What medication best prevents migraine in children?
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Propranolol, valproic acid, and amitriptyline are effective prophylaxis for migraine in children to varying degrees, are widely available, and have a reasonable safety profile (strength of recommendation [SOR]: B, based on either single randomized controlled trial, prospective or retrospective cohort studies, or trials with conflicting evidence). Flunarizine and nimodipine have the best evidence of benefit in children; however, availability, cost, and side effects limit their usefulness (SOR: B, based on multiple small randomized controlled trials).
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