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      Improvement of refractory migraine headache by propofol: case series

      case-report

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          Abstract

          Background

          Several studies have been conducted on managing migraine headaches and developing effective medications for decreasing migraine-associated pain.

          Case presentation

          Intravenous propofol was prescribed (10 mg every 5 min) for eight patients with intractable migraine headaches visiting the Emergency Department. The average pain score experienced by patients was recorded using the Visual Analogue Scale at the beginning of the treatment procedure and following the injection for 30 min (5-min intervals). The patients’ reported pain scores decreased significantly ( P = 0.01) from 8.87 ± 0.83 (CI: 8.17, 9.57) to 1.12 ± 0.83 (CI: 0.43, 1.82) before and 30 min following the injection.

          Discussion

          It seems that in the treatment of intractable migraine headaches, GABAergic receptors, compared to the normal conditions, have a lower activity status.

          Conclusion

          Because of the high tendency of propofol to GABAergic receptors, it probably changes this physiological condition by activating the receptors, which results in a significant pain reduction.

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          Most cited references11

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          Migraine--current understanding and treatment.

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            Sympathetic responses to induction of anesthesia in humans with propofol or etomidate.

            Anesthetic induction with propofol commonly results in hypotension. This study explored potential mechanisms contributing to hypotension by recording cardiovascular responses including sympathetic neural activity from patients during induction of anesthesia with propofol (2.5 mg.kg-1 plus 200 micrograms.kg-1.min-1) or, for comparison, etomidate (0.3 mg.kg-1 plus 15 micrograms.kg-1.min-1). Twenty-five consenting, nonpremedicated, ASA physical status 1 and 2, surgical patients were evaluated. Measurements of R-R intervals (ECG), blood pressure (radial artery), forearm vascular resistance (plethysmography), and efferent muscle sympathetic nerve activity ([MSNA] microneurography: peroneal nerve) were obtained at rest and during induction of anesthesia. In addition, a sequential bolus of nitroprusside (100 micrograms) followed by phenylephrine (150 micrograms) was used to obtain data to quantitate the baroreflex regulation of cardiac function (R-R interval) and sympathetic outflow (MSNA) in the awake and anesthetized states. Etomidate induction preserved MSNA, forearm vascular resistance, and blood pressure, whereas propofol reduced MSNA by 76 +/- 5% (mean +/- SEM), leading to a reduction in forearm vascular resistance and a significant hypotension. Both cardiac and sympathetic baroslopes were maintained with etomidate but were significantly reduced with propofol, especially in response to hypotension. These findings suggest that propofol-induced hypotension is mediated by an inhibition of the sympathetic nervous system and impairment of baroreflex regulatory mechanisms. Etomidate, conversely, maintains hemodynamic stability through preservation of both sympathetic outflow and autonomic reflexes.
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              Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography.

              Although the effects of propofol on cerebral metabolism have been studied in animals, these effects have yet to be directly examined in humans. Consequently, we used positron emission tomography (PET) to demonstrate in vivo the regional cerebral metabolic changes that occur in humans during propofol anesthesia. Six volunteers each underwent two PET scans; one scan assessed awake-baseline metabolism, and the other assessed metabolism during anesthesia with a propofol infusion titrated to the point of unresponsiveness (mean rate +/- SD = 7.8 +/- 1.5 mg.kg-1.h-1). Scans were obtained using the 18fluorodeoxyglucose technique. Awake whole-brain glucose metabolic rates (GMR) averaged 29 +/- 8 mumoles.100 g-1.min-1 (mean +/- SD). Anesthetized whole-brain GMR averaged 13 +/- 4 mumoles.100 g-1.min-1 (paired t test, P < or = 0.007). GMR decreased in all measured areas during anesthesia. However, the decrease in GMR was not uniform. Cortical metabolism was depressed 58%, whereas subcortical metabolism was depressed 48% (P < or = 0.001). Marked differences within cortical regions also occurred. In the medial and subcortical regions, the largest percent decreases occurred in the left anterior cingulate and the inferior colliculus. Propofol produced a global metabolic depression on the human central nervous system. The metabolic pattern evident during anesthesia was reproducible and differed from that seen in the awake condition. These findings are consistent with those from previous animal studies and suggest PET may be useful for investigating the mechanisms of anesthesia in humans.
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                Author and article information

                Journal
                Int J Emerg Med
                Int J Emerg Med
                International Journal of Emergency Medicine
                Springer
                1865-1380
                2012
                15 May 2012
                : 5
                : 19
                Affiliations
                [1 ]Emergency Medicine Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, 51664, Iran
                [2 ]Neurology Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, 51664, Iran
                [3 ]Nikookari Hospital, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, 51664, Iran
                [4 ]Gastroenterology Research Centre, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, 51664, Iran
                Article
                1865-1380-5-19
                10.1186/1865-1380-5-19
                3514246
                22587626
                568e94e9-8086-4bbf-a066-49a729722d70
                Copyright ©2012 Soleimanpour et al.; licensee Springer.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 December 2011
                : 1 April 2012
                Categories
                Case Report

                Emergency medicine & Trauma
                visual analogue scale,migraine headache,propofol,emergency department,gabaergic receptors

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