Table 1

Simple analgesics for the acute/rescue treatment of migraine with and without aura

Beware: Patients are susceptible to medication overuse headache, so use full doses but usually on no more than 2 days/week
AgeRouteDosePreparation (pack)Contraindications/cautions
1. Paracetamol
0–11 yearsOral



Per rectum		20 mg/kg 4–6 hrly, max 75 mg/kg/day
40 mg/kg, then 20 mg/kg 4–6 hrly, max 75 mg/kg/day		Tabs: 500 mg; dispersible tabs 120, 500 mg;
Oral suspension: 120 mg/5 mL, 250 mg/5 mL
Suppositories: 60, 125, 250, 500 mg		Hepatic impairment
Renal impairment
10–50 kgIntravenous15 mg/kg 4–6 hrly (max 60 mg/kg/day)Intravenous infusion: 10 mg/mL
>50 kg1 g 4–6 hrly (max 4 g daily)
12–18 yearsOral
PR/intravenous		0.5–1 g 4–6 hrly, max 4 g/day
doses as above		 
2. Ibuprofen (NSAID)
2–6 yearsOral100 mg three times a day, max 30 mg/kg/dayTabs: 200, 400, 600 mg;
Oral suspension: 100 mg/5 mL;
Orodispersible melts: 200 mg		Gastro pain, bleeding, ulceration, allergic reactions
7–11 years200 mg three times a day, max
30 mg/kg/day, max 2.4 g/day
12–18 years400 mg three times a day, max 600 mg four times a day
3. Diclofenac (NSAID)
1–18 yearsOral/PR0.3–1 mg/kg three times a day, max 150 mg/dayTabs: 25, 50 mg;
Dispersible tabs: 10, 50 mg
Suppositories: 100 mg		Gastro pain, bleeding, ulceration, allergic reactions
2–18 yearsIntravenous/intramuscular0.3–1 mg/kg twice daily max 150 mg/dayInjection: 25 mg/mL
4. Ketorolac (NSAID)
1–15 yearsIntravenous (slow)0.5–1 mg/kg (max 15 mg) stat then 0.5 mg/kg (max 15 mg)
6 hrly, max 60 mg/day for 48 h		Injection: 30 mg/mLGastro pain, nasty taste, flushing, confusion
16–18 years10 mg stat then 10–30 mg 4 hrly, max 90 mg daily for 48 hours

  • Some of the drugs/doses below are those suggested/used by the authors and may be outside the marketing authorisation. Always check usual reference sources/guidelines when using unfamiliar medicines.11

  • Hrly, hourly; max, maximum; NSAID, non-steroidal anti-inflammatory drug; tabs, tablets.