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Zolmitriptan Nasal Spray for Migraines in Adolescents

This treatment seems to be safe and effective.

Many treatment options are available for migraines in adults, but only ibuprofen, acetaminophen, and sumatriptan nasal spray are supported by consensus statements as being effective in children and adolescents. In an industry-supported, multicenter study designed to address the high rate of placebo responses in adolescents, 171 adolescents (age range, 12–17) with migraines were first given a placebo challenge, and then those who had no response within 15 minutes were randomized to receive either placebo or zolmitriptan (5 mg) nasal spray.

Response was defined as a 2-point reduction in headache intensity on a 4-point scale. During a total of 275 migraine attacks, zolmitriptan was associated with a significantly higher response rate than placebo at 1 hour after randomization (58% vs. 43%). Significantly more patients in the treatment group also reported being pain free at 1 hour (28% vs. 10%), 1.5 hours (32% vs. 16%), and 2 hours (39% vs. 19%) after treatment. Zolmitriptan was well tolerated.

Comment: A plethora of treatments is available for adult migraine, but the number of clinically proven drugs for children and adolescents is far more limited. The results of this study — in which roughly one in five patients responded above the placebo rate — suggest that zolmitriptan nasal spray can be added to the list.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 6, 2007

Citation(s):

Lewis DW et al. Efficacy of zolmitriptan nasal spray in adolescent migraine. Pediatrics 2007 Aug; 120:390-6.

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• Medline abstract (Free)

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