Ibuprofen to treat migraine in children

Although migraine is quite common in children - around 3% - 5% of school-age children experience periodic attacks - there has been little research into appropriate treatments. Intermittent use of analgesics is the mainstay of treatment for acute attacks and ibuprofen, at a prescribed dose of 10 mg/kg, has been shown to be more effective than paracetamol in aborting attacks13.

A double-blind placebo-controlled study has evaluated ibuprofen in the treatment of migraine at the lower dose in which OTC ibuprofen is normally taken (7.5mg/kg)14. In 84 children aged 6 - 12, the response rate (% children in whom moderate/severe headache was reduced to mild or no pain at 2 hours) was significantly higher with ibuprofen (76% vs. 53%) and significantly more children were pain-free (44% vs. 25%). Ibuprofen also increased the proportion of children with no nausea (60% vs. 40%). Only one of 45 children taking ibuprofen needed rescue analgesia compared with 15 of 39 given placebo. Among girls, the placebo response rate was comparable with that associated with ibuprofen (67% vs. 65%) but the response to ibuprofen was much greater among boys (84% vs. 43%) and headache recurrence less frequent (0 vs. 8 with placebo compared with 5 cases each with ibuprofen and placebo among girls). The authors were unable to account for this finding: although a sex-related difference in migraine pathogenesis cannot be excluded, the small size of the study is the most likely explanation.

Ibuprofen has been shown to be as effective as the 5-HT1 agonist zolmitriptan 2.5 mg in a new placebo-controlled crossover study in 32 children aged 7 - 1715. The dose of ibuprofen was 200 mg in the under-12s and 400 mg in older children. The 2-hour response rate (defined as above) was 78% with ibuprofen, 69% with zolmitriptan and 32% with placebo. Half of children were pain-free at 2 hours after taking ibuprofen or zolmitriptan (8% with placebo) and pain-free without recurrence in 24 hours in 41%, 39% and 8% respectively. There were no significant differences between ibuprofen and zolmitriptan and they were equally well tolerated.

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