Busy Doernbecher resident leads national study on pediatric migraine treatment in the ER

Dr. David Sheridan and his three daughters

As a resident who works 80 hours a week at times, who would think: “What else can I do at the hospital?” As crazy as it sounds, I said that as I planned to specialize in pediatric emergency medicine and enter fellowship training.

As a first-year resident, I thought about many specialties ranging from pediatric cardiology to neonatology. However, after a month in the OHSU Doernbecher Emergency Department, I fell in love with the procedures, diverse patient populations and overall organized chaos! With plans to apply for fellowship, I became interested in pursuing research to add new knowledge to the field.

As a father of three little girls and being married to the most amazing woman in the world, I had to find a way to succeed as a resident clinically and in the research realm, while continuing to be a dedicated husband and father who knows all the particulars of every Disney princess or Mickey Mouse character.

The beauty was that we had our first daughter my first year of medical school, and I learned to master time management. Thanks to these skills and my wife’s support (i.e., being lucky enough to have her accept my proposal 6.5 years ago!), I have been able to balance all aspects of my career and home life reasonably well.

It was incredibly easy to get involved with research in the OHSU Doernbecher Emergency Department because of the amazing interest and mentorship that exists here. I was blessed to find two amazing mentors in Garth Meckler, M.D., and David Spiro, M.D. – both supervising physicians in the OHSU Doernbecher Emergency Department. Their help and support has enabled my research study to thrive and expand to the point it is at today. Despite being two very busy people themselves, they have constantly devoted time to answering my questions, helping me think through my results and providing their wealth of clinical expertise.

My research has focused on helping children who come to the emergency department with severe headaches, a frequent emergency department complaint. Studies have shown that as many as 30 to 60 percent of children and adolescents will suffer from them.

In conjunction with the OHSU Doernbecher Emergency Department (Matt Hansen, M.D., Spiro and Meckler) and the head of Pediatric Neurology at OHSU Doernbecher, Thomas Koch, M.D., I recently completed a study looking at representative national data for pediatric headaches, and our results estimated that children have approximately 340,000 visits to the emergency department each year with this complaint.

One of the challenges for emergency department physicians is to decipher which children have headache disorders, also known as primary headaches, and which headaches are caused by other conditions, referred to as secondary headaches, such as brain tumors, meningitis, trauma, bleeding in the brain, etc.

Fortunately, most headaches are due to primary headache disorders and the most common form (approximately 75 percent in one study) is migraine headache.

Migraine headache treatment is two-fold, consisting of medications to prevent attacks and medications that treat an acute attack. Most children presenting to the emergency department have failed preventive medications and over-the-counter treatments such as acetaminophen or ibuprofen.

Acute treatments have not progressed much during the last 10 years, and some of these treatments have side effects, such as drowsiness, that can result in a longer emergency department stay. However, in some cases, our emergency department has started to use a new therapy in hopes of making the patient’s head feel better sooner thus shortening the time in the emergency room.

I was the lead author of a study recently published in Pediatric Emergency Care and presented at the Pediatric Academic Societies (PAS) national meeting in Boston, Mass. It reviewed our hospital’s experience with a medication called Propofol for migraine headache. Ours was the first-ever report on its use for migraine headaches in a pediatric population.

Propofol is used as a general anesthetic or sedative. It’s the white IV medication you see on most TV shows that patients about to undergo surgery receive just before they become groggy. Emergency medicine physicians are specially trained and certified in sedation and have very important airway skills, making it appropriate for use in this setting, but not in clinics or outpatient therapy.

In the OHSU Doernbecher Emergency Department we use it in very low doses for migraine headache. To put it in perspective, we use approximately 25 percent of the dose that is used for sedation or surgery and do not use it as a continuous infusion. It has a very fast onset and wears off quickly, which makes it an attractive option in the emergency department to give patients faster headache relief and recovery. And unlike surgery, most patients never actually fall asleep at these doses.

Our experience showed that when compared with standard treatments for migraine headache, Propofol was significantly more effective at reducing pain, resulted in a shorter emergency department stays and produced no side effects.

Based on this study, I was awarded a resident research grant from the American Academy of Pediatrics and am now the lead investigator on a study that will incorporate four institutions around the country, including OHSU Doernbecher, Boston Children’s Hospital, Vancouver B.C. Children’s Hospital and Hennepin County Medical Center.

With the advantages we have seen thus far in children, we will be comparing Propofol in low doses to standard therapy on a larger scale to help us provide the best possible care to improve this very difficult to treat disorder. Enrollment for this clinical trial should begin in the spring or summer 2013.

The support I have received from physicians and nurses at OHSU Doernbecher not only highlights the dedicated and most up-to-date care that children receive here, but also the education and research that happens at this institution. Every advancement or idea is with children’s health at the forefront of our decision making.

There is no doubt in my or my wife’s mind about which children’s hospital or emergency room to take our daughters if they get sick. With that important decision behind us, the next most important move for me is to find pink Seattle Seahawks jerseys so my daughters can cheer on their/my favorite sports team to the Lombardi trophy next year.

David Sheridan, M.D.
Resident in Pediatrics, Division of Emergency Medicine
OHSU Doernbecher Emergency Department
OHSU Doernbecher Children’s Hospital

3 responses to “Busy Doernbecher resident leads national study on pediatric migraine treatment in the ER

  1. Wow David, I am amazed at your knowledge and drive to help these children. I loved all your witty humor about the girls. and your loving devotion to my very special cousin. Good Job David! Your Aces in my book!! Stac is a Lucky woman! Congrats on all your hard work and acheviements, I will pray for this cause.

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