title: [Treatment of status migrainosus by general anesthesia: a case report].
abstract: OBJECTIVE
  The status migrainosus is a complication of migraine characterizedby severe headache for more than 72 h that did not respond to treatment, with risk of strokeand 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 goalis to present a case of refractory status migrainosus in that we decided to break the pain cycle by general anesthesia.
  
  
  METHODS
  Female patient, aged 50 years, with status migrainosus, in the last five days withvisits to the emergency department, medicated parenterally with various agents without result. Without comorbidities, dehydrated, described her pain as "well over 10" in Visual NumericScale (VNS). After consulting the literature, and given the apparent severity of the condition, we opted for a general anesthesia: induction with fentanyl, propofol, and vecuroniumand 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departamento de Anestesiologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil. Electronic address: au1849@gmail.com.
authors.forename: Artur
authors.initials: A
authors.lastname: Udelsmann
authors.affiliation: Serviço de Anestesia, Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
authors.forename: Priscila
authors.initials: P
authors.lastname: Saccomani
authors.affiliation: Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dreyer
authors.affiliation: Ambulatório de Cefaleia, Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
authors.forename: Alberto Luiz Cunha da
authors.initials: AL
authors.lastname: Costa
keywords: Anestesia geral; Combined therapy; General anesthesia; Migraine disorder; Terapia combinada; Transtorno de enxaqueca