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> First time for me.. And just a short question: Are we sure it was the Propofol that made him better? If I understood correctly, he got better after performing the LP, right? Did you measure the pressure?
--> Sensible question, but propofol DOES work, regardless of whether in this one case it might have been something else.
While I don't think I have ever used it in a very young person (probably no younger than 16), I have been using it for nearly 20 years now. Started before I had ever been trained in its use for RSI, etc - that came later. It was a very handy solution on board cruise ship, where I first was taught to use it, 'cause it was very effective and people could get back to boozing/gambling soon... ;-)
It was never the only option, but I remember when the -triptans came along and I recall thinking it was the best at managing migraine pain for patients who had already failed with their -triptan. Sorry - I did not even know how to spell "evidence" in those days...
20mg boluses until pain free. Rare to need a 3rd bolus. No-one falls asleep. No-one gets monitored. I don't even make them all lie down. For child, as usual, it's like for a small adult (yes - I know people keep preaching not to consider children as small adults, but who listens!) so it's STILL 20mg. I don't think expect to be called upon to manage a migraine IN MY CIRCUMSTANCES for a child who's too young/small to be considered a small adult...
Ketamine does work and, of course, prochloperazine with 1L IV saline to flush it in, oxygen, darkness...
There are some other tricks, with nose-drops, etc...
What commonly happens (again - adult set-up) is that we are asked to provide analgesia for a bad headache which has just presented and is not next to be assessed and will end up having to wait. So seems safest, until a full assessment, not knowing that this is a migraine at all (even if we suspect it's not), not to try certain drugs, so often these people get 100mg RECTAL diclofenac and 12.5 IM prochloperazine (and genrally will have taken their own paracetamol already) and keep waiting. By the time we see them, there's no need for much more in most cases, so we never get to try propofol much these days.
Of course, it is an unusual event these days for us to have anyone present to the ED with a migraine at all. Much less than a decade ago. But this is in my region of the UK (although other UK EDs may well find otherwise).
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