1.Please provide your name for us to contact you.

2.Please provide a phone number for us to contact you.

3.Is your child between 6 and 17 years old?

Yes

No

4.Does your child have a migraine diagnosis?

Yes

No

5.Has your child experienced migraines for at least six months?

Yes

No

6.Do these migraines last between 3 and 72 hours if untreated?

Yes

No

7.Has your child had between 1 and 14 migraine attacks per month in the last two months?

Yes

No

8.Has your child taken any over-the-counter medicine for migraines before?

Yes

No

9.Does your child weigh between 44 and 298 pounds?

Yes

No

10.Does your child have any other major health issues?

Yes

No

11.Has your child had cancer in the last five years?

Yes

No