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. 2023 Jan 17;100(3):e255-e263.
doi: 10.1212/WNL.0000000000201382. Epub 2022 Sep 29.

Incidence of Status Migrainosus in Olmsted County, Minnesota, United States: Characterization and Predictors of Recurrence

Juliana H VanderPluym  1 , Kartik Mangipudi  2 , Amir Abdallah Mbonde  2 , David Gritsch  2 , Edoardo Caronna  2 , Rashmi B Halker Singh  2 , Richard J Butterfield  2 , Jonathan H Smith  2
Affiliations

Incidence of Status Migrainosus in Olmsted County, Minnesota, United States: Characterization and Predictors of Recurrence

Juliana H VanderPluym et al. Neurology. .

Abstract

Background and objectives: SM is recognized as a complication of migraine in which pain and/or associated symptoms are unremitting and debilitating for more than 72 hours. The epidemiology of SM in the general population is not known. The aim of this study is to determine the incidence, recurrence rate, and clinical associations of status migrainosus (SM) in care-seeking residents of Olmsted County, Minnesota.

Methods: The Rochester Epidemiology Project was used to identify the incident cases of SM according to the International Classification of Headache Disorders, Third Edition criteria and based on the first physician-encountered case in the record. The clinical characteristics of the incident cases were abstracted from the medical record. One-year recurrence-free survival was evaluated and compared between clinically relevant groups, including baseline demographics, migraine characteristics, and treatment exposures.

Results: Between January 1, 2012, and December 31, 2017, 237 incident cases of SM were identified. The median age was 35 (IQR 26-47) years, and 210 (88.6%) were female. A history of chronic migraine was recorded in 82/226 (36.3%) and a history of aura in 76/213 (35.7%). At the time of the incident case, medication reconciliation included a triptan or ergotamine in 127/233 (53.6%) and/or an opioid-containing analgesic in 43/233 (18.5%). The overall age- and sex-adjusted incidence rate was 26.60 per 100,000 [95% CI, 23.21-29.97], with a peak incidence between ages 40 and 49 years. The median (95% CI) attack duration was 5 (4.48-5.42) days. The most frequent triggers were stress (40/237, 16.9%) and too much or too little sleep (27/237, 11.4%). Recurrence occurred in 35/237 (14.8%) at a median of 58 (IQR 23-130) days following the initial attack. In our age- and sex-adjusted multivariable model, too much or too little sleep as a trigger was associated with 12-month risk of recurrence (adjusted OR 3.59 [95% CI 1.58-8.14], p = 0.0022).

Discussion: Our study provides a population-based estimate of SM incidence. We identified aberrant sleep patterns as a potentially modifiable risk factor for 1-year SM recurrence.

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Conflict of interest statement

J.H. VanderPluym reports research grant from Amgen. K. Mangipudi, A.A. Mbonde, and D. Gritsch report no disclosures. E. Caronna has received honoraria from Novartis and Chiesi. R.B. Halker Singh reports research grant from Amgen. R.J. Butterfield reports no disclosures. J.H. Smith is currently a full-time employee of AbbVie and holds stock in AbbVie. The content does not reflect the views of AbbVie. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Identification and Classification of Individuals With Status Migrainosus
Figure 2
Figure 2. Age- and Sex-Adjusted Incidence of Status Migrainosus in Olmsted County, Minnesota
See this image and copyright information in PMC

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