Background: Migraine headache is a debilitating disorder that is difficult to manage and is often treated in the emergency department (ED). Many standard abortive therapies used in the ED have mixed efficacy and lead to unsatisfactory results. Propofol is a proposed treatment for acute migraine with the potential to have better efficacy than standard ED abortive medications. This review evaluates propofol’s effectiveness at reducing pain severity and headache recurrence in adult patients with migraine headache when compared to typical abortive therapies.
Methods: An exhaustive search of medical literature was completed using Medline-OVID, CINAHL, EBMR Multifile, and Web of Science. Key words used included: propofol, migraine, and headache. Relevant articles were assessed for quality using GRADE.
Results: Twenty-two articles were reviewed for relevancy. Two randomized, double blind studies met inclusion criteria and were included in this systematic review. The first randomized, double blind trial was conducted in an ED and demonstrated a significant decrease in pain severity, nausea and vomiting, and headache relapse within 24 hours when compared to sumatriptan. The second randomized, double blind trial was conducted in an ED and demonstrated a significant decrease in pain severity when compared to dexamethasone. Both studies revealed a significantly faster rate of pain severity reduction when compared to sumatriptan and dexamethasone.
Conclusion: Propofol can be an ideal abortive therapy for acute migraine in the ED. It has been shown to be more effective than sumatriptan and dexamethasone at treating migraine headache. More research is needed to compare propofol’s efficacy to these and other accepted abortive therapies.
Keywords: Propofol, migraine, headache, emergency department
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