Status migrainosus in children and adolescents: A systematic literature review of demographic and clinical characteristics, precipitating factors, prognosis, treatments, and response

Background Status migrainosus (SM) is a prolonged migraine attack lasting over 72 hours. Pediatric-specific data on SM remain sparse. Methods Searches were conducted in six medical databases to July 2025. Eligible studies included clinical trials, cohorts, and case series (≥5 patients) reporting SM. Independent reviewers conducted screening, extraction, and quality appraisal. Results Of 658 studies, 17 ( n = 7161;1857 pediatric SM cases) were included—predominantly single-center, retrospective studies, without randomized controlled trials. Most SM cohorts showed a female, adolescent (13–16 years) preponderance. SM's management strategies were heterogeneous; with peripheral nerve (PNB) and sphenopalatine ganglion (SPG) blocking procedures (3 studies, 690 patients) and anti-seizure medications (2 studies using valproate, 146 patients) being commonly reported. PNB and SPG blocking procedures were associated with short-term improvement and safety. In one comparative study of 94 patients, lidocaine infusions showed a trend toward faster pain relief and fewer adverse effects than IV valproate. One study of 177 patients directly compared IV dihydroergotamine to PNB, identifying a longer hospital duration of stay among dihydroergotamine recipients but a better response rate. Factors associated with poor response included older age, anxiety, medication overuse, and baseline severity. Among others, self-reported psychological stress was an SM trigger in two studies. Interpretation Available evidence on SM in pediatric populations remains limited by non-randomized evidence, prone to inherent bias. Consequently, multicenter, comparative, randomized trials are warranted to establish pediatric-specific protocols. Observational evidence suggests that PNB/SPG blocking procedures may offer promise to those with failure of medical management strategies. Trial Registration This PRISMA-compliant review was prospectively registered on PROSPERO (CRD420251088970).