Ibuprofen for migraine in children
New US guidelines on the management of migraine in children state that ibuprofen is effective and should be considered as a first-line agent for acute treatment (Neurology 2004;63:2215-24).

The American Academy of Neurology (AAN) defines the objectives of treatment as:

• rapid and consistent headache relief without recurrence
• restore the patient's ability to function
• minimise use of back-up and rescue medication
• optimise self-care and minimise use of resources
• cost effective
• minimal or no adverse effects

The AAN cites two randomised trials which provide strong evidence to support its recommendation for ibuprofen. One found a response rate (headache relief at 2 hours) of 68 percent vs. 37 percent with placebo in 4 - 16 year-olds at a dose of 10 mg/kg (p<0.05); the other, conducted in 6 - 12 year-olds treated with 7.5 mg/kg, reported a response rate of 76 percent vs. 53 percent with placebo (p=0.006). Adverse effects are described as 'infrequent'.

The principles of treating migraine in children are the same as for adults, says the AAN. In particular, agents such as the triptans should be used when an NSAID fails to provide relief of headache. The alternatives to ibuprofen are paracetamol, which is considered 'probably effective', and nasal sumatriptan; there are no data on the efficacy of oral triptans in children and adolescents.

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