Abstract
Background
Migraine headaches are a common reason for pediatric emergency department (ED) visits.
Small studies suggest the potential efficacy of sub-anesthetic doses of propofol for
migraine with a favorable side effect profile and potentially decreased length of
stay (LOS).
Objective
The objective of this study was to compare the efficacy of low-dose propofol (LDP)
to standard therapy (ST) in pediatric migraine treatment.
Methods
We conducted a prospective, pragmatic randomized controlled trial from April 2014
through June 2016 in the ED at two pediatric hospitals. Patients aged 7–19 years were
eligible if they were diagnosed with migraine by the emergency physician and had a
presenting visual analog pain score (VAS) of 6–10. Primary outcome was the percent
of pain reduction. Secondary outcomes were ED LOS, 24-h rebound headache, return visits
to the ED, and adverse reactions.
Results
Seventy-four patients were enrolled, but 8 were excluded, leaving 66 patients in the
final analysis (36 ST, 30 LDP). Pain reduction was 59% for ST and 51% for LDP (p = 0.34) with 72.2% vs. 73.3% achieving a VAS ≤ 4 with initial therapy (p = 0.92). There was a nonsignificant trend toward shorter median LOS from drug administration
to final disposition favoring propofol (79 min vs. 111 min; p = 0.09). Rebound headache was significantly more common in the ST vs. LDP group (66.7%
vs. 25.0%; p = 0.01).
Conclusions
LDP did not achieve better pain reduction than ST, however, LDP was associated with
significantly fewer rebound headaches and a nonsignificant trend toward shorter median
LOS from drug administration to disposition.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pediatric migraine: abortive management in the emergency department.Headache. 2014; 54: 235-245
- Diagnostic testing and treatment of pediatric headache in the emergency department.J Pediatr. 2013; 163: 1634-1637
- Acute treatment therapies for pediatric migraine: a qualitative systematic review.Headache. 2016; 56: 49-70
- Relative effectiveness of dopamine antagonists for pediatric migraine in the emergency department.Pediatr Emerg Care. 2016; ([Epub ahead of print])
- A comparison of acute treatment regimens for migraine in the emergency department.Pediatrics. 2015; 135: 232-238
- Treatment of children with migraine in emergency departments: national practice variation study.Pediatrics. 2010; 126: e150-e155
- Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac.Ann Emerg Med. 2004; 43: 256-262
- Intravenous sodium valproate for acute pediatric headache.J Emerg Med. 2015; 49: 541-545
- Intravenous magnesium as acute treatment for headaches: a pediatric case series.J Emerg Med. 2014; 46: 308-312
- Intravenous propofol: unique effectiveness in treating intractable migraine.Headache. 2000; 40: 224-230
- Propofol: a novel treatment for breaking migraine headache.Anesthesiology. 2007; 106: 405-406
- Propofol: a new treatment strategy for refractory migraine headache.Pain Med. 2002; 3: 366-369
- Effectiveness of intravenous dexamethasone versus propofol for pain relief in the migraine headache: a prospective double blind randomized clinical trial.BMC Neurol. 2012; 12: 114
- Propofol in the treatment of refractory migraine headaches.Expert Rev Neurother. 2016; 16: 1007-1011
- Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: propofol for migraine.Emerg Med J. 2013; 30: 688-689
- Pediatric Sedation Research Consortium. Emergency physician-administered propofol sedation: a report on 25,433 sedations from the pediatric sedation research consortium.Ann Emerg Med. 2011; 57: 462-468.e1
- Low-dose propofol for the abortive treatment of pediatric migraine in the emergency department.Pediatr Emerg Care. 2012; 28: 1293-1296
- Propofol induces changes in the cytosolic free calcium concentration and the cytoskeletal organization of cultured human glial cells and primary embryonic rat brain cells.Anesthesiology. 1994; 81: 1220-1229
- Actions of the general anesthetic propofol on recombinant human GABAA receptors: influence of receptor subunits.J Pharmacol Exp Ther. 1995; 274: 353-360
- Propofol hemisuccinate suppresses cortical spreading depression.Neurosci Lett. 2012; 514: 67-70
Article info
Publication history
Published online: February 15, 2018
Accepted:
January 6,
2018
Received in revised form:
January 3,
2018
Received:
October 23,
2017
Footnotes
This was partially supported by an American Academy of Pediatrics resident research award.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
