Headaches that occur more days than not are prevalent in youth, affecting as many as 1 in 60 children and adolescents.1,2 Chronic migraine is defined as frequently recurring episodes of severe pulsating headaches with features such as nausea, vomiting, and sensitivity to light and sound that occur along with daily or near-daily milder headaches.3 The majority of children with this disorder experience substantial impairment in their ability to function at school and to participate in typical physical and social activities.1,4 Yet rarely do children with chronic migraine seek treatment.1 If they did, historically most clinicians had little treatment to offer because of insufficient training in headache management,5 lack of preventive medications approved by the US Food and Drug Administration for this condition, and limited data from placebo-controlled randomized trials to guide treatment.6