Status migrainosus (SM) is usually resistant to standard migraine medications and leads to a large proportion of migraine hospitalizations. 

We tried to analyze the prevalence trend of SM, assess the risk factors to identify potential triggers and morbidity predictors for SM.

We performed a population-based retrospective cross-sectional analysis of Nationwide Inpatient Sample (years 2003-2014) in adult (>18-years) hospitalizations for status migrainosus(and intractable migraine) using ICD-9-CM code. Morbidity was defined by hospital stay >5days(>90 percentile of mean migraine hospitalizations) and discharge other than home(short-term hospitals/skilled nursing facility/home health care/intermediate care facility). We performed weighted univariate analysis using chi-square test, paired t-test, and cochran-armitage trend test. We performed weighted multivariate survey logistic regression analyses to evaluate the triggers of SM and predictors of SM-related morbidity.

A total of 446,446 US hospitalizations had a primary diagnosis of migraine. Out of these, 130,914(29.32%) patients had SM. There was a significant increase in the prevalence of SM in the migraineurs (2003:27.49% to 2014:32.68%;pTrend<0.0001). Patients with SM tend to be younger (median age 40-year vs. 44-year), females(85.86%vs.78.31%;p<0.0001), and whites(81.83%vs.70.31;p<0.0001), compared to patients without SM. On weighted analysis, drug abuse (4.76%vs.3.93%;aOR=1.13;95%CI=1.03-1.24), vitamin D deficiency (0.70%vs.0.53%;aOR=1.28;95%CI=1.05-1.56), opioid abuse (1.76%vs.0.99%;aOR=1.43;95%CI=1.22-1.68), organic sleep disorders (3.41%vs.3.06%;aOR=1.38;95%CI=1.26-1.50), medication overuse headache (1.66%vs.0.28%;aOR=3.63;95%CI=2.95-4.45), generalized anxiety disorder (1.36%vs.0.63%;aOR=1.50;95%CI=1.28-1.77), major depression disorder (29.03%vs.19.26%;aOR=1.56;95%CI=1.50-1.62), and post-traumatic stress disorder (1.90%vs.1.21%;aOR=1.37;95%CI=1.21-1.55) were associated with higher prevalence and odds of SM. SM patients had higher prevalence and odds of morbidity (1.20%vs.0.98%;aOR=1.67;95%CI=1.43-1.96) compared to patients without SM. Acute ischemic stroke (aOR=2.60;95%CI=1.34-5.07), hemorrhagic stroke (aOR=7.07;95%CI=1.94-25.72), obesity (aOR=1.47;95%CI=1.22-1.78), atrial fibrillation (aOR=1.62;95%CI=1.19-2.20), renal failure(acute/chronic/end-stage) (aOR=1.38;95%CI=1.04-1.83), epilepsy (aOR=2.31;95%CI=1.88-2.82), generalized anxiety disorder (aOR=1.78;95%CI=1.02-3.11), major depression disorder (aOR=1.38;95%CI=1.19-1.61), and post-traumatic stress disorder (aOR=1.74;95%CI=1.15-2.66) were associated with higher morbidity in SM patients. 

The study reveals triggers for SM and shows higher morbidity associated with SM. Early identification and management of triggers may help mitigate the burden of SM.