the authors as the foundation for the discussion.

The exact pathophysiology of migrainous status is not fully understood, but it shares several characteristics with common migraine, such as activation of the trigemino­vascular system and central and peripheral sensitization [4].

Furthermore, some research indicates that migrainous status may cause revers­ible structural changes in the brain, such as vasogenic edema and hypoperfusion, suggesting deeper involvement than typical migraine. However, such ndings are still rare and require validation through larger, controlled studies [4].

Based on the report of severe headache persisting for over 72h with inadequate response to usual treatment, the probable diagnosis is Migrainous Status. This con­dition is exacerbated by associated vomiting and other debilitating symptoms, char­acterizing a medical emergency.

This is a typical case of status migrainosus in a patient with a history of migraine, triggered by stress and sleep deprivation. The progression to a prolonged crisis unresponsive to standard medications justies the need for a more aggressive

approach, including intravenous (IV) therapies and hospital observation. Proper management can prevent complications such as the progression to chronic migraine and reduce the severe functional impact associated with the condition [3–7]. Given the refractoriness of the headache to standard treatments and its pro­longed duration, a more intensive management strategy in a hospital setting was warranted. The proposed plan included intravenous hydration with a saline solu­tion to address potential electrolyte imbalances and dehydration resulting from vomiting. Dexamethasone (8mg IV) was administered to reduce neuroinamma­tion and lower the risk of recurrence. Metoclopramide (10mg IV) was used to manage associated nausea and vomiting. Intravenous magnesium sulfate was added for its known prophylactic and crisis-modulating effects in refractory migraine. Additionally, an anticonvulsant such as intravenous valproic acid was considered due to its reported efcacy in treatment-resistant attacks. The patient was admitted for observation over the rst 24h to monitor clinical response and allow for timely adjustment of therapy as needed. With appropriate treatment, it is expected that the patient will show improvement within 24–48h, with a gradual resolution of symptoms. However, a subsequent evaluation should be considered to review long-term preventive medication and discuss the management of comor­bid conditions.

Risk factors for developing this condition include excessive use of pain medica­tions during attacks, sleep disturbances, stress, and lack of effective treatment for migraine attacks. One of the primary triggers includes irregular sleep patterns, both excess and deprivation, which are strongly associated with the risk of migrainous status recurrence. Patients with episodic migraine are also more likely to progress to chronic migraine if they experience recurrent migrainous status.

Additionally, migraine attacks resistant to acute pharmacological therapy increase the likelihood of complications, such as progression to chronic migraine and the development of medication dependency [6].