Abstract Details

Title A Cross-Sectional Survey of Prevailing Opinions from Headache Specialists Regarding Status Migrainosus Management

Topic Headache

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 2-001

Background SM is a debilitating migraine complication with intense symptoms lasting >72 hours. Although SM epidemiologic data are unclear, a recent population-based study in Minnesota reported that 15% of individuals experienced a recurrent SM attack during the following year. Although no evidence-based treatment guidelines for SM exist, treatment can include steroids, nerve blocks, nonsteroidal anti-inflammatory drugs, triptans, ergotamine, neuroleptics, and dihydroergotamine mesylate (DHE). Consensus on defining clinical trial endpoints for SM to improve future research and outcomes is an unmet need.

Objective To gather the prevailing opinions of headache specialists regarding status migrainosus (SM) management based on clinical experience and exposure to scientific data.

Design/Methods A cross-sectional phone survey was conducted with 33 headache specialists from tertiary headache centers across the United States. Verbal responses to 8 questions asked at random about SM patterns observed and treatment protocols used for SM management were given.

Results

Most headache specialists reported treating SM patients every week, sometimes several patients per day. Cases were frequently observed at the clinic, but some required hospital admission when clinics were considered inadequate for SM treatment. Most headache specialists used drug infusions, the Raskin or modified DHE protocol, or steroids to treat SM. While DHE is considered the gold standard to completely break recurrence, drug inaccessibility and hesitation to send patients to hospitals limit its use. Most headache specialists reported refractory patients being more prone to recurrent SM attacks. Treatment goals included avoiding emergency room (ER) visits and providing patients with autonomy and at-home treatments (eg, self-injections, oral steroids).

Conclusions Headache specialists treat multiple SM patients per week and value treatments that break the headache and offer sustained pain relief while avoiding ER visits. Although DHE was viewed favorably for SM, it was underutilized and often only as a last resort due to accessibility issues.

Authors/Disclosures
Jennifer V. Robblee, MD (Barrow Neurological Institute) PRESENTER	Dr. Robblee has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Impel. Dr. Robblee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Robblee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tonix. An immediate family member of Dr. Robblee has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Scottsdale Providence. The institution of Dr. Robblee has received research support from Eli Lilly. The institution of Dr. Robblee has received research support from AbbVie. The institution of Dr. Robblee has received research support from Barrow Neurological Institute. Dr. Robblee has received publishing royalties from a publication relating to health care. Dr. Robblee has received publishing royalties from a publication relating to health care.
Robert Vann, PhD (C2N Diagnostics)	Dr. Vann has received personal compensation for serving as an employee of Impel Neuropharma. Dr. Vann has received personal compensation for serving as an employee of Biogen.
Christopher J. Fitzpatrick, PhD (Marinus Pharmaceuticals)	Dr. Fitzpatrick has received personal compensation for serving as an employee of Impel Pharmaceuticals.
Michelle Murphy, PhD (Impel Neuro Pharmaceuticals)	Dr. Murphy has nothing to disclose.
Sutapa Ray, PhD (Impel NeuroPharma)	Dr. Ray has received personal compensation for serving as an employee of Impel Pharmaceuticals. Dr. Ray has stock in Impel Pharmaceuticals.
Stephen B. Shrewsbury, MD (Impel Pharmaceuticals)	Dr. Shrewsbury has received personal compensation for serving as an employee of Impel NeuroPharma. Dr. Shrewsbury has received stock or an ownership interest from Impel NeuroPharma.
Sheena K. Aurora, MD (Department of Neurology and Neurological Sciences)	Dr. Aurora has received personal compensation for serving as an employee of Impel Neuropharma. Dr. Aurora has stock in Impel Neurpharma.