STATUS MIGRAINOSUS: A COMPREHENSIVE REVIEW OF PATHOPHYSIOLOGY, CLINICAL MANAGEMENT, AND THERAPEUTIC STRATEGIES IN CENTRAL ASIA

Status migrainosus represents one of the most challenging and debilitating complications of migraine, characterized by a severe migraine attack persisting for more than 72 hours despite attempted treatment. This narrative review examines the current understanding of status migrainosus, with particular emphasis on epidemiological patterns in Central Asia, underlying pathophysiological mechanisms, diagnostic criteria, and evidence-based therapeutic interventions. The analysis reveals that status migrainosus affects approximately 1-3% of patients with migraine, with significantly higher prevalence reported in regions with limited access to specialized headache care, including Central Asian countries. The pathophysiology involves persistent activation of the trigeminovascular system, central sensitization, and neurogenic inflammation, complicated by medication overuse and psychological factors. Central Asian countries face unique challenges including limited availability of modern abortive therapies, socioeconomic barriers to healthcare access, and insufficient specialized headache services. The review evaluates contemporary treatment approaches, including intravenous medications, neuromodulation techniques, and emerging CGRP-targeted therapies, while addressing regional considerations for implementation in Central Asian healthcare systems. The findings underscore the urgent need for standardized protocols, healthcare professional training, and improved access to evidence-based treatments across the region.