Management A number of agents are available for the treatment of acute migraine ( Table 97.4 ) For many children, mild oral analgesics such as acetaminophen or ibuprofen combined with bed rest may provide sufficient relief and should be considered the first-line agents of choice TABLE 97.4 AGENTS FOR ACUTE TREATMENT OF MIGRAINE Drug Analgesics Acetaminophen Ibuprofen Ketorolac (Toradol) Antiemetics Metoclopramide (Reglan) Prochlorperazine (Compazine) Promethazine (Phenergan) Specific antimigraine agents Dihydroergotamine Sumatriptan (Imitrex) Usual dose 10–15 mg/kg/dose PO or PR q4h 5–10 mg/kg/dose PO q6h 30 mg initial dose, then 0.5 mg/kg (max 30 mg) IV or IM, or 10 mg/dose PO, q4–6h 0.5–2 mg/kg/dose PO or IV q4–6h 0.1 mg/kg/dose PO, IM, or IV q6h 0.25–1.0 mg/kg/dose PO, PR, IV, or IM q4–6h 0.5–1.0 mg/dose IV or IM; may repeat after hr mg SC or 100 mg PO PO, orally; PR, per rectum; IV, intravenously; IM, intramuscularly; SC, subcutaneously Sumatriptan succinate (Imitrex) is a serotonergic agent available for oral, intranasal, or subcutaneous administration Administered alone or in combination with naproxen, its effectiveness in relieving symptoms of acute migraine has been demonstrated in clinical trials in children and adults, but it has not been approved by the U.S Food and Drug Administration for use in younger children The dose for children 12 years and older is mg subcutaneously or 100 mg orally The intranasal sumatriptan dose is 20 mg for children >40 kg and 10 mg for children weighing 20 to 39 kg Sumatriptan is generally well tolerated Side effects include irritation at the injection site, flushing, tachycardia, disorientation, and chest tightness that last for several minutes after parenteral administration In one trial, adverse effects were more common in younger children A reasonable approach is