Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series
A 62-year-old woman with a history of complex migraine presents with 5 days of 9/10 headache, with no relief from her home regimen of ibuprofen and rizatriptan. Past medical history was significant for irritable bowel syndrome, hepatitis C, and arthritis. She also complained of photophobia, left-sided facial paresthesias, and nausea, all of which were consistent with past migraine episodes. Initial vital signs were heart rate 73, blood pressure 151/84, and respiratory rate 18. Physical exam was remarkable only for decreased sensation on the left side of the face, in all 3 dermatomes. The patient was consented and treated with 1 mg/kg propofol. After five minutes she reported marked improvement with her pain score reduced to 3/10. On repeat evaluation she requested further treatment and was given intravenous compazine 10 mg IV, diphenhydramine 50 mg IV, and ketorolac 30 mg IV with 2 L intravenous saline. At discharge she reported full resolution of headache symptoms. Her total LOS was 4.8 hours. Discharge vital signs were heart rate 61, blood pressure 137/71, and respiratory rate 18.