The appropriate treatment of migraine requires an individually tailored approach and is based on bio-behavioral, nonpharmacological and pharmacological methods. The available data in the pertinent literature on pharmacologic approaches are few and contradictory. Drug approaches for migraine attack include acetaminophen, NSAIDs and triptans. Acetaminophen and ibuprofen are often effective, but some migraine attacks may be refractory. The triptans can be a useful therapeutic option in adolescents. The literature data on prophylaxis are conflicting: flunarizine and topiramate are probably effective; for other drugs (including cyproheptadine, amitriptyline, divalproate and levetiracetam) there is insufficient evidence in children. The results from the use of propranolol are conflicting, whereas nimodipine and clonidine have been shown to be noneffective. Further studies are needed based on larger samples, multicenter trials, patient selection from primary care centers, and precise respect of current international diagnostic criteria. Moreover, new parameters of treatment efficacy should be considered.