• Biswadev Mitra, Cristina Roman, Eric Mercier, John Moloney, Gary Yip, Keshav Khullar, Kieran Walsh, SmitDe VilliersVEmergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., and Peter A Cameron.
• Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2020 Aug 1; 32 (4): 542-547.

ObjectiveTo test the administration of intravenous (i.v.) propofol at a procedural sedation dose compared to standard therapy for initial management of migraine in the ED.MethodsThis was an open label, randomised controlled pilot trial. Eligible patients were adults with a diagnosis of migraine and planned for treatment with i.v. medications. Patients were randomised to propofol or standard therapy groups. The primary outcome variable was time to discharge (TTD) defined as time from intervention to discharge from the ED. Secondary outcomes were safety of propofol administration and change in pain scores. A reduction of pain by ≥50% or discharge from the ED was defined as favourable. All analyses were performed on an intention-to-treat basis.ResultsData from 29 patients were analysed, with 15 patients in the propofol group and 14 patients in the standard therapy group. TTD was significantly lower in the propofol group with median of 290 (interquartile range 162-500) min compared to 554.5 (interquartile range 534-639) min in the standard therapy group (P = 0.021). The hazard ratio for the defined favourable outcome of reduction of pain scores or discharge from the ED was 1.54 (95% CI 0.69-3.41).ConclusionsInitial management of migraine with i.v. propofol at procedural sedation doses significantly reduced TTD compared to standard therapy. We did not detect any significant safety concerns although the study was not adequately powered to detect safety of the intervention and requires validation.© 2020 Australasian College for Emergency Medicine.

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