Preventive therapy in pediatric migraine

Preventive therapy for migraine headache includes identification of migrain e precipitants, possible adjustments in lifestyle, appropriate management o f acute headache, and, when necessary, the use of pharmacologic agents. The re are no well-controlled clinical trials with sufficient patient numbers t o support the use of any agent in the prevention of migraine headache in ch ildren. Data on the use of amitriptyline and divalproex sodium in open-labe l studies suggest that these agents may be efficacious. The mechanism of ac tion for these agents is unknown but may be related to the 5-hydroxytryptam ine-2 (5-HT2) receptor antagonism or regulation of ion channels. A review o f the pertinent literature on migraine prophylaxis in children is presented . Dosing guidelines are presented based on the limited data available and c linical experience.