Treatment of status migrainosus by general anesthesia: a case report

Detalhes bibliográficos
Autor(a) principal: Udelsmann,Artur
Data de Publicação: 2015
Outros Autores: Saccomani,Priscila, Dreyer,Elisabeth, Costa,Alberto Luiz Cunha da
Tipo de documento: Relatório
Idioma: eng
Título da fonte: Revista Brasileira de Anestesiologia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942015000500407
Resumo: ABSTRACTBACKGROUND AND OBJECTIVES: The status migrainosus is a complication of migraine characterized by severe headache for more than 72 h that did not respond to treatment, with risk of stroke and suicide. Researches on treatment are directed to drugs that stimulate GABA receptors; propofol and isoflurane act on sub-GABAa receptors and theoretically could be interesting. The first has been the subject of research in severe migraine. Opioids are employed in pain, and its use in chronic headache is debatable, but these agents are employed in acute cases. The goal is to present a case of refractory status migrainosus in that we decided to break the pain cycle by general anesthesia.CASE REPORT: Female patient, aged 50 years, with status migrainosus, in the last five days with visits to the emergency department, medicated parenterally with various agents without result. Without comorbidities, dehydrated, described her pain as "well over 10" in Visual Numeric Scale (VNS). After consulting the literature, and given the apparent severity of the condition, we opted for a general anesthesia: induction with fentanyl, propofol, and vecuronium and maintenance with isoflurane and propofol for two hours. Following the treatment, in the postanesthetic recuperation (PAR), the patient related her pain as VNS 3, and was released after five hours with VNS 2. Subsequently, her preventive treatment was resumed.CONCLUSION: Status migrainosus is a rare disabling complication and anesthetics have been the subject of research in its treatment; the option for general anesthesia with agents that stimulate GABA receptors, propofol and isoflurane, in association with fentanyl, proved effective and should encourage new research.
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spelling Treatment of status migrainosus by general anesthesia: a case reportMigraine disorderCombined therapyGeneral anesthesiaABSTRACTBACKGROUND AND OBJECTIVES: The status migrainosus is a complication of migraine characterized by severe headache for more than 72 h that did not respond to treatment, with risk of stroke and suicide. Researches on treatment are directed to drugs that stimulate GABA receptors; propofol and isoflurane act on sub-GABAa receptors and theoretically could be interesting. The first has been the subject of research in severe migraine. Opioids are employed in pain, and its use in chronic headache is debatable, but these agents are employed in acute cases. The goal is to present a case of refractory status migrainosus in that we decided to break the pain cycle by general anesthesia.CASE REPORT: Female patient, aged 50 years, with status migrainosus, in the last five days with visits to the emergency department, medicated parenterally with various agents without result. Without comorbidities, dehydrated, described her pain as "well over 10" in Visual Numeric Scale (VNS). After consulting the literature, and given the apparent severity of the condition, we opted for a general anesthesia: induction with fentanyl, propofol, and vecuronium and maintenance with isoflurane and propofol for two hours. Following the treatment, in the postanesthetic recuperation (PAR), the patient related her pain as VNS 3, and was released after five hours with VNS 2. Subsequently, her preventive treatment was resumed.CONCLUSION: Status migrainosus is a rare disabling complication and anesthetics have been the subject of research in its treatment; the option for general anesthesia with agents that stimulate GABA receptors, propofol and isoflurane, in association with fentanyl, proved effective and should encourage new research.Sociedade Brasileira de Anestesiologia2015-10-01info:eu-repo/semantics/reportinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942015000500407Revista Brasileira de Anestesiologia v.65 n.5 2015reponame:Revista Brasileira de Anestesiologia (Online)instname:Sociedade Brasileira de Anestesiologia (SBA)instacron:SBA10.1016/j.bjane.2013.09.011info:eu-repo/semantics/openAccessUdelsmann,ArturSaccomani,PriscilaDreyer,ElisabethCosta,Alberto Luiz Cunha daeng2015-10-20T00:00:00Zoai:scielo:S0034-70942015000500407Revistahttps://www.sbahq.org/revista/https://old.scielo.br/oai/scielo-oai.php||sba2000@openlink.com.br1806-907X0034-7094opendoar:2015-10-20T00:00Revista Brasileira de Anestesiologia (Online) - Sociedade Brasileira de Anestesiologia (SBA)false
dc.title.none.fl_str_mv Treatment of status migrainosus by general anesthesia: a case report
title Treatment of status migrainosus by general anesthesia: a case report
spellingShingle Treatment of status migrainosus by general anesthesia: a case report
Udelsmann,Artur
Migraine disorder
Combined therapy
General anesthesia
title_short Treatment of status migrainosus by general anesthesia: a case report
title_full Treatment of status migrainosus by general anesthesia: a case report
title_fullStr Treatment of status migrainosus by general anesthesia: a case report
title_full_unstemmed Treatment of status migrainosus by general anesthesia: a case report
title_sort Treatment of status migrainosus by general anesthesia: a case report
author Udelsmann,Artur
author_facet Udelsmann,Artur
Saccomani,Priscila
Dreyer,Elisabeth
Costa,Alberto Luiz Cunha da
author_role author
author2 Saccomani,Priscila
Dreyer,Elisabeth
Costa,Alberto Luiz Cunha da
author2_role author
author
author
dc.contributor.author.fl_str_mv Udelsmann,Artur
Saccomani,Priscila
Dreyer,Elisabeth
Costa,Alberto Luiz Cunha da
dc.subject.por.fl_str_mv Migraine disorder
Combined therapy
General anesthesia
topic Migraine disorder
Combined therapy
General anesthesia
description ABSTRACTBACKGROUND AND OBJECTIVES: The status migrainosus is a complication of migraine characterized by severe headache for more than 72 h that did not respond to treatment, with risk of stroke and suicide. Researches on treatment are directed to drugs that stimulate GABA receptors; propofol and isoflurane act on sub-GABAa receptors and theoretically could be interesting. The first has been the subject of research in severe migraine. Opioids are employed in pain, and its use in chronic headache is debatable, but these agents are employed in acute cases. The goal is to present a case of refractory status migrainosus in that we decided to break the pain cycle by general anesthesia.CASE REPORT: Female patient, aged 50 years, with status migrainosus, in the last five days with visits to the emergency department, medicated parenterally with various agents without result. Without comorbidities, dehydrated, described her pain as "well over 10" in Visual Numeric Scale (VNS). After consulting the literature, and given the apparent severity of the condition, we opted for a general anesthesia: induction with fentanyl, propofol, and vecuronium and maintenance with isoflurane and propofol for two hours. Following the treatment, in the postanesthetic recuperation (PAR), the patient related her pain as VNS 3, and was released after five hours with VNS 2. Subsequently, her preventive treatment was resumed.CONCLUSION: Status migrainosus is a rare disabling complication and anesthetics have been the subject of research in its treatment; the option for general anesthesia with agents that stimulate GABA receptors, propofol and isoflurane, in association with fentanyl, proved effective and should encourage new research.
publishDate 2015
dc.date.none.fl_str_mv 2015-10-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/report
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dc.language.iso.fl_str_mv eng
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dc.relation.none.fl_str_mv 10.1016/j.bjane.2013.09.011
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dc.publisher.none.fl_str_mv Sociedade Brasileira de Anestesiologia
publisher.none.fl_str_mv Sociedade Brasileira de Anestesiologia
dc.source.none.fl_str_mv Revista Brasileira de Anestesiologia v.65 n.5 2015
reponame:Revista Brasileira de Anestesiologia (Online)
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