1.4.1 Status migrainosus

Identification: Female patient, 38 years old, teacher, with a history of chronic migraine for 15 years. Clinical History: The patient reports episodes of unilateral, pulsatile headache associated with photophobia, phonophobia, and nausea, lasting 4 to 72 hours, since the age of 23. In the past 6 months, the episodes have become daily, with moderate to severe intensity pain, refractory to multiple treatments. She reports previous use of common analgesics, triptans, beta-blockers, tricyclic antidepressants, and anticonvulsants, without significant improvement. Three weeks ago, the pain became continuous, characterizing status migrainosus. Physical and Neurological Examination: Blood pressure: 120/80 mmHg. Neurological examination without focal deficits. Fundoscopy normal. No meningeal signs or alterations in consciousness. Complementary Examinations: Cranial MRI: normal. MR angiography of intracranial vessels: no alterations. Lumbar puncture: cerebrospinal fluid with normal pressure, cytochemistry, and microbiology. Previous Treatment: Use of intravenous corticosteroids (methylprednisolone 1g/day for 5 days) without response. Dihydroergotamine infusion: partial and transient relief. Attempt of occipital nerve anesthetic block: slight improvement.