migraine pain, people with intractable migraine often end up in the emergency room seeking acute care.

Causes of Intractable Migraine

Neurologists are still trying to pinpoint exactly why certain people (less than one percent of those with chronic migraine) experience these treatment-resistant and persistent headaches. Not knowing the root cause of intractable migraine can make it challenging to treat, but there are preventative and acute medications that can help.

Diagnosing Intractable Migraine

That’s why if you experience intractable headaches, it’s crucial to meet with a healthcare professional—our primary care doctor, a neurologist, or a headache specialist. She’ll will likely begin by ruling out other causes of chronic daily headache, like medication overuse headache, post-traumatic headache, cluster headache, or a condition called hemicrania continua. If you’re diagnosed with intractable migraine, your provider will discuss treatment options based on your specific health profile and set of symptoms. It may require some patience and trial and error to find a combination of treatments that work—even more so than with typical migraine. You should also manage your expectations; there’s no “cure” for intractable migraine, and while preventatives and treatments can greatly minimize the frequency and severity of your migraine attacks, they probably won’t eliminate them entirely.

Treatment for Intractable Migraine

As with all forms of migraine headache, preventive steps are the biggest key to improving your quality of life when living with intractable migraine. An important part of this is avoiding triggers that cause a typical migraine to escalate into intractable migraine. Top culprits include stress and changes in medications or hormonal birth control methods. It’s also very important to stick to a regular schedule for meals, sleep, and gentle exercise. Talk to your healthcare provider about taking a magnesium supplement, which has been shown to help prevent and even treat migraine attacks. Antidepressants like amitriptyline are also commonly prescribed as migraine preventatives and may help ward off intractable migraines too.

When you do get a migraine attack, it’s crucial to take abortive medication immediately when your symptoms begin. This is true of all migraine headaches, but it’s even more critical if you’ve experienced intractable headaches; early treatment with acute medication may help keep the pain from spiraling out of control. Try to recognize your own prodrome or pre-headache symptoms so you can take your migraine medication as promptly as possible. Even this may not always prevent an intractable headache from spiraling, though. If you do end up needing to head to the emergency room because of a migraine attack, there are a variety of inpatient interventions that doctors can employ to help you, including intravenous fluids to treat dehydration, nerve block injections, corticosteroids like dexamethasone, the anti-nausea medication metoclopramide, the migraine medication dihydroergotamine (given via injection or nasal spray), the anti-seizure drug valproate, and opioid pain medications. Once you’ve had to visit the emergency room for a headache disorder, doctors may prescribe a combination of at-home migraine medications or recommend ongoing outpatient treatment. The most important thing to keep in mind, even when it’s hard: Stressing about your intractable migraines will only make them worse, since stress is a major migraine trigger. It’s crucial to focus on migraine self-care and continue giving recommended treatment options a chance until you find the regimen that finally breaks your never-ending cycle of never-ending headaches.

Petra Guglielmetti is a health, wellness, and beauty journalist who taps into a broad network of doctors, scientists, and medical experts to write in-depth service articles for leading publications like Glamour, Health, Real Simple, and Parents.

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