Expert: Dr Ian Jackson - please note UK based - 7/23/2008

Question

I'm a GP with occasional severe Migraine that makes me vomit for hours. I've had a recent GA which has caused distressing post op vomiting and daily Migraine since (5 days) 2 GAs  20 years ago made me vomit for hours but I had no trouble at all with a major op under spinal anaesthetic a year ago. Any suggestions how this could be prevented if I have to have another G.A. ?

Answer
Hi there
Difficult one this. I haven't found GAs to be a problem in patients who suffer from Migraine - however there is no doubt that this can be an issue. Perhaps worth finding out if you had a volatile anaesthetic e.g. sevoflurane, isoflurane or had TIVA (total intravenous anaesthesia). I would be tempted to try the TIVA if that hasn't been tried (but then I routinely use it and so bias there). Given that Migraine is linked to blood supply issues in the brain then TIVA might be better than the volatiles. Also the propofol we use is a good antiemetic.
Otherwise not much I can offer except for you to have any of the current range of drugs that helps your Migraine available to take postop - plus LA wherever possible (sorry stating the obvious!)
Kind regards
Dr Ian Jackson
ps If you ever do have another GA and TIVA helps then please let me know!