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The review will also explore additional attack dimensions that could support a more patient\u2010centric and clinically actionable definition.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>ICHD\u20103 defines SM as a debilitating migraine attack lasting more than 72\u2009h. This 72\u2010h threshold is historically derived rather than empirically validated, and limited evidence is available to guide treatment. We posit that a primarily duration\u2010based definition restricts both the clinical utility of SM and its usefulness as a construct in acute treatment trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review was structured around five key questions: (Q1) Do we need specific diagnostic criteria for SM; (Q2) Should time be used within the definition; (Q3) Should attack severity and disability be included; (Q4) Should treatment response be included; and (Q5) Should migraine attack phases be considered. Targeted PubMed searches (inception\u2013mid\u20102025) were performed for questions 2\u20135. One reviewer was assigned to each of these questions and independently conducted title\/abstract screening, full\u2010text review, and data extraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Searches yielded 36 publications from 504 screened for question 2, 12 from 322 for question 3, 61 from 171 for question 4, and 13 from 1708 for question 5. Q1: Although SM remains clinically useful, the current criteria do not capture the heterogeneity of prolonged attacks and provide limited guidance for treatment escalation. Q2: Attack duration varies widely across migraine phenotypes, and the 72\u2010h cutoff lacks clear justification and is misaligned with real\u2010world practice, where escalation occurs well before 72\u2009h. Q3: \u201cDebilitating\u201d is undefined, and pain severity alone insufficiently reflects functional impact; disability may offer a more meaningful indicator for clinical decision\u2010making. Q4: Treatment refractoriness is central to how prolonged attacks are managed but is not incorporated into current criteria, and standardized definitions of acute treatment failure are lacking. Q5: Prodrome, aura, and postdrome can meaningfully contribute to attack burden, yet SM criteria do not specify whether nonheadache phases count toward attack duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A revised definition of SM should move beyond a rigid 72\u2010h threshold and give greater weight to functional impairment, treatment response, and more explicit definitions of attack duration that clarify how nonheadache phases are handled.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.70075","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T06:28:58Z","timestamp":1774679338000},"page":"1117-1127","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Redefining status migrainosus: A narrative review"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2556-1125","authenticated-orcid":false,"given":"Jennifer","family":"Robblee","sequence":"first","affiliation":[{"name":"Department of Neurology, Barrow Neurological Institute St. Joseph's Hospital and Medical Center  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H.","family":"Smith","sequence":"additional","affiliation":[{"name":"AbbVie  North Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5500-3100","authenticated-orcid":false,"given":"Sarah","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Davis School of Medicine  Sacramento California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Geiser","sequence":"additional","affiliation":[{"name":"University of Arizona College of Medicine \u2013 Phoenix  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashhar","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Neurology Henry Ford Health, Wayne State University School of Medicine, Michigan State University College of Human Medicine  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417738202"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000201382"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.13767"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102416686341"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12553"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14769"},{"key":"e_1_2_11_8_1","first-page":"S24","article-title":"Migraine heterogeneity. 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