Episodic daily migraine or episodic status migrainosus

To the Editor:

I read Singh et al.’s excellent retrospective study on “Episodic status migrainosus: A novel migraine subtype” (1) with interest. I have also seen many patients with only long duration migraines lasting weeks or months without or with episodic migraine which I termed “episodic daily migraine” in a report of two cases which meet their proposed diagnostic criteria (2). Thomas Jefferson may have had this migraine variant (3). Medina and Diamond (4) described a somewhat similar pattern in 27 patients whom they termed as having “cyclical migraine”, but many had a constant low-grade headache with superimposed severe headaches.

My anecdotal experience has been that episodic daily migraine is often difficult to treat. I have had some success with a regimen of intravenous metoclopramide, dihydroergotamine, sodium valproate, and ketorolac, although less than with those with single episodes of migraine status (5).

In agreement with the authors’ inclusion and exclusion criteria for their study, their proposed diagnostic criteria could be amended with the addition of the words in bold to the following description: A recurrent headache disorder occurring in migraineurs with 14 or fewer headache days per month manifesting in attacks otherwise meeting criteria for (1.1 Migraine without aura and/or 1.2 Migraine with aura), except that exclusive duration of attacks last more than 72 hours.” To further increase awareness and study, consideration should be given to including the proposed diagnostic criteria in the appendix of the International Classification of Headache Disorders (6).