Have you experienced a migraine headache that lasted more than 72 hours and didn’t improve with your usual treatments? This may be what’s known as an intractable migraine headache (or intractable migraine). These prolonged migraine headaches can be highly disabling and challenging to manage, making timely medical care essential.

Symptoms of an intractable migraine are often more intense and harder to manage than typical migraine attacks. Here’s what you need to know about these difficult-to-treat migraine attacks.

1. Intractable Migraine Is Long-Lasting and Treatment-Resistant

Intractable migraine, also known as status migrainosus, involves severe headaches that last more than 72 hours and don’t respond with typical treatments. They can occur in people who have been diagnosed with different types of migraine, including chronic migraine and migraine with aura. The thing that defines intractable migraine the most is that these attacks are resistant to treatment — so, just because a migraine is prolonged, that doesn’t make it intractable migraine.

Health experts aren’t sure how common intractable migraine is because there isn’t much data on the topic. Due to the severity and duration of these migraine headaches, individuals may seek care at an emergency room or neurology clinic.

2. Intractable Migraine Headaches Might Feel Like Regular Migraine Headaches but More Severe

The symptoms of an intractable headache aren’t very different from other migraine attacks, but they may be more severe. An intractable migraine is like a migraine headache that has gotten out of control.

Typical migraine symptoms include:

• Intense throbbing or pulsing on one side of the head
• Migraine pain that gets in the way of daily life
• Nausea and vomiting
• Sensitivity to noises and light

Describing your migraine symptoms to your health care provider is important to help them understand your headache disorder and find the best treatment options.

Some people notice signs of a migraine attack beforehand, known as the prodrome phase, which may include mood swings, neck stiffness, or constipation. Being aware of your symptoms can help with managing attacks.

Once an intractable migraine finally subsides, it’s normal to feel relieved — but also anxious about future attacks. Lingering symptoms, such as brief head pain with sudden head movements, may occur. Feeling fatigued or drained is also normal when recovering from a migraine attack.

Although the symptoms of intractable migraine are similar to typical migraine, they are often more severe, especially if symptoms last beyond 72 hours. According to the World Health Organization, migraine is the second highest cause of disability. Intractable migraine headaches come with a high risk of disability.

3. Most Intractable Migraine Headaches Are Primary Headaches

If you go to the doctor for a persistent headache or migraine attack, the first step is to figure out what’s causing it. Headaches can be classified as either primary or secondary.

A primary headache occurs on its own, without being caused by another medical condition. In contrast, secondary headaches result from an underlying health issue, such as an infection or a brain tumor.

Most intractable migraine headaches are classified as primary headaches. Your health care provider can run imaging studies and other tests to see if you have a primary or secondary headache. Magnetic resonance imaging (MRI) and computerized tomography (CT) scans are two common imaging tests for this purpose.

MRI uses magnetic fields and radio waves to create detailed images of the brain and blood vessels, while CT scans use X-rays to produce cross-sectional images of the brain. These tests help identify potential causes, and your doctor will want to rule out issues such as brain tumors, strokes, bleeding, or other neurological conditions when diagnosing your migraine.

4. The Cause of Intractable Migraine Headaches Isn’t Clear

Health care providers don’t always know what causes intractable migraine headaches. However, certain triggers can contribute to regular migraine attacks that may evolve into intractable migraine headaches.

Possible migraine triggers include:

• Changing medications
• Doing more or less exercise than usual
• Changing your eating schedule

5. Different Types of Headaches Can Become Intractable

In addition to migraine headaches, other types of headaches can also become intractable, including:

• Tension headaches
• Post-traumatic headaches
• Hemicrania continua

Certain factors can make treating migraine attacks, including intractable migraine, more challenging. For instance, overuse of acute migraine medications — those used for short-term relief — can lead to medication-overuse headache, complicating the management of chronic migraine. Stress can also reduce the effectiveness of treatments, leading to increased medication use and further complicating treatment.

Accurately identifying the type of headache is crucial for health care professionals to prescribe the most effective treatment.

6. There’s a Range of How Long Intractable Migraine May Last

Members of MyMigraineTeam have described a wide range of durations for their intractable migraine headaches. “Recovering from a two-day intractable migraine,” shared one member.

Another wrote, “I’m about to begin my 70th day of an intractable headache. I just finished three days of infusion therapy without breaking the attack. This is new territory for me. I’m feeling frustrated and lost,” they said.

Research on the average duration of intractable migraine is limited. However, one study reported they can last an average of 4.8 weeks in some cases. If you experience a migraine headache that lasts longer than 72 hours and doesn’t improve with your usual treatments, consult your health care provider or neurologist.

7. Intractable Migraine May Be Difficult To Treat

Treating intractable migraine headaches can be difficult. There are currently no established guidelines or expert consensus for managing this type of migraine attack.

Treatment and goals for treating an intractable migraine headache will depend on your migraine history. A health care professional will consider factors like your migraine diagnosis and medication history when deciding how to best treat an intractable migraine.

Health care providers may recommend medications for at-home use, such as pain relievers like acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and analgesics. Migraine-specific medications such as gepants, triptans, and calcitonin gene-related peptide (CGRP) monoclonal antibodies are also available.

Additional treatments that may be used alongside standard migraine medications include:

• Intravenous lidocaine
• Steroids
• Muscle relaxants
• Antiseizure medications

If at-home medications are not effective, you may need treatment at a clinic or infusion center. There, health care providers can administer medications intravenously and provide fluids to prevent dehydration, along with antiemetics to combat nausea.

If you experience a particularly severe or long-lasting migraine headache, reach out to your health care provider. Even if the headache eventually goes away, it's important for your provider to be aware so they can review your treatment plan and consider adjustments to help prevent future intractable migraine headaches.

Talk With Others Who Understand

On MyMigraineTeam, the social network for people with migraine and their loved ones, more than 83,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Have you ever had an intractable migraine that was hard to treat? How did you cope with the symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.

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