Effectiveness and Safety of Low-Dose Propofol for the Treatment of Migraine in the Emergency Department: A Matched Retrospective Cohort Study.

Introduction This study aimed to evaluate the effectiveness and safety of propofol compared to metoclopramide for the treatment of migraines in the emergency department (ED). Methodology We reviewed the health records of patients aged 16 years and older treated with propofol for migraine between 2014 and 2017 at a teaching hospital in Québec City. The local protocol consisted of administering propofol (20 mg) every 10 minutes as needed (up to six doses), vital signs before and after each dose, and continuous cardiac monitoring. The primary outcome measure was the mean reduction of pain following first-line therapy (propofol or metoclopramide). The secondary outcome measures were: (1) adjusted relative risks of requiring rescue medication after first-line therapy; and (2) the incidence of the following side effects associated with propofol administered as first- or second-line therapy: hypotension (systolic <90 mmHg or mean <65 mmHg), desaturation, excessive sedation, and arrhythmia. The cohorts were paired for gender, age, triage priority, and date of ED visit. Results Medical records of 34 patients treated with propofol and 58 patients treated with metoclopramide as first-line therapy were analyzed. Five patients in the metoclopramide group received propofol as rescue medication. Among those treated with propofol, 10 patients (29.4%) experienced pain relief, compared to 38 (66%) in the metoclopramide group (P < 0.001). Rescue medication was more frequent in first-line propofol patients (28 patients, 82.4%, versus 22, 37.9%, P < 0.001). In this group, four participants (10.3%) received an intravenous fluid bolus for a mean blood pressure below 60 mmHg, but no other persistent adverse effects were recorded. Conclusions Though less effective than metoclopramide, propofol at low doses may be an alternative to treat migraine in the ED. Monitoring of vital signs would be prudent, but continuous nursing is likely unnecessary.