This 23-year-old student suffered from migrainous infarction following her first migraine with aura attack. She hesitated to seek medical attention, because as a medical student she was well aware of her migraine and suspected this to be her first migraine with typical aura that she knew well from her mother. The persistence of symptoms made her realize that this may not be a typical migraine attack after all and present to the emergency room. Neurological examination revealed hemianopia, hypoesthesia of the right arm, and mild expressive aphasia. CCT scan was unremarkable and symptoms were classified as status migrainosus but remained refractory to specific treatment attempts. MRI in the post-acute phase revealed laminar necrosis indicative of migrainous infarction. The neurological symptoms gradually improved, and she was discharged from the hospital 3 weeks after symptom onset without any residual neurological deficit.

Five complications of migraine are recognized by the ICHD-3 beta (Table 7.1): status migrainosus, persistent aura without infarction, migrainous infarction, migraine aura-triggered seizure, and in the appendix migraine aura status. The complication should be coded in addition to the underlying migraine subtype.

Status migrainosus is defined as debilitating migraine attack that lasts more than 72 h but has otherwise all the typical characteristics of a migraine attack with or without aura. Remissions of up to 12 h related to medication or sleep are accepted. Status migrainosus can last several weeks (mean 4.8 weeks; range 3–10), and patients with aura are more likely to develop status migrainosus. Precipitating factors can be stress and anxiety, menstruation, and lack of sleep.