title: Low-dose propofol for the abortive treatment of pediatric migraine in the emergency department.
abstract: OBJECTIVE
  Limited progress has been made in the past decade for abortive treatment of migraine headache in the pediatric emergency department (PED). Propofol, a general anesthetic, has been reported to be effective in the treatment of refractory headaches in adults at subanesthetic doses but never in the pediatric population. The goal of this study was to review our institution's experience with subanesthetic doses of propofol for the abortive treatment of pediatric migraine and compare propofol with standard abortive therapy in the PED.
  
  
  METHODS
  Retrospective review of all patients discharged from the Oregon Health and Science University PED with a diagnosis of migraine headache from January 2010 to July 2011. Patients treated with subanesthetic doses of propofol were compared with matched controls who received standard abortive migraine therapy, defined as the combined use of a nonsteroidal anti-inflammatory medication, diphenhydramine, and prochlorperazine. Outcome variables of interest included reduction of pain as measured on a self-reported visual analog scale and length of stay after administration of initial abortive medication.
  
  
  RESULTS
  Patients who received subanesthetic doses of propofol achieved significantly greater reduction in pain scores (80.1% vs 61.1%; P < 0.05) compared with matched controls as well as shorter stay (122 minutes vs 203 minutes; P = 0.2) after treatment. No adverse effects (hypotension, respiratory depression, or hypoxia) were recorded in either group.
  
  
  CONCLUSIONS
  Propofol seems to be effective for the abortive treatment of pediatric migraine headache in the PED. Further prospective trials are warranted to either support or refute these initial findings.
authors.affiliation: Department of Pediatrics, Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA. sheridda@ohsu.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Sheridan
authors.forename: David M
authors.initials: DM
authors.lastname: Spiro
authors.forename: Thuan
authors.initials: T
authors.lastname: Nguyen
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Koch
authors.forename: Garth D
authors.initials: GD
authors.lastname: Meckler
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D004155:Diphenhydramine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy*; D010147:Pain Measurement; D011346:Prochlorperazine / Q000627:therapeutic use; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004155:Diphenhydramine; D011346:Prochlorperazine; D015742:Propofol