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

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

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

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* 4. Does your child have a migraine diagnosis?

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

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

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

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

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

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

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

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