Aberrant Sleep Patterns Show Risk Associated With Status Migrainosus Recurrence

Data from a study in Olmsted County, Minnesota, identified the incidence rate of status migrainosus to be 26.60 per 100,000, with more than 10% of the cohort reporting that too much or too little sleep triggered the condition.

A study of the overall age- and sex-adjusted incidence of status migrainosus in Olmsted County, Minnesota, identified that the incidence rate of the migraine condition was 26.60 per 100,000 individuals (95% CI, 23.21-29.97), with an estimated 15% of the cohort experiencing a recurrent attack of status migrainosus over the following 12 months. Notably, too much or too little sleep showed potential predictive ability of status migrainosus recurrence.1

The data collected included incident cases identified as the first physician-encountered case in the record from January 1, 2012, to December 31, 2017. Individuals with status migrainosus had a median age of 35 years (IQR, 26-47), with 88.6% (n = 210) of the cohort being women. At the time of status presentation, the medications included triptans or ergotamine in 129 cases (55.4%) and/or an opioid-containing analgesic in 43 cases (18.5%).

These data were presented at the 2022 American Headache Society (AHS) Annual Scientific Meeting, June 9-11, in Denver, Colorado, by Juliana H. VanderPluym, MD, neurologist, Mayo Clinic. She and colleagues wrote that this “study provides the first population-based perspective on status migrainosus incidence, a diagnosis which may be inherently enriched among persons with chronic migraine. We identified aberrant sleep patterns, a potentially modifiable risk factor, as a risk factor for 1-year status migrainosus recurrence.”

Recurrence of status migrainosus was reported by 35 individuals (14.8%) at a median of 58 days (IQR, 23-130) following their initial attack. Notably, too much/too little sleep—which was among the most commonly reported triggers, by 11.4% (n = 27) of the cohort—was associated with 12-month risk of recurrence (adjusted odds ratio, 3.59; 95% CI, 1.58-8.14; P = .0022).

Chronic migraine was recorded in 36.3% (n = 82) of people and aura in 35.7% (n = 76). The median duration of attack was 5 days (IQR, 4-9), and the other most frequently recorded trigger was stress (16.9%; n = 40).

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“The epidemiology of status migrainosus in the general population is not known,” VanderPluym et al wrote. The group noted that they “used the Rochester Epidemiology Project (REP) to identify incident cases,” using the ICHD-3 criteria for the condition and “the REP convention previously shown to be valid and not requiring documentation of 5 independent migraine attacks if the case was otherwise typical.”

Incidence rates, including adjusted and stratified rates, were calculated based on population data from REP. Recurrence-free survival at 1 year was compared between clinically relevant groups using a cox proportional hazard model and the log-rank P-value.

“We don't have a lot of information on status migrainosus, and I think it's really important to gain more information on that specific aspect of migraine disease just because it has a lot of disability associated with it,” study coinvestigator Rashmi Halker Singh, MD, FAHS, FAAN, told NeurologyLive®. “We're still trying to better understand how to help people who are dealing with status migraine. There’s a lot of conversation happening, actually, at this meeting itself in terms of how we define status migrainosus. Is it different when someone has episodic migraine and then has a bout of status migrainosus? Can someone who has chronic migraine also have status migrainosus? And, do we treat that differently?”

“The thing is that we actually don't have a lot of literature on the topic to explore, if you're doing a literature search or trying to figure out how to best help patients. I think this study will help to add to that a little bit,” she added.

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