Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series
A 59 year old man with past medical history significant for migraines, insomnia, and hypothyroidism presented with four hours of 8/10 right-sided headache and photophobia. Symptoms were consistent with his typical migraine. Home treatment with naproxen and gabapentin had failed to improve his symptoms. Previous migraines requiring ED admission were treated with prochlorperazine 10 mg IV, diphenhydramine 50 mg IV, ketorolac 30 mg IV, morphine 6 mg IV, and promethazine 12.5 mg IV. Initial vital signs were heart rate 79, blood pressure 116/78, and respiratory rate 18. Neurologic examination revealed no focal deficits. The patient was then consented and treated with 1 mg/kg propofol. After 5 minutes the patient reported near complete resolution of symptoms with a pain score of 1/10. He was able to ambulate, tolerate oral intake, and was discharged shortly thereafter. His ED LOS was 2.8 hours. Discharge vital signs were heart rate 80, blood pressure 104/66, and respiratory rate 16.