risk factors should avoid the use of beta blockers for migraine prevention. Antidepressants Antidepressants are suggested to be both efficacious and tolerable in the treatment of migraine prevention for both migraine frequency and migraine index. The exact mechanism of action is unknown but seems to be related to serotonin's impact on migraine. In particular, amitryptyline (a tricyclic antidepressant) has the most evidence to suggest its efficacy. Selective serotonin re-uptake inhibitors as well as serotonin and norepinephrine re-uptake inhibitors are likely effective as well, but more studies are required in order to provide more evidence. Adverse events of antidepressants can include fatigue, nausea, drowsiness, dizziness, dry mouth, GI upset and weakness. Sedation is also common. Anticonvulsants Both sodium valproate and divalproex sodium have been established as efficacious for migraine prophylaxis. They are well tolerated short term, but should be monitored during long term therapy because of risks of pancreatitis, liver failure and teratogenicity. Valproate should not be used in females of childbearing age because studies suggest that children exposed to valproate in the prenatal period are associated with having lower IQ scores. Topiramate is another anticonvulsant with therapeutic efficacy in migraine prophylaxis. It is a safe medication but should be used in caution in females of childbearing ages because it is suggested to cause birth defects. Calcitonin gene receptor peptide (CGRP) antagonists CGRP antagonists can be used for both acute migraine treatment as well as prophylactically. CGRP is a neuropeptide which is thought to induce migraines via vasodilation of cranial arteries. CGRP can also release inflammatory agents and cause nervous system sensitization. It is theorized that by antagonizing the CGRP receptor of the trigeminal ganglia, lowered CGRP is released and less migraine occurs. Erenumab is a highly selective human monoclonal antibody which is a promising new development in migraine treatment. It has low risk of hepatoxicity like gepants can have, due to being mostly eliminated via proteolysis. Melatonin There have been some studies suggesting the benefit of using melatonin for prophylaxis of migraine, however, there is a lack of strength of evidence due to a low number of studies as well as conflicting results. Melatonin has a good safety profile but there have been rare instances of serious side effects. More studies are needed in order to suggest the therapeutic use of melatonin for prophylaxis of migraine. Prophylaxis in pediatric patients There is not a strong degree of evidence for the