Migraine is a chronic paroxysmal headache that progresses through attacks between which the patient does not suffer (free interval) [1] .

Its most frequent medical complication remains status migrainosus [2] .

Status migrainosus is defined by severe migraine attacks lasting more than 72 hours and resisting the usual treatment for migraine attacks [1] . It affects 10% of the population with a clear female predominance (2 out of 3 cases).

It most often begins between the ages of 10 and 40 (90% of cases), sometimes in childhood and rarely after the age of 40 [3] .

In the United States, the direct and indirect economic cost of this pathology is estimated at between 5 and 17 billion dollars [1] .

Its prevalence in France and in European countries is estimated at between 12 and 15% of the population [3] .

In Africa (Nigeria and Zimbabwe) the prevalence of status epilepticus is rare and is reported to be 7 and 12% respectively [4] .

We found no local or regional epidemiological data because migraine remains underdiagnosed.

In Chad we have not found any studies on this subject.

Thus the scarcity of studies on this subject; the different diagnoses and management in the context of countries with limited health resources motivated the choice of this theme entitled:

“STATUS MIGRAINOSIS: case study and literature review in the Neurology Department of the National General Reference Hospital of N’Djamena.”

This is Mrs. TS, aged 35, a professional gendarme, received for:

Moderate to severe headaches of unilateral pulsating type associated with digestive signs:

Nausea and projectile vomiting and dizziness

Evolution over the past 4 days

Status migrainosus is a rare complication of migraine and is rarely reported in the literature. We report the case of a 35-year-old woman who consulted our department for a disabling migraine attack lasting more than 72 hours without remission caused by medication abuse associated with nausea and vomiting.

In the literature, migraine is 3 times more common in women than in men [5] .

This predominance could be explained by the rapid and significant drop in estrogen and progesterone levels during menstruation following luteolysis [6] . This drop could be one of the causes of migraines in women.

Several studies report that age 30 to 45 years is a risk factor; our patient is included in this age group [5] .

The reasons for our patient’s consultation were headaches lasting more than 72 hours, unilateral in location, pulsating with moderate to severe intensity, aggravated by simple physical activities (walking) associated with nausea and vomiting without photophobia or phonophobia, which correspond to the criteria dictated by the International Headache Society (IHS).

The history of the disease reports the progressive onset of headaches lasting more than 72 hours, unilateral in location, pulsating type with moderate to severe intensity in 2 hours, accompanied by easy projectile vomiting resistant to analgesics and anti-inflammatories.

This clinical description of the signs is found in the study by Dumas et al., who report the same installation procedures [2] .

Our patient reported a family history of migraine in her mother and sister. These family histories are also found in the cases reported by Annequin D [7] .

Although migraine is often hereditary, it is often underreported, since 1/3 of patients with migraine in adulthood are unaware that they have this disease.

Our patient is a single mother of a living son who does not drink alcohol or smoke tobacco.

The neurological examination did not reveal any particularities.

D Valade [4] had not found any particularities in the neurological examination.

The absence of localization signs could be explained by the fact that the disease does not completely alter neuronal functions even if the auras sometimes manifest as transient ischemic attacks.

Delays in diagnosis and treatment could contribute to the development of a stroke [4] .

We performed the MRI angiography which turned out to be normal.

Angio-MRI; lumbar puncture and blood tests allowed us to eliminate:

Infectious or non-infectious encephalitis

An arteriovenous malformation

The diagnosis of status migrainosus was retained based on epidemiological, clinical and therapeutic arguments.

During the hospitalization she was subjected to tricyclic antidepressants (Amitriptyline): Laroxyl 25 mg IV over 2 hours then 2 tablets/day orally due to lack of triptans and Hydroxyzine in our country associated with antiemetics based on Metoclopramide Primperan 2 amps/day morning and evening and hydration based on 1 l/day.

The evolution was marked by the complete regression of symptoms after 5 days of hospitalization and the patient was released with basic treatment consisting of tricyclic antidepressants, analgesics and benzodiazepines.

Although status migrainosus is rare, it constitutes a complication of migraine without aura, the management of which is difficult, especially in countries with limited health resources [7] .

The clinical picture of our patient is dominated by intense headaches lasting more than 72 hours, unilateral in location, pulsatile type with moderate to severe intensity associated with vomiting and resistant to non-specific anti-migraine treatment.

The diagnosis is based on the criteria of the International Headquarters Society (IHS).

Management of a patient who has received an NSAID is carried out in a specialized environment with the introduction of rehydration associated with triptan 25 mg IV over 2 hours and Metoclopramide ± Hydroxyzine in the event of failure of treatment based on a tricyclic antidepressant Amitriptyline, Dexamethasone 10 to 20 mg slow IV or chlorpromazine 0.1 mg/kg slow IV [4] .

A future study based on the evolution of seizures under treatment will clarify the short, medium and long-term prognosis in our context.