Psychopharmacological management of migraine in children and adolescents.

ABSTRACT Migraine is one of the most common causes of pain and headache seen in the offices of pediatricians and child neurologists. In addition to standard antimigraine treatments (ergots, cyproheptadine), several types of psychotropic medication have been used in the treatment of migraine, primarily prophylactically, with varying degrees of success. Although there is some evidence of their efficacy in treating migraine in adults, there are relatively few studies of their efficacy or safety with children. The authors review the literature on childhood migraine, its relationship to mood and anxiety disorders, modern pathophysiological theories, and current treatment approaches. Despite the widespread use of propranolol, further studies are needed before beta blockers can be considered an effective prophylactic agent in childhood migraine. Antidepressants seem promising in adolescents and children, but more controlled studies are needed to determine their long-term efficacy in children and adolescents. Antidepressant agents with mixed serotonin and norepinephrine action (e.g., amitriptyline) seem more effective than the more selective agents in adults, but it generally remains to be seen whether antimigraine medications that are effective in adults will be equally useful in children and adolescents. Studies on mood and anxiety disorders in children and adolescents might be usefully extended to evaluate migraine headaches.