OBJECTIVES: To perform a systematic review and network meta-analysis of randomized trials comparing efficacy of pharmacological treatments on migraine in children and adolescent METHODS: Electronic databases (e.g., Pubmed, Embase, CENTRAL etc.) were searched up to Dec 2015. Outcomes were both dichotomous (i.e., number of patients who had a number of migraine attack or migraine day reduction >50%), and continuous outcomes (i.e., means number of attacks per month, means number of migraine days per month, means Visual Analogue Scale, and means durations of headache per attacks). A network meta-analysis was applied to estimate pooled risk ratios (RR) or weighted mean differences (WMD) for dichotomous and continuous outcomes. Treatment regimens were then ranked using surface under the cumulative ranking (SUCRA) probabilities RESULTS: A total of 33 studies were included. Topiramate plus thioctic acid (RR: 3.30, 95%CI; 1.18, 9.18), Pregabalin (RR: 2.65, 95%CI; 1.63, 4.30), and Cinnarizine (RR: 1.57, 95%CI; 1.10, 2.24), were the interventions that significantly reduced number of migraine attack or migraine day reduction >50%. Piracetam (WMD: -3.95, 95%CI; -6.13, -1.78), Pregabalin (WMD: -3.10, 95%CI; -6.2, -0.001), Topiramate plus thioctic acid (WMD: -2.79, 95%CI; -4.96, -0.62), and Cinnarizine (WMD: -2.26, 95%CI; -4.13, -0.39) significantly reduced number of migraine attack per month. Of these, Topiramate plus thioctic acid also significantly reduced migraine-day per month (WMD: -7.035, 95%CI; -8.48, -5.69). CONCLUSIONS: Our study suggests potential efficacy of several therapeutic agents for migraine prophylaxis. These findings are however based on a small number of studies and additional studies are required to strengthen this network meta-analysis.