Pediatric Migraine Study

Does your child or teen experience migraines?

You may be interested in a clinical trial for kids and teens dealing with migraine attacks.

The study medicine and any trial-related procedures will be provided for you. Participants do not need health insurance to take part. Participants or their parents/guardians may be reimbursed for any reasonable expenses that they may have as a result of taking part in this trial.

Participants in this trial will receive care from a team of dedicated medical professionals and help to advance medical research.

What happens if I sign up? 

We will match your child or teen to a clinical trial center in your area that is seeking kids and teens with migraines or notify you when one becomes available. Someone from the trial team will contact you to explain more about the study before you make your decision to participate.

Sign Up

Fields marked with an * are required.

Do you consent to the collection and processing of your personal data, including information about your race and ethnicity (as applicable), and your health information, including symptoms, diagnoses, medications, and treatments and our sharing of this information for the purpose of recruitment into clinical research studies, determining your eligibility for studies, and provision of other services you requested? You may withdraw your consent at any time by contacting us at info@autocruitment.com. Please note that your revocation will not impact any records or health data already collected, disclosed, or processed based on your consent. *

Yes

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If you are under the age of 13 (or 16 if you are in California or in Europe), you may not directly enter any information and your legal parent or guardian must enter this information on your behalf. By filling out this form, you are confirming that you meet these requirements.

Who are you interested in this study for? *

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First Name of Child/Teen Participant *

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Last Name of Potential Child/Teen Participant *

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What is the Child/Teen's month and year of birth (MM/YYYY)? *

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Zip Code or Postal Code of Parent/Guardian *

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Is the Child/Teen Participant Male or Female?

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Has the Child/Teen Participant been diagnosed with migraine, by a doctor? *

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How long has the Child/Teen Participant been experiencing migraine attacks? *

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On average, in a 30-day month, how many times/days does the Child/Teen Participant have a migraine? *

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If left untreated, does the Child/Teen Participant’s migraine attacks typically last at least 3 hours? *

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Is the Child/Teen Participant currently taking any medication to prevent migraine attacks? *
These may include over-the-counter pain relief medications, Acetaminophen (Tylenol ®), Ibuprofen (Advil®, Advil Migraine, Motrin®), Naproxen (Aleve®), Aspirin®, or medications prescribed by your doctor for migraine.

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How many medications is the Child/Teen Participant currently taking to prevent migraine attacks before they happen? *

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Has the Child/Teen Participant been diagnosed (by a doctor) with any other medical conditions? *
(For example: schizophrenia, bipolar disorder, borderline personality disorder, cancer, seizure disorder, cardiovascular disease, cardiomyopathy, cerebrovascular disease, diabetes, Raynaud’s disease, anaphylaxis, hepatitis B, hepatitis C, human immunodeficiency virus (HIV))
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.

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Is the Child/Teen Participant taking any medications for migraine or other health conditions? *

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How much does the Child/Teen Participant weigh in Lbs (pounds)? *

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If female, is the Child/Teen Participant currently pregnant or breastfeeding?

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Which racial or ethnic group(s) is the Potential Participant?
Please select all that apply. This question is optional and you do not have to answer.

American Indian or Alaskan Native

Asian

Black or African American

Hispanic / Latino / Spanish

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Another race or ethnicity

I prefer not to answer

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First Name of caregiver/parent to contact *

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Last Name of caregiver/parent to contact *

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Phone Number of caregiver/parent to contact *

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Email of caregiver/parent to contact *

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What is the best day/time to reach you via telephone (we know you are busy)? *

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The information you are providing here will be processed in accordance with our Privacy Policy, which describes our data privacy practices, including how we share your information with our Research Partners and use your information to send you details about potential clinical trial opportunities. When you submit this information, you consent to AutoCruitment’s use of your data as described in our Privacy Policy. By providing your phone number and clicking “Submit” below, you consent to receive messages, including SMS/MMS text messages, sent by or on behalf of AutoCruitment, with information about research studies for which you may be eligible. By clicking Submit, you also agree to our SMS Terms. If you have any questions regarding the handling of the information you have provided to AutoCruitment, or if you would like to make any changes or withdraw your consent, please contact us at info@autocruitment.com.

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