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Real‐world approaches to outpatient treatment of status migrainosus: A survey study.

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Title: Real‐world approaches to outpatient treatment of status migrainosus: A survey study.
Authors: Robblee, Jennifer, Orlova, Yulia Y., Ahn, Andrew H., Ali, Ashhar S., Birlea, Marius, Charleston, Larry, Singh, Niranjan N., Souza, Marcio Nattan P.
Source: Headache: The Journal of Head & Face Pain. Sep2024, Vol. 64 Issue 8, p1040-1048. 9p.
Subjects: Adrenocortical hormones, Nonsteroidal anti-inflammatory agents, Research funding, Outpatient medical care, Membership, Descriptive statistics, Treatment duration, Hospital emergency services, Antipsychotic agents, Surveys, Tryptamine, Dihydroergotamine, Pain management, Migraine
Geographic Terms: United States
Abstract: Objectives: Identify how the American Headache Society (AHS) membership manages status migrainosus (SM) among outpatients. Background: SM is defined as a debilitating migraine attack lasting more than 72 h. There is no standard of care for SM, including whether a 72‐h duration is required before the attack can be treated as SM. Methods: The Refractory Headache Special Interest Group from AHS developed a four‐question survey distributed to AHS members enquiring (1) whether they treat severe refractory migraine attacks the same as SM regardless of duration, (2) what their first step in SM management is, (3) what the top three medications they use for SM are, and (4) whether they are United Council for Neurologic Subspecialties (UCNS) certified. The survey was conducted in January 2022. Descriptive statistical analyses were performed. Results: Responses were received from 196 of 1859 (10.5%) AHS members; 64.3% were UCNS certified in headache management. Respondents treated 69.4% (136/196) of patients with a severe refractory migraine attack as SM before the 72‐h period had elapsed. Most (76.0%, 149/196) chose "treat remotely using outpatient medications at home" as the first step, 11.2% (22/196) preferred procedures, 6.1% (12/196) favored an infusion center, 6.1% (12/196) sent patients to the emergency department (ED) or urgent care, and 0.5% (1/196) preferred direct hospital admission. The top five preferred medications were as follows: (1) corticosteroids (71.4%, 140/196), (2) nonsteroidal anti‐inflammatory drugs (NSAIDs) (50.1%, 99/196), (3) neuroleptics (46.9%, 92/196), (4) triptans (30.6%, 60/196), and (5) dihydroergotamine (DHE) (21.4%, 42/196). Conclusions: Healthcare professionals with expertise in headache medicine typically treated severe migraine attacks early and did not wait 72 h to fulfill the diagnostic criteria for SM. Outpatient management with one or more medications for home use was preferred by most respondents; few opted for ED referrals. Finally, corticosteroids, NSAIDs, neuroleptics, triptans, and DHE were the top five preferred treatments for home SM management. Plain Language Summary: In this research study, we asked members of the American Headache Society how they treat status migrainosus, a very severe migraine attack lasting more than 3 days. Out of the 196 people who answered the survey, most used stronger treatments before the headache lasted 72 h, and the majority preferred to use home‐based treatments to avoid the hospital. The five most common treatments they use are corticosteroids (like dexamethasone), nonsteroidal anti‐inflammatory drugs (like ketorolac), neuroleptics (like prochlorperazine), triptans (like naratriptan), and dihydroergotamine. [ABSTRACT FROM AUTHOR]
Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Real‐world approaches to outpatient treatment of status migrainosus: A survey study.
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  Data: <searchLink fieldCode="AR" term="%22Robblee%2C+Jennifer%22">Robblee, Jennifer</searchLink><br /><searchLink fieldCode="AR" term="%22Orlova%2C+Yulia+Y%2E%22">Orlova, Yulia Y.</searchLink><br /><searchLink fieldCode="AR" term="%22Ahn%2C+Andrew+H%2E%22">Ahn, Andrew H.</searchLink><br /><searchLink fieldCode="AR" term="%22Ali%2C+Ashhar+S%2E%22">Ali, Ashhar S.</searchLink><br /><searchLink fieldCode="AR" term="%22Birlea%2C+Marius%22">Birlea, Marius</searchLink><br /><searchLink fieldCode="AR" term="%22Charleston%2C+Larry%22">Charleston, Larry</searchLink><br /><searchLink fieldCode="AR" term="%22Singh%2C+Niranjan+N%2E%22">Singh, Niranjan N.</searchLink><br /><searchLink fieldCode="AR" term="%22Souza%2C+Marcio+Nattan+P%2E%22">Souza, Marcio Nattan P.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Headache%3A+The+Journal+of+Head+%26+Face+Pain%22">Headache: The Journal of Head & Face Pain</searchLink>. Sep2024, Vol. 64 Issue 8, p1040-1048. 9p.
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  Data: <searchLink fieldCode="DE" term="%22Adrenocortical+hormones%22">Adrenocortical hormones</searchLink><br /><searchLink fieldCode="DE" term="%22Nonsteroidal+anti-inflammatory+agents%22">Nonsteroidal anti-inflammatory agents</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Outpatient+medical+care%22">Outpatient medical care</searchLink><br /><searchLink fieldCode="DE" term="%22Membership%22">Membership</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+duration%22">Treatment duration</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+emergency+services%22">Hospital emergency services</searchLink><br /><searchLink fieldCode="DE" term="%22Antipsychotic+agents%22">Antipsychotic agents</searchLink><br /><searchLink fieldCode="DE" term="%22Surveys%22">Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Tryptamine%22">Tryptamine</searchLink><br /><searchLink fieldCode="DE" term="%22Dihydroergotamine%22">Dihydroergotamine</searchLink><br /><searchLink fieldCode="DE" term="%22Pain+management%22">Pain management</searchLink><br /><searchLink fieldCode="DE" term="%22Migraine%22">Migraine</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
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  Data: Objectives: Identify how the American Headache Society (AHS) membership manages status migrainosus (SM) among outpatients. Background: SM is defined as a debilitating migraine attack lasting more than 72 h. There is no standard of care for SM, including whether a 72‐h duration is required before the attack can be treated as SM. Methods: The Refractory Headache Special Interest Group from AHS developed a four‐question survey distributed to AHS members enquiring (1) whether they treat severe refractory migraine attacks the same as SM regardless of duration, (2) what their first step in SM management is, (3) what the top three medications they use for SM are, and (4) whether they are United Council for Neurologic Subspecialties (UCNS) certified. The survey was conducted in January 2022. Descriptive statistical analyses were performed. Results: Responses were received from 196 of 1859 (10.5%) AHS members; 64.3% were UCNS certified in headache management. Respondents treated 69.4% (136/196) of patients with a severe refractory migraine attack as SM before the 72‐h period had elapsed. Most (76.0%, 149/196) chose "treat remotely using outpatient medications at home" as the first step, 11.2% (22/196) preferred procedures, 6.1% (12/196) favored an infusion center, 6.1% (12/196) sent patients to the emergency department (ED) or urgent care, and 0.5% (1/196) preferred direct hospital admission. The top five preferred medications were as follows: (1) corticosteroids (71.4%, 140/196), (2) nonsteroidal anti‐inflammatory drugs (NSAIDs) (50.1%, 99/196), (3) neuroleptics (46.9%, 92/196), (4) triptans (30.6%, 60/196), and (5) dihydroergotamine (DHE) (21.4%, 42/196). Conclusions: Healthcare professionals with expertise in headache medicine typically treated severe migraine attacks early and did not wait 72 h to fulfill the diagnostic criteria for SM. Outpatient management with one or more medications for home use was preferred by most respondents; few opted for ED referrals. Finally, corticosteroids, NSAIDs, neuroleptics, triptans, and DHE were the top five preferred treatments for home SM management. Plain Language Summary: In this research study, we asked members of the American Headache Society how they treat status migrainosus, a very severe migraine attack lasting more than 3 days. Out of the 196 people who answered the survey, most used stronger treatments before the headache lasted 72 h, and the majority preferred to use home‐based treatments to avoid the hospital. The five most common treatments they use are corticosteroids (like dexamethasone), nonsteroidal anti‐inflammatory drugs (like ketorolac), neuroleptics (like prochlorperazine), triptans (like naratriptan), and dihydroergotamine. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=179298216
RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1111/head.14769
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      – Code: eng
        Text: English
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        PageCount: 9
        StartPage: 1040
    Subjects:
      – SubjectFull: Adrenocortical hormones
        Type: general
      – SubjectFull: Nonsteroidal anti-inflammatory agents
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Outpatient medical care
        Type: general
      – SubjectFull: Membership
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Treatment duration
        Type: general
      – SubjectFull: Hospital emergency services
        Type: general
      – SubjectFull: Antipsychotic agents
        Type: general
      – SubjectFull: Surveys
        Type: general
      – SubjectFull: Tryptamine
        Type: general
      – SubjectFull: Dihydroergotamine
        Type: general
      – SubjectFull: Pain management
        Type: general
      – SubjectFull: Migraine
        Type: general
      – SubjectFull: United States
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      – TitleFull: Real‐world approaches to outpatient treatment of status migrainosus: A survey study.
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              M: 09
              Text: Sep2024
              Type: published
              Y: 2024
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