Moreover, there may be a difference in severity of migraine attacks between the study populations. However, we are not able to compare the severity of the migraine

in our population with the studies from France and the UK, because migraine severity was not mentioned in these studies. Triptans were less frequently used in the younger p38 MAP Kinase pathway group when compared with the older group (2.4% vs 15.7%). An increase in triptan use by age was also seen in the UK primary care study.[14] Nausea was present in 71.7%, and vomiting in 49.3% of the participants during a migraine attack. However, antiemetics were only prescribed in a minority of cases by their GP. Although domperidone is an on-label drug for ordinary nausea and vomiting in children, the use of domperidone is not recommended in the DCGP guideline MLN8237 mouse for nausea and vomiting in children suffering from a migraine attack. Nevertheless, it is still unknown if antiemetics are effective as treatment of nausea and vomiting during an acute migraine attack in childhood.[15] About 12% of the children

had used prophylactic treatment before referral. Prophylactic treatment was mainly used in patients from the older group. Unfortunately, there are only a few well-designed trials evaluating prophylactic treatment for migraine in children. The high placebo response in these trials impedes to interpret the efficacy of the drug being tested.[16]

It has been reported that the efficacy of topiramate or sodium valproate as prophylactic migraine treatment in children from 5 till 18 years of age is more or less the same.17-19 Another meta-analysis demonstrated only suggestive effectiveness for trazodone and topiramate as prophylactic treatment in children with migraine.[20] A 5-FU purchase study from the UK reported prophylactic drug treatment by the GPs in 21.4% of the patients between 5 to 17 years of age, with an increase in prophylactic drug use when children were older, confirming the findings of this study.[14] The more frequent prescription of prophylactic treatment in the UK compared with the Netherlands is likely due to differences in GP guidelines.[8] Moreover, differences might be explained by differences in severity of migraine in the 2 studies. However, this could not be retrieved from the UK article. Migraine characteristics according to the ICHD-II criteria were not associated with the use of medication not listed in the guideline. However, other factors were associated with the prescription of not-listed medication by GPs. In the group with children younger than 12 years, the use of medication not listed in the DCGP guideline tended to be older than the children using only medication listed in the DCGP guideline.