Treating a migraine effectively comes down to timing, the right medication, and knowing your options. The single most important thing you can do during an attack is take your medication early, ideally when the pain is still mild. Waiting until the pain peaks makes every treatment less effective.
Over-the-Counter Pain Relief
For mild to moderate migraines, a combination of acetaminophen (250 mg), aspirin (250 mg), and caffeine (65 mg) in a single dose is one of the most effective over-the-counter options. This is the formula behind products like Excedrin Migraine. The standard dose is two caplets with water, with a maximum of two caplets in 24 hours. Ibuprofen and naproxen also work well on their own, particularly when taken at the first sign of pain.
The caffeine in combination products isn’t just filler. It helps your body absorb pain relievers faster and constricts blood vessels that dilate during a migraine. That said, using any acute pain medication more than two or three days a week can lead to medication-overuse headache, a rebound cycle where the treatment itself starts triggering more headaches.
Prescription Medications for Acute Attacks
When over-the-counter options aren’t enough, triptans are the most widely prescribed class of migraine-specific medication. They work by narrowing blood vessels and blocking pain signals in the brain. Among the triptans, rizatriptan (10 mg), eletriptan (80 mg), and almotriptan (12.5 mg) consistently show the highest rates of complete pain relief at two hours. Sumatriptan (100 mg), the most commonly prescribed triptan, provides complete pain freedom in about 29% of patients at two hours, while those three outperform it.
There are trade-offs between the options. Rizatriptan works fast and reliably but has a higher rate of headache recurrence later in the day. Eletriptan has one of the lowest recurrence rates but a slightly higher chance of side effects like dizziness or fatigue. Almotriptan strikes a balance, with strong pain-free rates and one of the lowest side effect profiles at just under 13%. Your doctor can help you match a triptan to your pattern.
A newer class of medications targets a protein called CGRP, which plays a central role in migraine pain. Three of these drugs are available for acute treatment: ubrogepant (a tablet), rimegepant (a dissolving tablet), and zavegepant (a nasal spray). These are typically reserved for people who haven’t responded well to at least two different triptans. They don’t constrict blood vessels, which makes them an option for people with heart disease or other conditions that rule out triptans.
What to Do During an Attack Beyond Medication
Medication works best when paired with basic environmental changes. Lie down in a dark, quiet room if you can. Light and sound amplify migraine pain because your brain’s sensory processing goes into overdrive during an attack. A cold pack on your forehead or the back of your neck can help by numbing the area and reducing inflammation. Some people find relief from pressing firmly on the temples or the space between the thumb and index finger.
Caffeine can help if you don’t consume it regularly, but skip it if you’re already a heavy coffee drinker. For nausea, which accompanies many migraines, ginger tea or ginger chews can settle the stomach enough to keep oral medication down. If vomiting is a problem, nasal spray or dissolving tablet formulations bypass the stomach entirely.
Preventing Future Migraines
If you’re getting four or more migraines a month, or your attacks are severe enough to disrupt your life despite treatment, preventive therapy is worth discussing with your doctor. Prevention doesn’t eliminate migraines entirely, but it can cut their frequency in half or more.
The first-line preventive medications include two types: beta-blockers (propranolol, metoprolol, timolol) and the anticonvulsant topiramate. These are taken daily regardless of whether you have a headache. They typically take four to eight weeks to reach full effect, and finding the right dose often involves some trial and error. Side effects vary by drug. Beta-blockers can cause fatigue and cold hands. Topiramate can cause tingling in the fingers, cognitive fogginess, and weight loss.
CGRP-targeting therapies are now considered a first-line preventive option as well, according to a 2024 position statement from the American Headache Society. These are given as monthly or quarterly injections, or as a daily dissolving tablet in the case of rimegepant (which can serve double duty for both prevention and acute treatment). They tend to have fewer side effects than older preventive drugs, though they’re typically more expensive and may require insurance authorization.
Supplements That Reduce Migraine Frequency
Several supplements have enough clinical evidence to be worth trying, especially if you prefer to start with something lower-risk before moving to prescription prevention. The American Headache Society recognizes three in particular:
- Magnesium oxide: 400 to 500 mg daily. Magnesium plays a role in nerve signaling, and many people with migraines have lower levels. Loose stools are the main side effect.
- Riboflavin (vitamin B2): 400 mg daily. This supports energy production in brain cells. It turns your urine bright yellow, which is harmless.
- Coenzyme Q10: 300 mg daily. Research has found this dose reduces migraine frequency in adults.
These supplements take two to three months of consistent daily use before you’ll notice a difference. They work best as part of a broader prevention strategy rather than on their own.
Lifestyle Changes That Actually Help
Stress reduction is the single most effective lifestyle change for migraine. That doesn’t mean eliminating stress, which is impossible, but building in regular habits that lower your baseline stress level. Regular moderate-to-vigorous aerobic exercise, done consistently over several months, has been shown to reduce headache frequency, intensity, and duration. Walking, swimming, and cycling are all good options. Start gently if exercise itself tends to trigger attacks, and build up gradually.
Sleep consistency matters more than sleep duration. Going to bed and waking up at the same time every day, including weekends, stabilizes the brain’s internal clock. Both too little and too much sleep can trigger attacks. Eating on a regular schedule helps for the same reason: your migraine brain doesn’t handle disruption well.
Food triggers get a lot of attention, but only about 10% of migraine sufferers are genuinely sensitive to specific foods, according to headache specialist Dr. Vincent Martin. If you suspect a food trigger, keep a headache diary for a few weeks before eliminating anything. Skipping meals is a far more common trigger than any specific ingredient.
Neuromodulation Devices
Several FDA-cleared devices offer drug-free treatment through mild electrical or magnetic stimulation. The Cefaly device, worn on the forehead like a headband, stimulates the trigeminal nerve. Its acute treatment program runs one to two hours during an attack, while a 20-minute daily session works as prevention. Clinical trials show it outperforms sham devices for both two-hour pain freedom and reducing monthly migraine days.
The Nerivio device, worn on the upper arm, uses remote electrical stimulation during an attack for 45 minutes. For prevention, it’s used every other day. The gammaCore device stimulates the vagus nerve on the side of the neck. These devices are generally well-tolerated, with minimal side effects, though their effectiveness varies and they tend to work best as add-ons to other treatments rather than replacements.
When a Headache Needs Emergency Attention
Most migraines, even severe ones, are not dangerous. But certain features signal something more serious. A thunderclap headache that hits maximum intensity within seconds is the biggest red flag. This can indicate a blood vessel problem like an aneurysm and needs immediate evaluation.
Other warning signs include new neurological symptoms you’ve never experienced before: weakness on one side of your body, unusual numbness, or sudden vision changes that don’t fit your typical migraine pattern. Headaches accompanied by fever, night sweats, or weight loss suggest an underlying systemic illness. A new severe headache in someone who is immunocompromised also warrants urgent attention. Headache specialists use the mnemonic SNOOP4 to screen for these red flags: systemic symptoms, neurological signs, sudden onset, older age at first onset, and pattern changes from your usual headaches.