1 Department of Neurology, Mayo Clinic, Rochester, MN, USA.
2 Department of Neurology, University of Kentucky, Lexington, KY, USA.
Cephalalgia. 2018 Feb;38(2):304-311. doi: 10.1177/0333102416686341. Epub 2017 Jan 5.
Objective To report a case series of a novel migraine subtype, which we term as episodic status migrainosus (ESM), characterized by attacks of migraine exclusively lasting more than 72 hours. We hypothesized that this would represent a novel nosologic entity, possibly an unstable migraine phenotype with a high conversion rate to chronic migraine (CM). Methods We conducted a retrospective review of patients diagnosed with status migrainosus at the Mayo Clinic, Rochester, between January 2005 and December 2015. All the records were then manually reviewed for patients with migraine headaches exclusively lasting more than 72 hours. Results We identified 18 patients with ESM, with a female predominance (15(83.3%)) and a median age of onset of 16.5 (IQR 13-19) years. The median monthly attack frequency was two (IQR 1-3), with each attack lasting a median duration of seven (IQR 4-12.5) days. Stress was the most commonly reported precipitant (11 (61.1%)). Migraine with aura was common (10 (55.6%)), as was comorbid depression (10 (55.6%)). Fifteen (83.3%) patients developed CM at a median of 7.8 (IQR 2.6-21.9) years from their first attack. There was no significant association between the time to the development of chronic migraine with either attack frequency or duration. Conclusions and relevance We report the existence of a novel migraine subtype, episodic status migrainosus. This migraine subtype appears to have similar clinical characteristics to episodic migraine with or without aura, except for a notably high tendency to progress to chronic migraine.
报告一系列新型偏头痛亚型病例，我们将其命名为发作性丛集性偏头痛（ESM），其特征为偏头痛发作持续时间超过 72 小时。我们假设这将代表一种新的分类实体，可能是一种不稳定的偏头痛表型，向慢性偏头痛（CM）转化的比例较高。
我们对 2005 年 1 月至 2015 年 12 月期间在梅奥诊所罗切斯特院区诊断为丛集性偏头痛的患者进行了回顾性研究。然后，对所有记录进行手动审查，以确定偏头痛发作仅持续超过 72 小时的患者。
我们共确定了 18 例 ESM 患者，其中女性居多（15 例[83.3%]），发病中位年龄为 16.5 岁（IQR 13-19）。每月发作频率中位数为 2 次（IQR 1-3），每次发作持续时间中位数为 7 天（IQR 4-12.5）。压力是最常见的诱发因素（11 例[61.1%]）。偏头痛伴先兆很常见（10 例[55.6%]），共病抑郁也很常见（10 例[55.6%]）。从首次发作到发展为慢性偏头痛的中位时间为 7.8 年（IQR 2.6-21.9），其中 15 例（83.3%）患者发展为慢性偏头痛。慢性偏头痛的发病时间与发作频率或持续时间之间没有显著相关性。
我们报告了一种新型偏头痛亚型的存在，即发作性丛集性偏头痛。这种偏头痛亚型似乎与有或无先兆的发作性偏头痛具有相似的临床特征，除了向慢性偏头痛转化的明显倾向较高。
