Treatment of idiopathic headache in childhood and adolescence: Revised recommendations of the Society for Neuropediatrics and the German Migraine and Headache Society

According to the principles of evidence-based medicine, controlled studies on the treatment of idiopathic headache in childhood and adolescence were analysed and compiled into treatment recommendations. For acute treatment of migraine attacks or tension-type headache, ibuprofen (10 mg/kg body weight) is most highly recommended. Drugs of second choice are acetaminophen (15 mg/kg body weight) for all ages and for migraine attacks only, intranasal sumatriptan (10-20 mg) for the age of 12 years and older, in isolated cases also below 12 years of age. If the first or second choice acute drugs are not effective alternative drugs of third choice are zolmitriptan 2.5 mg as melting tablet, intranasal zolmitriptan 5 mg, rizatriptan 5-10 mg, almotriptan 12.5 and dihydroergotamine 20-40 A mu g/kg body weight. For the prophylaxis of migraine, magnesium, betablockers (propranolol and metoprolol) and flunarizine are recommended. Flunarizine is also the drug of first choice for the prophylactic treatment of migraine-related disorders. No controlled studies are available on the treatment of further headache types in childhood. First line methods recommended for the non-drug prophylactic treatment of headache in childhood are progressive relaxation therapy, biofeedback procedures and specific cognitive-behavioral therapeutic schedules.