Hossein Moshtaghion1, Najmeh Heiranizadeh1, Abolghasem Rahimdel2, Alireza Esmaeili3, Hamidreza Hashemian3, Seyedhossein Hekmatimoghaddam4. 1. Pain Research Center, Department of Anesthesiology and Intensive Care Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2. Department of Neurology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 3. Trauma Research Center, Department of Emergency Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 4. Department of Laboratory Sciences, School of Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Abstract
BACKGROUND: In this double-blinded, randomized trial, we hypothesized that propofol is as effective as sumatriptan in treating acute migraine headaches, with better control of nausea and vomiting, and fewer side effects. METHODS:Ninety cases of acute migraine attack admitted to the emergency department were randomly allocated into two treatment groups: (1) 6 mg of sumatriptan subcutaneously or (2) propofol injected intravenously in 30 to 40 mg boluses, followed by 10 to 20 mg intermittent bolus doses to sedate the patients to Ramsey score of 3 to 4. Headache severity was assessed using an 11-point visual analog scale before treatment and 30 minutes, 1 hour, and 2 hours after treatment. Accompanying symptoms, improvement in headache, and the need for anti-emetic therapy were also assessed. RESULTS:A total of 91 patients were enrolled in this study. One patient in the sumatriptan group was excluded due to severe chest tightness, and 90 patients were included in the final analysis. Pain intensity was significantly lower in the propofol group 30 minutes after treatment (P = 0.001); however, after 1 and 2 hours, there were no significant differences between the groups. The need for anti-emetic therapy and the recurrence of symptoms were significantly lower in the propofol group (P = 0.045 and P = 0.001, respectively). CONCLUSION:Propofol is equally suitable as sumatriptan for the acute treatment of migraine headaches in an emergency department setting. Moreover, the use of propofol avoids some of the adverse side effects of sumatriptan while providing better control of nausea and vomiting.
RCT Entities:
BACKGROUND: In this double-blinded, randomized trial, we hypothesized that propofol is as effective as sumatriptan in treating acute migraine headaches, with better control of nausea and vomiting, and fewer side effects. METHODS: Ninety cases of acute migraine attack admitted to the emergency department were randomly allocated into two treatment groups: (1) 6 mg of sumatriptan subcutaneously or (2) propofol injected intravenously in 30 to 40 mg boluses, followed by 10 to 20 mg intermittent bolus doses to sedate the patients to Ramsey score of 3 to 4. Headache severity was assessed using an 11-point visual analog scale before treatment and 30 minutes, 1 hour, and 2 hours after treatment. Accompanying symptoms, improvement in headache, and the need for anti-emetic therapy were also assessed. RESULTS: A total of 91 patients were enrolled in this study. One patient in the sumatriptan group was excluded due to severe chest tightness, and 90 patients were included in the final analysis. Pain intensity was significantly lower in the propofol group 30 minutes after treatment (P = 0.001); however, after 1 and 2 hours, there were no significant differences between the groups. The need for anti-emetic therapy and the recurrence of symptoms were significantly lower in the propofol group (P = 0.045 and P = 0.001, respectively). CONCLUSION:Propofol is equally suitable as sumatriptan for the acute treatment of migraine headaches in an emergency department setting. Moreover, the use of propofol avoids some of the adverse side effects of sumatriptan while providing better control of nausea and vomiting.
Authors: Ashley R Etchison; Lia Bos; Meredith Ray; Kelly B McAllister; Moiz Mohammed; Barrett Park; Allen Vu Phan; Corey Heitz Journal: West J Emerg Med Date: 2018-09-10
Authors: David Giampetro; Victor Ruiz-Velasco; Ashlee Pruett; Matthew Wicklund; Robert Knipe Journal: Pain Res Manag Date: 2018-01-21 Impact factor: 3.037