Effectiveness of intravenous Dexamethasone versus Propofol for pain relief in the migraine headache: A prospective double blind randomized clinical trial

Abstract

BackgroundThere are many drugs recommended for pain relief in patients with migraine headache.MethodsIn a prospective double blind randomized clinical trial, 90 patients (age ≥ 18) presenting to Emergency medicine Department with Migraine headache were enrolled in two equal groups. We used intravenous propofol (10 mg every 5–10 minutes to a maximum of 80 mg, slowly) and intravenous dexamethasone (0.15 mg/kg to a maximum of 16 mg, slowly), in group I and II, respectively. Pain explained by patients, based on VAS (Visual Analogue Scale) was recorded at the time of entrance to ED, and after injection. Data were analyzed by paired samples t test, using SPSS 16. P < 0.05 was considered to be statistically significant.ResultsThe mean of reported pain (VAS) was 8 ± 1.52 in propofol group and 8.11 ± 1.31 in dexamethasone group at presenting time (P > 0.05). The VAS in propofol group was obviously decreased to 3.08 ± 1.7, 1.87 ± 1.28 and 1.44 ± 1.63 after 10, 20 and 30 minutes of drug injection, respectively. The VAS in dexamethasone group was 5.13 ± 1.47, 3.73 ± 1.81 and 3.06 ± 2 after 10, 20 and 30 minutes of drug injection, respectively. The mean of reported VAS in propofol group was less than dexamethasone group at the above mentioned times (P < 0.05). The reduction of headache in propofol group, also, was very faster than dexamethasone group (P < 0.05). There were no adverse side effects due to administration of both drugs.ConclusionsIntravenous propofol is an efficacious and safe treatment for patients presenting with Migraine headache to the emergency department.Trial registrationClinical Trials IRCT201008122496N4

Propofol for Treatment of Acute Migraine in the Emergency Department: A Systematic Review

“…Nine studies were included for a total of 290 patients (Figure ) . These studies are summarized in Table and consisted of five case reports or series ( n = 5), one retrospective cohort study ( n = 1), and three randomized controlled trials ( n = 3).…”

“…Furthermore, one study utilized a loading dose . The three randomized controlled trials included active comparators . The adult randomized controlled trials utilized subcutaneous sumatriptan or IV dexamethasone .…”

“…Generalizability is also limited based on these studies. Both adult randomized controlled trials excluded patients who received a triptan or dihydroergotamine prior to ED presentation . One randomized controlled trial also excluded patients who had received opioids or systemic corticosteroids .…”

“…It should be noted that in pediatric studies, most patients had no history of treatment . Additionally, both adult randomized controlled trials and one case series took place at single sites in Iran . Similarly, most patients enrolled in the two pediatric studies were from the same ED .…”

“…Adverse effects were assessed in all included studies . Overall, subanesthetic doses of propofol seemed to be well tolerated.…”