Table of ContentsView AllTable of ContentsDifferencesCausesSelf-Care and MedicationsHospital TreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Differences
Causes
Self-Care and Medications
Hospital Treatment
Prevention
Severe migraine headaches that are not responding to treatment may be called intractable migraine,status migrainosus, refractory headaches, or treatment-resistant migraine. There are overlaps among these types, but the terms all describe headaches that do not improve with usual treatment and last for more than three days.
Treatment for intractable migraines requires medical therapy and intervention and may require hospitalization.
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What Makes an Intractable Migraine Different?
Intractable migraine is different from a usual migraine in that it lasts longer than a few hours and does not respond to medication that is usually effective for treating migraines. The symptoms are severe, debilitating, and prolonged.
Several descriptions are used for treatment-resistant migraines and headaches, including:
There is some overlap with these headache types, and some people can experience more than one type.Many people who experience severe intractable migraines for some time will experience relief with medical intervention.
What Is Intractable Migraine (Status Migrainosus)?
According to the International Classification of Headache Disorders (ICHD-3), intractable migraine, also called status migrainosus, is diagnosed based on the following criteria:
Primary headaches occur without an underlying cause.Tension headachesandmigrainesare the most common types of primary headaches.Secondary headacheshave an underlying cause.
Migraine
You can have an intractable migraine if you have an underlying primary headache disorder, or it can be the result of a secondary headache. Having a primary headache disorder with an additional secondary headache can further increase the likelihood of experiencing an intractable migraine.
Causes of secondary headaches include:
Initial Migraine: Self-Care and Medications
It can be hard to know if a migraine is going to be intractable when it first starts.If you have had migraines that are treatable with medication or lifestyle strategies, you are likely to try these treatments when you start to get a headache.
It’s only when your symptoms don’t improve the way they usually do that you may suspect you have something other than your usual migraine.
Things you can do to prevent a migraine from becoming intractable include the following:
You might already have some strategies that help take the edge off your migraines. Use the lifestyle measures and treatments that have worked for you in the past.
There are effective treatments for primary and secondary intractable migraines. They may include intravenous (IV) pain medications or other interventional therapies provided in the hospital.
Normal saline may be given intravenously if you are dehydrated. Medications used for intractable migraines include:
Seek prompt medical attention if you have any of the following symptoms along with your headache:
Any of these symptoms could be indications that you have a serious underlying medical condition that’s causing your headache. In addition to getting treatment for your headache symptoms, you would also need urgent medical attention for the underlying condition.
Prevention During Remission
If you have had intractable migraines, you could be prone to experiencing these types of headaches again. One of the best ways to prevent an intractable migraine is to work on preventing migraines.
If you’ve been prescribedmigraine prevention therapies, it’s important that you maintain your schedule of preventive medications between your migraine episodes. Avoiding triggers, getting enough sleep, exercising regularly and using relaxation techniques (such as yoga, meditation, and breathing exercises) are all a crucial part of migraine prevention and management.
Sometimes interventions such asBotox (onabotulinumtoxinA) injectionsorneuromodulation therapiesare used to prevent intractable migraine episodes from happening.
Summary
Intractable migraines are migraines that do not respond to medication and last more than 72 hours. Many people who have intractable migraines also have treatable migraines. If you have recurrent migraines, it’s important to discuss a plan with your healthcare provider so that you will know what to do if you experience a migraine that’s not responding to your usual treatment.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.International Headache Society.ICHD-3.American Migraine Foundation.Intractable headache.Singh TD, Cutrer FM, Smith JH.Episodic status migrainosus: a novel migraine subtype.Cephalalgia. 2018;38(2):304-311. doi:10.1177/0333102416686341American Headache Society.Choosing the right preventative treatment.Ali AS, Stillman M.What inpatient treatments do we have for acute intractable migraine?CCJM. 2018;85(7):514-516. doi: 10.3949/ccjm.85a.17049Vécsei L, Szok D, Nyári A, Tajti J.Treating status migrainosus in the emergency setting: what is the best strategy?Expert Opin Pharmacother. 2018;19(14):1523-1531. doi:10.1080/14656566.2018.1516205American Migraine Foundation.Relaxation and paced breathing exercises for migraine.Legarda SB, Michas-Martin PA, McDermott D.Remediating intractable headache: an effective nonpharmacological approach employing infralow frequency neuromodulation.Front Hum Neurosci.2022;16:894856. doi:10.3389/fnhum.2022.894856Atraszkiewicz D, Ito R, Bahra A.The efficacy of botulinum toxin type-A for intractable chronic migraine patients with no pain-free time.Br J Pain.2022;16(1):41-49. doi:10.1177/20494637211014544
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.International Headache Society.ICHD-3.American Migraine Foundation.Intractable headache.Singh TD, Cutrer FM, Smith JH.Episodic status migrainosus: a novel migraine subtype.Cephalalgia. 2018;38(2):304-311. doi:10.1177/0333102416686341American Headache Society.Choosing the right preventative treatment.Ali AS, Stillman M.What inpatient treatments do we have for acute intractable migraine?CCJM. 2018;85(7):514-516. doi: 10.3949/ccjm.85a.17049Vécsei L, Szok D, Nyári A, Tajti J.Treating status migrainosus in the emergency setting: what is the best strategy?Expert Opin Pharmacother. 2018;19(14):1523-1531. doi:10.1080/14656566.2018.1516205American Migraine Foundation.Relaxation and paced breathing exercises for migraine.Legarda SB, Michas-Martin PA, McDermott D.Remediating intractable headache: an effective nonpharmacological approach employing infralow frequency neuromodulation.Front Hum Neurosci.2022;16:894856. doi:10.3389/fnhum.2022.894856Atraszkiewicz D, Ito R, Bahra A.The efficacy of botulinum toxin type-A for intractable chronic migraine patients with no pain-free time.Br J Pain.2022;16(1):41-49. doi:10.1177/20494637211014544
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
International Headache Society.ICHD-3.American Migraine Foundation.Intractable headache.Singh TD, Cutrer FM, Smith JH.Episodic status migrainosus: a novel migraine subtype.Cephalalgia. 2018;38(2):304-311. doi:10.1177/0333102416686341American Headache Society.Choosing the right preventative treatment.Ali AS, Stillman M.What inpatient treatments do we have for acute intractable migraine?CCJM. 2018;85(7):514-516. doi: 10.3949/ccjm.85a.17049Vécsei L, Szok D, Nyári A, Tajti J.Treating status migrainosus in the emergency setting: what is the best strategy?Expert Opin Pharmacother. 2018;19(14):1523-1531. doi:10.1080/14656566.2018.1516205American Migraine Foundation.Relaxation and paced breathing exercises for migraine.Legarda SB, Michas-Martin PA, McDermott D.Remediating intractable headache: an effective nonpharmacological approach employing infralow frequency neuromodulation.Front Hum Neurosci.2022;16:894856. doi:10.3389/fnhum.2022.894856Atraszkiewicz D, Ito R, Bahra A.The efficacy of botulinum toxin type-A for intractable chronic migraine patients with no pain-free time.Br J Pain.2022;16(1):41-49. doi:10.1177/20494637211014544
International Headache Society.ICHD-3.
American Migraine Foundation.Intractable headache.
Singh TD, Cutrer FM, Smith JH.Episodic status migrainosus: a novel migraine subtype.Cephalalgia. 2018;38(2):304-311. doi:10.1177/0333102416686341
American Headache Society.Choosing the right preventative treatment.
Ali AS, Stillman M.What inpatient treatments do we have for acute intractable migraine?CCJM. 2018;85(7):514-516. doi: 10.3949/ccjm.85a.17049
Vécsei L, Szok D, Nyári A, Tajti J.Treating status migrainosus in the emergency setting: what is the best strategy?Expert Opin Pharmacother. 2018;19(14):1523-1531. doi:10.1080/14656566.2018.1516205
American Migraine Foundation.Relaxation and paced breathing exercises for migraine.
Legarda SB, Michas-Martin PA, McDermott D.Remediating intractable headache: an effective nonpharmacological approach employing infralow frequency neuromodulation.Front Hum Neurosci.2022;16:894856. doi:10.3389/fnhum.2022.894856
Atraszkiewicz D, Ito R, Bahra A.The efficacy of botulinum toxin type-A for intractable chronic migraine patients with no pain-free time.Br J Pain.2022;16(1):41-49. doi:10.1177/20494637211014544
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