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Pediatric Migraine: Update on Therapy
Donald Lewis, MD; Marc Avener, MD; Yessid Gozzo, MD
Posted: October 2005  
Headache & Pain 2005;16(3):133-140

Objective:   This article reviews current therapeutic options for children with migraine headaches.

Summary:   The goals of treatment are the same for children as they are for adult migraineurs. These include reduced headache frequency, severity, duration, disability, and reliance on poorly tolerated, ineffective, or unwanted medications; improved quality of life; decreased use of abortive medications; and diminished headache-related distress and psychological symptoms. A balanced approach with nonpharmacologic measures, biobehavioral strategies, and medications is key. The most rigorously studied agents for acute treatment of migraine are ibuprofen, acetaminophen, and sumatriptan nasal spray, all of which have been shown to be safe and effective in controlled trials. For preventative therapy in children and adolescents with frequent, disabling migraines, flunarizine -- which is not currently available in the United States -- is most effective. Encouraging data are emerging for several anti-epileptic agents, such as topiramate, divalproex sodium, and levatiracetam, as well as the antihistamine cyproheptadine and the antidepressant amitriptyline.