Purpose of the Review <p>Pediatric migraine contributes to disability with significant interference on academic success. This review aims to explore the evidence of school-based accommodations and provide clinicians with guidance on how to support academic success.</p> Recent Findings <p>Many clinicians support the implementation of school-based accommodations for youth with migraine; however, there has been little research exploring efficacy despite wide-spread acceptance. Findings from anxiety literature offer insight into prospective issues with certain accommodations, warranting consideration for potential best practices for youth with migraine.</p> Summary <p>Despite significant academic challenges and the generally accepted use of school-based supports, most accommodations have few or no experimental studies and fail to show evidence of clear benefits for youth with migraine. This review offers clinicians guidance on selecting appropriate accommodations, recognizing that each patient is unique and suggested supports are best when they are based on a thorough assessment and tailored to the individual student’s needs and specific goals. Further research on the effectiveness of academic accommodations would help guide clinicians in supporting students with migraine.</p>