Low-dose Propofol for the Treatment of Severe Refractory Migraine Headache in the Emergency Department
Status:
Terminated
Trial end date:
2016-01-01
Target enrollment:
Participant gender:
Summary
Migraine headache is a frequent Emergency Department complaint. While first-line Emergency
Department treatment for this condition is well-established, optimal second-line treatment
options are not well-defined. First line Emergency Department treatments include
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), dopamine antagonists. Second line treatments
that have been proposed include triptans, steroids, antiepileptics, benzodiazepines,
magnesium and narcotics, but none have shown reliable Emergency Department efficacy (less
than 50% in most studies). In the past ten years there have been several case series
published on using low, sub-anesthetic doses of propofol for the treatment of refractory
migraine. These case series have reported very impressive efficacy rates, especially in
comparison to the published efficacy rates of other second-line treatments. Personal
experience using this treatment modality has also yielded impressive clinical results. Most
of the published series, however, have not been conducted in the Emergency Department.
The Investigators propose to conduct a prospective, observational trial of low-dose propofol
for the treatment of refractory migraine in the Emergency Department. Propofol is a
frequently-used Emergency Department sedative, with a good safety profile when administered
by experienced Emergency Medicine practitioners using appropriate monitoring. The primary
outcome measurement will be reduction of pain after treatment, with secondary outcome
measures related to the safety of treatment and continuation of pain relief after leaving the
Emergency Department. Although the protocol will involve the use of low-dose propofol with
the aim of achieving light-to-moderate sedation only, all patients will care for and monitor
at a level appropriate for deep procedural sedation.