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Pharmacological Treatment of Migraine Headache in
Children and Adolescents
Lewis D, Ashwal S, Hershey A, Hirtz D, Yonker M,
Silberstein S.
Posted: January 2006  
Neurology 2004;63:2215-2224

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 medications.

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.