Acute treatment of migraine in children and adolescents

The management of headaches with juvenile onset presents several problems, related not only to appropriate drug selection but also to the specific features distinguishing headache disorders in children and adolescents: a child is not a "little adult". Many age-related factors influence the clinical expression of headache and these should be taken into account not only in the treatment, but also in the diagnosis, of juvenile headache. Few randomised placebo-controlled clinical trials of acute or preventive drugs have been conducted in paediatric headache patients, and those that have show a high placebo response rate in children (e.g. up to 55% for prophylactic drugs and up to 69% for symptomatic ones). The available data on symptomatic drugs are presented and discussed, focusing, in particular, on mechanisms of action, evidence of efficacy, and tolerability.