This review summarizes recent guidelines for diagnosis of migraine in children and adolescents and inherent issues regarding their headaches that influence evaluation of therapies. With the shorter duration of pediatric migraine attacks and the prominent placebo responder rate, design of randomized clinical trials becomes more problematic than in the adult population. Regarding abortive therapies, several agents have appreciable efficacy in randomized controlled trials. Ibuprofen, acetaminophen, and sumatriptan nasal spray are probably beneficial and safe to use in pediatric migraine. For the minority of children who should be candidates for prophylactic therapy, there is a limited amount of information available for clinicians to make judicious treatment decisions.
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