Accurately diagnosing and managing migraine in children and adolescents can prevent related disability and improve quality of life. The American Academy of Neurology and the American Headache Society have updated practice guidelines for the acute treatment and pharmacological prevention of migraine in children and adolescents based on a systematic review of randomized clinical trials comparing active treatment with placebo.

The acute treatment guideline states that the goal of treatment is to achieve fast, complete pain relief with minimal side effects. Associated symptoms, such as nausea and vomiting, should also be addressed. Beginning treatment within an hour of pain onset improves rates of freedom from pain. For many children and adolescents, oral nonprescription medications-such as ibuprofen, acetaminophen, and naproxen-are effective. Certain triptans may also be effective in children, but they are less commonly prescribed in this population compared with adults.

Selection of medication should be based on the characteristics of each migraine. Nonoral formulations may be more effective for migraines that peak rapidly in severity or are associated with nausea or vomiting. A combination of a nonsteroidal antiinflammatory drug (NSAID) and a triptan may improve pain response in adolescents. In addition to NSAIDs and/or triptans, antiemetic agents should be prescribed in children and adolescents who experience nausea and vomiting. Patients and families should be counseled about lifestyle modification and the avoidance of migraine triggers and medication overuse.-KR