Summary of evidence and Expert Committee recommendations
The EMLc Subcommittee considered the burden of disease of migraine in children, nothing that management is similar to that in adults but fewer drugs are approved for treatment of migraine in children.
Acetylsalicylic acid is not recommended for use in children due to the risk of Reye's syndrome. Paracetamol has been shown to be effective for acute migraine attacks, as has ibuprofen, although there are no NSAIDs currently listed on the EML for this indication.
There is conflicting evidence on the efficacy of propranolol in the prevention of migraine in children, but it is the only medicine approved for the prevention of migraine in children.
The EMLc Subcommittee therefore recommended that:
1. Acetylsalicylic acid be deleted from the EMLc for the treatment of acute migraine attacks and ibuprofen tablets 200 mg and 400 mg be added to the EMLc in its place.
2. Paracetamol be endorsed for inclusion on the EMLc for acute migraine attacks.
3. Propranolol be endorsed for inclusion in the EMLc but without a square box listing, in the absence of evidence of effectiveness of other beta blocking agents for prevention of migraine in children.