Propofol for migraine in the emergency department: A pilot randomised controlled trial

Biswadev Mitra, Cristina Roman, Eric Mercier, John Moloney, Gary Yip, Keshav Khullar, Kieran Walsh, De Villiers Smit, Peter A. Cameron

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3 Citations (Scopus)

Abstract

Objective: To test the administration of intravenous (i.v.) propofol at a procedural sedation dose compared to standard therapy for initial management of migraine in the ED. Methods: This was an open label, randomised controlled pilot trial. Eligible patients were adults with a diagnosis of migraine and planned for treatment with i.v. medications. Patients were randomised to propofol or standard therapy groups. The primary outcome variable was time to discharge (TTD) defined as time from intervention to discharge from the ED. Secondary outcomes were safety of propofol administration and change in pain scores. A reduction of pain by ≥50% or discharge from the ED was defined as favourable. All analyses were performed on an intention-to-treat basis. Results: Data from 29 patients were analysed, with 15 patients in the propofol group and 14 patients in the standard therapy group. TTD was significantly lower in the propofol group with median of 290 (interquartile range 162–500) min compared to 554.5 (interquartile range 534–639) min in the standard therapy group (P = 0.021). The hazard ratio for the defined favourable outcome of reduction of pain scores or discharge from the ED was 1.54 (95% CI 0.69–3.41). Conclusions: Initial management of migraine with i.v. propofol at procedural sedation doses significantly reduced TTD compared to standard therapy. We did not detect any significant safety concerns although the study was not adequately powered to detect safety of the intervention and requires validation.

Original languageEnglish
Pages (from-to)542-547
Number of pages6
JournalEMA - Emergency Medicine Australasia
Volume32
Issue number4
DOIs
Publication statusPublished - Aug 2020

Keywords

  • analgesia
  • headache
  • migraine disorder
  • pain
  • propofol

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