Neurologist, associate professor of neurology, Weill Cornell Medicine and NewYork-Presbyterian Hospital

Matthew Robbins, MD

“There’s thought that, say there was a high-risk population who could lapse into status migrainosus, or they do, in the emergency room. If you gave them this IV medication, [eptinezumab], not only could it get them out of the emergency room and feeling better in the moment, it could prevent the onset of status migrainosus.”

Status migrainosus, a condition in which a headache attack lasts 72 hours or longer, has posed significant clinical challenges for physicians and has placed a severe burden on the large population of patients with migraine. Currently, little literature on effective treatment options exists, with many physicians opting for a variety of approaches that are adjusted based on the situation at hand.

Some have suggested that one of the newer calcitonin gene-related peptide (CGRP) targeted therapies, eptinezumab (Vyepti; Lundbeck), could be a potential treatment for these individuals, Matthew Robbins, MD, told 

American Headache Society (AHS) Annual Scientific Meeting

, June 9-11, in Denver, Colorado. Although this needs to be explored further, some headache specialists think it could even prevent the future onset of status migrainosus because of the long half-life of the medication.

Although, Robbins, who is a neurologist and associate professor of neurology at Weill Cornell Medicine and NewYork-Presbyterian Hospital, explained that there are still barriers to this approach. These new CGRP therapies require prior authorizations, and clinicians outside of the headache specialty are often unfamiliar with their use and may be uncertain about utilizing them. Robbins offered his insight into this challenge and the state of treating status migrainosus.

Videos

The neurologist at Weill Cornell Medicine and NewYork-Presbyterian Hospital offered his insight into the state of treatment for status migrainosus and whether or not the new migraine medications can help improve care. [WATCH TIME: 2 minutes]

The Treatment of Status Migrainosus in Emergency Care Settings: Matthew Robbins, MD

“It’s a total evidence-free zone. Often when these patients come to the emergency room because the headache attack has been so long, that’s perceived as a red flag, and there’s a big focus on diagnosis. These are patients who are often getting CT scans of the head, or MRIs, and there is a wait to treat them until the neurologist arrives.”

, June 9-11, in Denver, Colorado, new data were presented on the incidence of status migrainosus in Olmsted County, Minnesota, by Juliana H. VanderPluym, MD,

 in a session moderated by Matthew Robbins, MD. The study provided the first population-based perspective on this incidence, noting that it might be inherently more common among individuals with chronic migraine. Overall, the study showed an age- and sex-adjusted incidence rate of 26.60 per 100,000 (95% CI, 23.21-29.97), with a peak incidence occurring between ages 40 and 49 years. These rates were higher in women (46.97 per 100,000; 95% CI, 40.61-53.32) compared with men (6.23 per 100,000; 95% CI, 3.88-8.58).

To find out more about the state of care for status migrainosus, 

 inquired with Robbins, a neurologist and associate professor of neurology at Weill Cornell Medicine and NewYork-Presbyterian Hospital. He highlighted the research of VanderPluym et al, and shared his experience with treating the condition, as well as detailed some of the difficulties in providing evidence-based care for patients who experience such debilitating attacks.

REFERENCE
1. VanderPluym J, Mangipudi K, Mbonde A, et al.Incidence of status migrainosus in Olmsted County, Minnesota, United States: Characterization and predictors of recurrence. Presented at: AHS Annual Scientific Meeting; June 9-11, 2022; Denver, CO. OR-17

The neurologist at Weill Cornell Medicine and NewYork-Presbyterian Hospital offered his insight into the hot topics at the American Headache Society Annual Scientific Meeting, including a presentation on the prevalence of status migrainosus. [WATCH TIME: 4 minutes]

The Need for Effective Treatments for Status Migrainosus: Matthew Robbins, MD

“We’ve seen a number of secondary headaches disorders with COVID-19 at our institution. This includes various types of cerebrovascular diseases such as cerebral venous thrombosis, cervical artery dissection, post-irreversible encephalopathy syndrome.”

While researchers have continued to uncover more about the neurologic symptoms linked to COVID-19, few have noted the differences in primary and secondary headaches, which may offer additional insight. Although, as the director of the Neurology Residency Program at Weill Cornell Medicine, Matthew Robbins, MD, took a keen look at whether the majority of the headaches were primary or secondary. 

Robbins then shared the department’s overall experience in a presentation at the 2020 American Headache Society (AHS) Annual Meeting. The intention of the overview was to present how the virus impacted headache-focused and general neurological care, review emerging phenomenology of headache and COVID-19, and to shed light on the experience of those in the residency program. 

Among other things, Robbins understands that this has been a learning experience for everyone involved. In an interview with 

, he provided insight on headaches and their association with the virus, as well as the long-term takeaways from pandemic from a clinician perspective.

The director of the Neurology Residency Program at Weill Cornell Medicine highlighted some of the differences in types of headaches that patients with COVID-19 experience, as well as overall takeaways from the pandemic itself.

Matthew Robbins, MD: Headaches Associated With COVID-19

“The neurology that emerges from this will teach them [not just] about what COVID-19 can do, but what other disorders can do as well.”

Throughout the COVID-19 pandemic, doctors, clinicians, and medical professionals at all levels have been thrust into uncomfortable roles and asked to adapt to a climate that is just as unfamiliar. The same has been the case for residents, who are inexperienced to some extent and did not initially expect to handle a pandemic in the early days of their careers.

Matthew Robbins, MD, assistant professor, and director, Neurology Residency Program, Weill Cornell Medicine, shared insight from his experience throughout the pandemic as well as in his role as an overseer of residents at the 

2020 American Headache Society (AHS) Annual Meeting

. Robbins went on to commend his residents, claiming that this learning experience will be like none other and may offer them a unique chance to take on hard lessons.

, Robbins details how his residents handled the pandemic, and explained the long-term benefits an experience such an this can provide them.

The director of the Neurology Residency Program at Weill Cornell Medicine provided insight on the experience residents have had during the COVID-19 pandemic and how it has shaped them for the future.

Matthew Robbins, MD: Residency During COVID-19

“The way this has impacted both our patients and the way we care for them has been extraordinary and unpredictable.”

2020 American Headache Society Annual Meeting

, Matthew Robbins, MD, presented his experience on how COVID-19 impacted headache and neurological care in New York, as well as giving an overview of emerging clinical phenomenology of headache and COVID-19 to provide perspective from him and his colleagues.

The assistant professor of neurology and director of the Neurology Residency Program at Weill Cornell Medicine noted the substantial changes and adjustments that needed to be made on the fly at all levels throughout the pandemic. He claims that everyone is thrusted into uncomfortable positions but being able to adapt under the pressure has shown the true colors of those on the front lines.

, Robbins discusses how his team of clinicians continued to adjust as the pandemic continued to increase, and why having an open mind has been helped the situation.

The director of the Neurology Residency Program at Weill Cornell Medicine details his first-hand experience working in the epicenter of the COVID-19 pandemic and how his department adapted.

Matthew Robbins, MD

Articles

The Treatment of Status Migrainosus in Emergency Care Settings: Matthew Robbins, MD

The Need for Effective Treatments for Status Migrainosus: Matthew Robbins, MD

Matthew Robbins, MD: Headaches Associated With COVID-19

Matthew Robbins, MD: Residency During COVID-19

Matthew Robbins, MD: Experience Adjusting to COVID-19 in Migraine Care

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