Migraine according to the criteria of the International
Headache Society, occurs in about 3 to 7% of all children. Despite this high incidence, and unlike the situation with adult
migraine, only a very few controlled trials have investigated the acute and prophylactic treatment of
migraine in children. In the acute
migraine attack,
ibuprofen 10 mg/kg and
paracetamol (
acetaminophen) 15 mg/kg have been shown to be effective, with only a few adverse effects. In severe
migraine attacks,
dihydroergotamine mesylate (
dihydroergotamine) administered orally (20 to 40 microg/kg) or intravenously (maximum 1 mg/day) may be helpful, but there have been no large placebo-controlled trials of this treatment. Oral
sumatriptan has not been effective in several double-blind and placebo-controlled trials; administered subcutaneously, this
drug might be helpful but the only data for this application come from open trials. For
migraine prophylaxis, only
flunarizine 5 mg/day has been shown to be effective in more than 1 double-blind, placebo-controlled trial. Some evidence also exists that
propranolol >60 mg/day and
pizotifen 0.5 to 1.5 mg/day are effective; however, the results from different trials are contradictory. For all other drugs studied in
migraine prophylaxis, the results remain vague (e.g.
amitriptyline,
nimodipine,
trazodone) or suggest inefficacy (e.g.
timolol,
clonidine,
tryptophan). In
migraine-related disorders,
pizotifen 0.5 to 0.75 mg/day for
abdominal migraine and
flunarizine 10 to 25 mg/day for
alternating hemiplegia have been shown to be effective. Most of the drugs used in the treatment of
migraine in children are well tolerated and without relevant adverse effects. In
migraine prophylaxis, the most common adverse effects are drowsiness and bodyweight gain.