A multicenter, randomized, double-blind, placebo-controlled trial of sumatriptan nasal spray (5 mg, 10 mg, and 20 mg) was conducted in 653 adolescents presenting with acute migraine at the Palm Beach Headache Center, Florida; Cleveland Clinic, OH; Michigan Headache Institute, Ann Arbor; and San Antonio Center, TX. All 3 dosages studied were effective in providing headache relief within 1 or 2 hours postdose. Younger patients 12-14 years of age reported higher efficacy rates at lower doses, while older patients 15-17 years of age obtained the greatest benefit at the 20 mg dose of sumatriptan NS. Photophobia and phonophobia were significantly reduced within 2 hours of treatment with the 20 mg dose, and headache recurrence was reduced in frequency or delayed for >8 hours. Taste disturbance was the most common adverse event, reported in up to 30% of patients. [1]

COMMENT. Sumatriptan nasal spray may be an effective and well-tolerated treatment of acute migraine in adolescents. In this large multicenter study, the 20 mg dose was most effective, especially in older patients.

Cognitive functioning during a migraine attack. A significant loss of cognitive efficiency was demonstrated in 10 adult migraineurs during a migraine attack, in a study at the Headache Care Center, Springfield, MO [2]. Recovery of cognitive function followed within 15 minutes of sumatriptan injection (6 mg) and continued to improve at 45 minutes. The adverse impact of cognitive effects of migraine on work and study efficiency is an important consideration in a decision to treat aggressively and prophylactically.