Migraine is a common, recurrent, and often severe and
debilitating primary headache disorder. It is the most common recurring headache pattern among children and adolescents brought to medical attention.1 In the United States
(US), migraine occurs in an estimated 6.3% of adolescents,
and 12% of the total population.2,3 In adults the prevalence
is approximately 18% in women and 6% in men.3
Migraine in pediatric patients is associated with pulsating pain, as well as associated symptoms such as nausea,
vomiting, photophobia, phonophobia, and osmophobia.
Migraine in children and adolescents may result in substantial amounts of missed school and social activities and
impaired quality of life (QOL).4-6
While many types of prescription and over-the-
counter (OTC) medications are used to manage pediatric
migraine, most data on these agents have been extrapo-
lated from adult studies.1 Consequently, the US Food and
Drug Administration (FDA) has approved only 4 medications
for acute treatment (rizatriptan, almotriptan, sumatriptan/
naproxen, and zolmitriptan) at the time of this publication.
Of these, zolmitriptan (ZOMIG) nasal spray is the only nasal
spray approved in the United States for pediatric patients
12 to 17 years of age. This article will review the charac-
teristics and impact of pediatric migraine headache, and
the clinical ef;cacy and safety data for zolmitriptan nasal
spray in the management of adolescent migraineurs.
DEFINITION AND DIAGNOSIS OF
The International Classi;cation of Headache Disorders, 3rd
edition (beta version) (ICHD-3 beta), published in 2013, is
the most current standardized diagnostic criteria for primary and secondary headache disorders.7 The ICHD-3
beta includes all types of migraine, including both migraine
without aura and migraine with aura.7 Migraine without
ALAN RAPOPORT, MD
Department of Neurology
David Geffen School of Medicine at UCLA
University of California, Los Angeles
Los Angeles, California
ANDREW D. HERSHEY, MD, PhD, FAHS
Cincinnati Children’s Hospital
University of Cincinnati College of Medicine
PAUL WINNER, DO, FAAN, FAAP, FAHS
Palm Beach Headache Center and
Premiere Research Institute
West Palm Beach, Florida
Acute Management of Migraine
in the Pediatric Population*:
Zolmitriptan (ZOMIG) Nasal Spray
Impax Specialty Pharma is the sole ;nancial sponsor of this supplement and aided
in content development and author selection.
Dr. Rapoport reports that he is on the speakers’ bureaus for Depomed, Inc., and Teva Pharmaceuticals USA. He is on the advisory boards for
Autonomic Technologies; Avanir Pharmaceuticals, Inc.; Depomed; Doctor Reddy’s Laboratories; ElectroCore Medical, LLC; Impax Pharmaceuticals;
Pernix Therapeutics; Teva; and Zosano Pharma Inc.
Dr. Hershey reports that he is on the advisory board of Amgen Pharmaceuticals; Curelator, Inc; and Eli Lilly and Company. He has research grant
support from Curelator, Inc., and National Institutes of Health-National Institute of Neurological Disorders and Stroke.
Dr. Winner reports that he received research support from AstraZeneca for ZOMIG Nasal Spray.
Writing assistance was provided by Frontline Medical Communications.
*Zomig Nasal Spray is indicated for patients 12 years of age and older.
Supplement to Neurology Reviews® | May 2016 S1