{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:38:12Z","timestamp":1791902292166,"version":"4.3.4"},"reference-count":22,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,8,1]]},"abstract":"<jats:p>Objective. Treatment of pediatric migraine includes an individually tailored regimen of both nonpharmacologic and pharmacologic measures. The mainstay of symptomatic treatment in children with migraine is intermittent oral or suppository analgesics, but there is no coherent body of evidence on symptomatic treatment of childhood migraine available. The objective of this review is to describe and assess the evidence from randomized and clinical controlled trials concerning the efficacy and tolerability of symptomatic treatment of migraine in children.<\/jats:p>\n               <jats:p>Design. Systematic review according to the standards of the Cochrane Collaboration.<\/jats:p>\n               <jats:p>Methods. Databases were searched from inception to June 2004. Additional reference checking was performed. Two authors independently selected randomized and controlled trials evaluating the effects of symptomatic treatment in children (&amp;lt;18 years old) with migraine, using headache (HA) clinical improvement as an outcome measure. Two authors assessed trial quality independently by using the Delphi list, and data were extracted from the original reports by using standardized forms. Quantitative and qualitative analysis was conducted according to type of intervention.<\/jats:p>\n               <jats:p>Results. A total of 10 trials were included in this review, of which 6 studies were considered to be of high quality. The number of included participants in each trial ranged from 14 to 653, with a total of 1575 patients included in this review. Mean dropout rate was 19.8% (range: 0\u201339.1%), and the mean age of participants was 11.7 \u00b1 2.2 years (range: 4\u201318 years).<\/jats:p>\n               <jats:p>All studies used HA diaries to assess outcomes. In most studies, a measure of clinical improvement was calculated by using these diaries. Improvement often was regarded as being clinically relevant when the patients' HA declined by \u226550%.<\/jats:p>\n               <jats:p>Regarding oral analgesic treatment, the effectiveness of acetaminophen, ibuprofen, and nimesulide were evaluated. When compared with placebo, acetaminophen (relative risk [RR]: 1.5; 95% confidence interval [CI]: 1.0\u20132.1) and ibuprofen (pooled RR: 1.5; 95% CI: 1.2\u20131.9) significantly reduced HAs. We conclude that there is moderate evidence that both acetaminophen and ibuprofen are more effective in reduction of symptoms 1 and 2 hours after intake than placebo with minor adverse effects. No clear differences in effect were found between acetaminophen and ibuprofen or nimesulide.<\/jats:p>\n               <jats:p>Regarding the nonanalgesic interventions, nasal-spray sumatriptan, oral sumatriptan, oral rizatriptan, oral dihydroergotamine, intravenous prochlorperazine, and ketorolac were evaluated. When compared with placebo, nasal-spray sumatriptan (pooled RR: 1.4; 95% CI: 1.2\u20131.7) seemed to significantly reduce HAs. We conclude that there is moderate evidence that nasal-spray sumatriptan is more effective in reduction of symptoms than placebo but with significantly more adverse events. No differences in effect were found between oral triptans and placebo. All medications were well tolerated, but significantly more adverse events were reported for nasal-spray sumatriptan compared with placebo.<\/jats:p>\n               <jats:p>We also conclude that there is moderate evidence that intravenous prochlorperazine is more effective than intravenous ketorolac in the reduction of symptoms 1 hour after intake. No differences in effect were found between oral dihydroergotamine and placebo.<\/jats:p>\n               <jats:p>Conclusions. Acetaminophen, ibuprofen, and nasal-spray sumatriptan are all effective symptomatic pharmacologic treatments for episodes of migraine in children. The new frontier for symptomatic treatment is likely to be the development of triptan agents for use in children. Most treatments have only been evaluated in 1 or 2 studies, which limits the generalizability of the findings.<\/jats:p>\n               <jats:p>We strongly recommend performing a large, high-quality randomized, controlled trial evaluating different symptomatic medications compared with each other or to placebo treatment. Favorable high-quality studies should be performed and reported according to the CONSORT statement. Clinical improvement of HA should be used as the primary outcome measure, but quality of life, days missed at school, and satisfaction of child or parents should also be used as an outcome measure in future studies.<\/jats:p>","DOI":"10.1542\/peds.2004-2742","type":"journal-article","created":{"date-parts":[[2005,8,2]],"date-time":"2005-08-02T14:55:38Z","timestamp":1122994538000},"page":"e295-e302","source":"Crossref","is-referenced-by-count":111,"title":["Symptomatic Treatment of Migraine in Children: A Systematic Review of Medication Trials"],"prefix":"10.1542","volume":"116","author":[{"given":"Le\u0301onie","family":"Damen","sequence":"first","affiliation":[{"name":"Departments of General Practice"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques K.J.","family":"Bruijn","sequence":"additional","affiliation":[{"name":"Pediatric Neurology"},{"name":"Department of Pediatrics, Vlietland Hospital, Vlaardingen, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianne P.","family":"Verhagen","sequence":"additional","affiliation":[{"name":"Departments of General Practice"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjolein Y.","family":"Berger","sequence":"additional","affiliation":[{"name":"Departments of General Practice"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Passchier","sequence":"additional","affiliation":[{"name":"Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart W","family":"Koes","sequence":"additional","affiliation":[{"name":"Departments of General Practice"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2005,8,1]]},"reference":[{"key":"2021121003175920800_R1","doi-asserted-by":"crossref","unstructured":"Annequine D, Tourniaire B, Massiou H. Migraine and headache in children and adolescence. Pediatr Clin North Am.\u20082000;37:617\u2013631","DOI":"10.1016\/S0031-3955(05)70229-7"},{"key":"2021121003175920800_R2","doi-asserted-by":"crossref","unstructured":"Guidetti V, Galli F, Fabrizi P, et al. Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year follow-up study. Cephalalgia.\u20081998;18:455\u2013462","DOI":"10.1046\/j.1468-2982.1998.1807455.x"},{"key":"2021121003175920800_R3","unstructured":"Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia.\u20081988;8(suppl 7):1\u201396"},{"key":"2021121003175920800_R4","unstructured":"Headache Classification Committee of the International Headache Society. The international classification of headache disorders. Cephalalgia.\u20082004;24(suppl 1):1\u2013152"},{"key":"2021121003175920800_R5","doi-asserted-by":"crossref","unstructured":"Major PW, Grubisa HIS, Thie NMR. Triptans for treatment of acute pediatric migraine: a systematic literature review. Pediatr Neurol.\u20082003;29:425\u2013429","DOI":"10.1016\/S0887-8994(03)00400-4"},{"key":"2021121003175920800_R6","doi-asserted-by":"crossref","unstructured":"Robinson KA, Dickerson K. Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol.\u20082002;31:150\u2013153","DOI":"10.1093\/ije\/31.1.150"},{"key":"2021121003175920800_R7","unstructured":"Ad Hoc Committee on the Classification of Headache of the National Institute of Neurological Diseases and Blindness. Classification of headache. JAMA.\u20081962;179:717\u2013718"},{"key":"2021121003175920800_R8","doi-asserted-by":"crossref","unstructured":"Verhagen AP, de Vet HCW, de Bie RA, et al. The Delphi list: a criteria list for quality assessment of randomised clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol.\u20081998;51:1235\u20131241","DOI":"10.1016\/S0895-4356(98)00131-0"},{"key":"2021121003175920800_R9","doi-asserted-by":"crossref","unstructured":"van Tulder M, Furlan A, Bombardier C, Bouter L; Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine.\u20082003;28:1290\u20131299","DOI":"10.1097\/01.BRS.0000065484.95996.AF"},{"key":"2021121003175920800_R10","doi-asserted-by":"crossref","unstructured":"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.\u20082004;43:256\u2013262","DOI":"10.1016\/S0196-0644(03)00716-9"},{"key":"2021121003175920800_R11","doi-asserted-by":"crossref","unstructured":"Prensky AL, Sommer D. Diagnosis and treatment of migraine in children. Neurology.\u20081979;29:506\u2013510","DOI":"10.1212\/WNL.29.4.506"},{"key":"2021121003175920800_R12","doi-asserted-by":"crossref","unstructured":"Ha\u0308ma\u0308la\u0308inen 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.\u20081997;48:103\u2013107","DOI":"10.1212\/WNL.48.1.103"},{"key":"2021121003175920800_R13","doi-asserted-by":"crossref","unstructured":"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.\u20082000;106:989\u2013997","DOI":"10.1542\/peds.106.5.989"},{"key":"2021121003175920800_R14","doi-asserted-by":"crossref","unstructured":"Lewis DW, Kellstein D, Dahl G, et al. Children's ibuprofen suspension for the acute treatment of pediatric migraine. Headache.\u20082002;42:780\u2013786","DOI":"10.1046\/j.1526-4610.2002.02180.x"},{"key":"2021121003175920800_R15","unstructured":"Soriani S, Battistella PA, Naccarella C, Tozzi E, Fiumana E, Fanaro S. Nimesulide and acetaminophen for the treatment of juvenile migraine: a study for comparison of efficacy, safety, and tolerability. Headache Q.\u20082001;12:233\u2013236"},{"key":"2021121003175920800_R16","doi-asserted-by":"crossref","unstructured":"Ahonen K, Ha\u0308ma\u0308la\u0308inen ML, Rantala H, Hoppu K. Nasal sumatriptan is effective in treatment of migraine attacks in children: a randomized trial. Neurology.\u20082004;62:883\u2013887","DOI":"10.1212\/01.WNL.0000115105.05966.A7"},{"key":"2021121003175920800_R17","doi-asserted-by":"crossref","unstructured":"Ueberall MA, Wenzel D. Intranasal sumatriptan for the acute treatment of migraine in children. Neurology.\u20081999;52:1507\u20131510","DOI":"10.1212\/WNL.52.7.1507"},{"key":"2021121003175920800_R18","doi-asserted-by":"crossref","unstructured":"Ha\u0308ma\u0308la\u0308inen 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.\u20081997;48:1100\u20131103","DOI":"10.1212\/WNL.48.4.1100"},{"key":"2021121003175920800_R19","doi-asserted-by":"crossref","unstructured":"Winner P, Lewis D, Visser WH, Jiang K, Ahrens S, Evans JK; Rizatriptan Adolescent Study Group. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: a randomized, double-blind, placebo-controlled study. Headache.\u20082002;42:49\u201355","DOI":"10.1046\/j.1526-4610.2002.02013.x"},{"key":"2021121003175920800_R20","doi-asserted-by":"crossref","unstructured":"Ha\u0308ma\u0308la\u0308inen ML, Hoppu K, Santavuori PR. Oral dihydroergotamine for therapy-resistant migraine attacks in children. Pediatr Neurol.\u20081997;16:114\u2013117","DOI":"10.1016\/S0887-8994(96)00289-5"},{"key":"2021121003175920800_R21","doi-asserted-by":"crossref","unstructured":"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.\u20082004;63:2215\u20132224","DOI":"10.1212\/01.WNL.0000147332.41993.90"},{"key":"2021121003175920800_R22","doi-asserted-by":"crossref","unstructured":"Culter NR, Hussey EK, Sramek JJ, et al. Pharmacokinetics of oral sumatriptan in migraine patients during an attack and while pain free. Biol Psychiatry.\u20081992;31:180A","DOI":"10.1016\/0006-3223(92)90628-D"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/116\/2\/e295\/1004475\/zpe0080500e295.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/116\/2\/e295\/1004475\/zpe0080500e295.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T09:50:51Z","timestamp":1639129851000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/116\/2\/e295\/62893\/Symptomatic-Treatment-of-Migraine-in-Children-A"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,8,1]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2005,8,1]]},"published-print":{"date-parts":[[2005,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2004-2742","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,8,1]]}}}