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From the Division of Child Neurology (Dr. Lewis), Department of Pediatrics, Children’s Hospital of the King’s Daughters, Eastern Virginia Medical School, Norfolk; Division of Child Neurology (Dr. Ashwal), Department of Pediatrics, Loma Linda University School of Medicine, CA; Department of Neurology (Dr. Hershey), Children’s Hospital Medical Center, Cincinnati, OH; National Institute of Neurological Disorders and Stroke (Dr. Hirtz), NIH, Bethesda, MD; Division of Child Neurology (Dr. Yonker), Department of Pediatrics, AI Dupont Hospital for Children, Wilmington, DE; and Jefferson Headache Center (Dr. Silberstein), Jefferson University, Philadelphia, PA.
Address correspondence and reprint requests to American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.
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: The authors identified and reviewed 166 articles. For acute treatment, five agents were reviewed. Sumatriptan nasal spray and ibuprofen are effective and are well tolerated vs placebo. Acetaminophen is probably effective and is well tolerated vs 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 (>age 6 years), ibuprofen is effective and acetaminophen is probably effective and either can be considered for the acute treatment of migraine. For adolescents (>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 United States. 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.
Received May 11, 2004. Accepted in final form September 8, 2004.
Endorsed by the American Academy of Pediatrics and the American Headache Society.
Approved by the QSS on April 27, 2004; by the Practice Committee on August 7, 2004; and by the AAN Board of Directors on October 16, 2004.
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