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Pharmacological Treatment of Migraine Headache in
Children and Adolescents
Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M,
Posted: January 2006
Objective: To review evidence on the
pharmacologic treatment of the child with migraine headache.
Methods: The authors reviewed, abstracted, and
classified relevant literature. Recommendations were based on a
four-tiered scheme of evidence classification. Treatment options
were separated into medications for acute headache and preventive
Results: For acute treatment, five agents were
reviewed. Sumatriptan nasal spray and ibuprofen are effective
and are well tolerated versus placebo. Acetaminophen is probably
effective and is well tolerated versus placebo. Rizatriptan and
zolmitriptan were safe and well tolerated but were not superior to
placebo. For preventive therapy, 12 agents were evaluated.
Flunarizine is probably effective. The data concerning
cyproheptadine, amitriptyline, divalproex sodium, topiramate, and
levetiracetam were insufficient. Conflicting data were found
concerning Propranolol and Trazodone. Pizotifen, nimodipine, and
clonidine did not show efficacy.
Conclusions: For children less than 6 years old,
ibuprofen is effective and acetaminophen is probably effective
and either can be considered for the acute treatment of migraine.
For adolescents, more than 12 years of age, sumatriptan nasal
spray is effective and should be considered for the acute
treatment of migraine. For preventive therapy, flunarizine is
probably effective and can be considered, but is not available in
the U.S. There are conflicting or insufficient data to make any
other recommendations for the preventive therapy of migraine in
children and adolescents. For a clinical problem so prevalent in
children and adolescents, there is a disappointing lack of
evidence from controlled, randomized, and masked trials.