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Acute treatment of migraine in children

Robert P Cruse, DO
Section Editors
Marc C Patterson, MD, FRACP
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD


Migraine is the most common acute and recurrent headache syndrome in children. It is characterized by periodic episodes of headache accompanied by nausea, vomiting, abdominal pain, and relief with sleep.

The management of migraine consists of general measures, abortive treatment, and preventive treatment. An individual patient may need all three approaches. Unfortunately, there is a paucity of data from controlled, randomized, and blinded trials regarding treatment of migraine in children and adolescents [1-3]. Thus, most management recommendations are based upon experience in adults.

The acute treatment of migraine in children is reviewed here. Other aspects of pediatric migraine are discussed separately. (See "Classification of migraine in children" and "Pathophysiology, clinical features, and diagnosis of migraine in children" and "Preventive treatment of migraine in children".)


General precepts of acute migraine treatment include the following:

Educating the child and family about migraine headache is an important aspect of care. A headache calendar should be maintained in order to identify triggering factors, clarify features of the attacks, and to help evaluate the effectiveness of treatment [4]. Precipitating factors (eg, stress, poor sleep habits, irregular meals, odors), if identified, should be avoided if possible. A headache diary suitable for children can be downloaded from Boston Children’s Hospital.


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Literature review current through: Sep 2016. | This topic last updated: Jun 2, 2016.
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  1. Lewis D, Ashwal S, Hershey A, et al. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology 2004; 63:2215.
  2. El-Chammas K, Keyes J, Thompson N, et al. Pharmacologic treatment of pediatric headaches: a meta-analysis. JAMA Pediatr 2013; 167:250.
  3. O'Brien HL, Kabbouche MA, Hershey AD. Treating pediatric migraine: an expert opinion. Expert Opin Pharmacother 2012; 13:959.
  4. Metsähonkala L, Sillanpää M, Tuominen J. Headache diary in the diagnosis of childhood migraine. Headache 1997; 37:240.
  5. Taylor FR, Kaniecki RG. Symptomatic treatment of migraine: when to use NSAIDs, triptans, or opiates. Curr Treat Options Neurol 2011; 13:15.
  6. Gelfand AA, Goadsby PJ. Treatment of pediatric migraine in the emergency room. Pediatr Neurol 2012; 47:233.
  7. Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium. Headache 2012; 52:114.
  8. Bachur RG, Monuteaux MC, Neuman MI. A comparison of acute treatment regimens for migraine in the emergency department. Pediatrics 2015; 135:232.
  9. Damen L, Bruijn JK, Verhagen AP, et al. Symptomatic treatment of migraine in children: a systematic review of medication trials. Pediatrics 2005; 116:e295.
  10. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database Syst Rev 2016; 4:CD005220.
  11. Hämäläinen ML, Hoppu K, Valkeila E, Santavuori P. Ibuprofen or acetaminophen for the acute treatment of migraine in children: a double-blind, randomized, placebo-controlled, crossover study. Neurology 1997; 48:103.
  12. Prensky AL. Headache. In: Oski's Pediatrics. Principles and Practice, 4th ed, McMillan JA, Feigin RD, DeAngelis C, Jones MD (Eds), Lippincott, Williams & Wilkins, Philadelphia 2006. p.2388.
  13. Brousseau DC, Duffy SJ, Anderson AC, Linakis JG. Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac. Ann Emerg Med 2004; 43:256.
  14. Tepper SJ, Rapoport AM, Sheftell FD. Mechanisms of action of the 5-HT1B/1D receptor agonists. Arch Neurol 2002; 59:1084.
  15. Tfelt-Hansen P, De Vries P, Saxena PR. Triptans in migraine: a comparative review of pharmacology, pharmacokinetics and efficacy. Drugs 2000; 60:1259.
  16. Bartsch T, Knight YE, Goadsby PJ. Activation of 5-HT(1B/1D) receptor in the periaqueductal gray inhibits nociception. Ann Neurol 2004; 56:371.
  17. Eiland LS, Hunt MO. The use of triptans for pediatric migraines. Paediatr Drugs 2010; 12:379.
  18. Rolan PE. Drug interactions with triptans : which are clinically significant? CNS Drugs 2012; 26:949.
  19. Evans RW. Concomitant triptan and SSRI or SNRI use: what is the risk for serotonin syndrome? Headache 2008; 48:639.
  20. Wenzel RG, Tepper S, Korab WE, Freitag F. Serotonin syndrome risks when combining SSRI/SNRI drugs and triptans: is the FDA's alert warranted? Ann Pharmacother 2008; 42:1692.
  21. Linder SL, Mathew NT, Cady RK, et al. Efficacy and tolerability of almotriptan in adolescents: a randomized, double-blind, placebo-controlled trial. Headache 2008; 48:1326.
  22. Winner P, Lewis D, Visser WH, et al. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: a randomized, double-blind, placebo-controlled study. Headache 2002; 42:49.
  23. Ahonen K, Hämäläinen ML, Eerola M, Hoppu K. A randomized trial of rizatriptan in migraine attacks in children. Neurology 2006; 67:1135.
  24. Evers S, Rahmann A, Kraemer C, et al. Treatment of childhood migraine attacks with oral zolmitriptan and ibuprofen. Neurology 2006; 67:497.
  25. Linder SL, Dowson AJ. Zolmitriptan provides effective migraine relief in adolescents. Int J Clin Pract 2000; 54:466.
  26. Fujita M, Sato K, Nishioka H, Sakai F. Oral sumatriptan for migraine in children and adolescents: a randomized, multicenter, placebo-controlled, parallel group study. Cephalalgia 2014; 34:365.
  27. Hämäläinen ML, Hoppu K, Santavuori P. Sumatriptan for migraine attacks in children: a randomized placebo-controlled study. Do children with migraine respond to oral sumatriptan differently from adults? Neurology 1997; 48:1100.
  28. Ueberall MA, Wenzel D. Intranasal sumatriptan for the acute treatment of migraine in children. Neurology 1999; 52:1507.
  29. Winner P, Rothner AD, Saper J, et al. A randomized, double-blind, placebo-controlled study of sumatriptan nasal spray in the treatment of acute migraine in adolescents. Pediatrics 2000; 106:989.
  30. Ahonen K, Hämäläinen ML, Rantala H, Hoppu K. Nasal sumatriptan is effective in treatment of migraine attacks in children: A randomized trial. Neurology 2004; 62:883.
  31. Winner P, Rothner AD. Headaches in Children and Adolescents, BC Decker, Hamilton 2001.
  32. MacDonald JT. Treatment of juvenile migraine with subcutaneous sumatriptan. Headache 1994; 34:581.
  33. Linder SL. Subcutaneous sumatriptan in the clinical setting: the first 50 consecutive patients with acute migraine in a pediatric neurology office practice. Headache 1996; 36:419.
  34. Lewis DW, Winner P, Hershey AD, et al. Efficacy of zolmitriptan nasal spray in adolescent migraine. Pediatrics 2007; 120:390.
  35. Derosier FJ, Lewis D, Hershey AD, et al. Randomized trial of sumatriptan and naproxen sodium combination in adolescent migraine. Pediatrics 2012; 129:e1411.
  36. Polizos P, Engelhardt DM. Dyskinetic phenomena in children treated with psychotropic medications. Psychopharmacol Bull 1978; 14:65.
  37. Kabbouche MA, Vockell AL, LeCates SL, et al. Tolerability and effectiveness of prochlorperazine for intractable migraine in children. Pediatrics 2001; 107:E62.
  38. Kaar CR, Gerard JM, Nakanishi AK. The Use of a Pediatric Migraine Practice Guideline in an Emergency Department Setting. Pediatr Emerg Care 2016; 32:435.
  39. Ellis GL, Delaney J, DeHart DA, Owens A. The efficacy of metoclopramide in the treatment of migraine headache. Ann Emerg Med 1993; 22:191.
  40. Leopold NA. Prolonged metoclopramide-induced dyskinetic reaction. Neurology 1984; 34:238.
  41. Cowan AN. Acute dystonic reaction to Maxolon (metoclopramide). Med J Aust 1982; 2:215.
  42. Raskin NH. Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology 1986; 36:995.
  43. Kabbouche MA, Powers SW, Segers A, et al. Inpatient treatment of status migraine with dihydroergotamine in children and adolescents. Headache 2009; 49:106.
  44. Linder SL. Treatment of childhood headache with dihydroergotamine mesylate. Headache 1994; 34:578.
  45. Reiter PD, Nickisch J, Merritt G. Efficacy and tolerability of intravenous valproic acid in acute adolescent migraine. Headache 2005; 45:899.
  46. Avraham SB, Har-Gil M, Watemberg N. Acute confusional migraine in an adolescent: response to intravenous valproate. Pediatrics 2010; 125:e956.
  47. Edwards KR, Norton J, Behnke M. Comparison of intravenous valproate versus intramuscular dihydroergotamine and metoclopramide for acute treatment of migraine headache. Headache 2001; 41:976.
  48. Tanen DA, Miller S, French T, Riffenburgh RH. Intravenous sodium valproate versus prochlorperazine for the emergency department treatment of acute migraine headaches: a prospective, randomized, double-blind trial. Ann Emerg Med 2003; 41:847.
  49. Leniger T, Pageler L, Stude P, et al. Comparison of intravenous valproate with intravenous lysine-acetylsalicylic acid in acute migraine attacks. Headache 2005; 45:42.