The literature (166 articles identified and reviewed) on the pharmacological treatment of the child with migraine headache was classified according to acute headache and preventive medications, and the results of drug trials were evaluated by Committees of the Child Neurology Society and American Academy of Neurology. Five agents reviewed for acute treatment were evaluated as follows: sumatriptan nasal spray and ibuprofen - effective and well tolerated compared to placebo; acetaminophen - probably effective and well tolerated cf placebo; rizatriptan and zolmitriptan - safe and well tolerated but not superior to placebo. Twelve agents for preventive therapy: flunarizine - probably effective; insufficient data concerning cyproheptadine, amitryptyline, divalproex sodium, topiramate and levetiracetam; conflicting data concerning propranolol and trazodone; and pizotifen, nimodipine, and clonidine - no effect demonstrated. For children > 6 yrs, ibuprofen or acetaminophen may be considered for relief of acute migraine, and for adolescents > 12 yrs, sumatriptan nasal spray may be recommended for acute treatment. In the United States, preventive therapy recommended for migraine is of unproven value; flunarizine may be considered but is not available. 
COMMENT. Evidence available in published reports provides insufficient data to make general recommendations for the preventive therapy of childhood migraine. Except for the calcium channel blocker, flunarizine, which is unavailable in the US and which showed significant benefit in one double-blind, placebo-controlled, crossover trial, trials of antiepileptic medications, antidepressants, antihistamines, and antihypertensive agents have provided insufficient data, conflicting results, or have failed to demonstrate an effect.
Non-steroidal anti-inflammatory agents are effective in treatment of acute attacks of migraine in young children, and sumatriptan nasal spray may be used in adolescents. Standardized criteria are needed for the diagnosis of migraine in children, and multicentered, placebo-controlled clinical trials are essential to adjust for the high placebo response rate encountered in this age group. Failure to investigate and avoid dietary and other headache triggers is a frequent explanation for excessive use of medications. 
Petasites hybridus root (butterbur) is an effective preventive treatment for migraine in adults (ages 18 to 65) . Over 4 months of treatment, migraine attack frequency was reduced by 48% for Petasites extract 75 mg bid (p=0.0012 vs placebo). Apart from mild gastrointestinal symptoms, predominantly burping, no side effects were related to the treatment. In the US, Petasites extract is marketed as a food supplement (Petadolex). The authors caution that only the commercially available preparation of the herb extract should be taken internally. Feverfew has also been tested in controlled trials as a prophylactic migraine therapy.