The Efficacy of Propofol vs. Subcutaneous Sumatriptan for Treatment of Acute Migraine Headaches in the Emergency Department: A Double-Blinded Clinical Trial.

Abstract

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. Ninety cases of acute migraine attack admitted to the emergency department were randomly allocated into two treatment groups: (1) 6mg of sumatriptan subcutaneously or (2) propofol injected intravenously in 30 to 40mg boluses, followed by 10 to 20mg 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 30minutes, 1hour, and 2hours after treatment. Accompanying symptoms, improvement in headache, and the need for anti-emetic therapy were also assessed. 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 30minutes after treatment (P=0.001); however, after 1 and 2hours, 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). 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.