Propofol vs. Chlorpromazine for Acute Migraine Treatment: Insights from a Prospective Randomized Trial

Objective: This study aimed to compare the efficacy of propofol and chlorpromazine in managing acute migraine attacks and to contribute to optimizing the treatment of patients with migraine in the ED. Methods: This prospective, randomized observational study included 180 migraine patients aged 18–65 presenting to the ED. Patients were randomized into two groups: one received propofol (10 mg every 10 minutes, up to 50 mg), and the other received chlorpromazine (12.5 mg every 20 minutes, up to 37.5 mg). Pain was monitored every 10 minutes using a visual analog scale (VAS). Results: At admission, the mean VAS score was 8.24 ± 1.72 in the propofol group and 8.83 ± 1.43 in the chlorpromazine group. In the propofol group, the VAS score decreased by 5.19 ± 2.79, 2.66 ± 2.91, and 1.25 ± 2.14 units at the 10th, 20th, and 30th minutes, respectively. In the chlorpromazine group, the VAS score decreased by 4.82 ± 2.99, 2.50 ± 2.93, and 1.03 ± 2.20 units at the 10th, 20th, and 30th minutes, respectively. By the 60th minute, the total VAS reduction was 25.00 ± 12.25 in the propofol group and 23.10 ± 11.40 in the chlorpromazine group. Although pain reduction initially occurred more rapidly in the chlorpromazine group, there was no statistically significant difference between the groups at the 60-minute mark. Conclusion: Propofol was as effective as chlorpromazine for treating migraines in the ED, with a comparable onset of action and a better side-effect profile.