Treating a migraine effectively depends on two things: stopping the attack you’re having right now and reducing how often attacks happen in the first place. Most people with migraine benefit from a combination of acute treatments, lifestyle changes, and, if attacks are frequent enough, preventive therapy. Here’s what works, how to use it, and what to watch out for.
Stopping an Attack: Over-the-Counter Options
For mild to moderate migraines, standard pain relievers are the starting point. Ibuprofen, naproxen, and aspirin all work best when taken early, ideally within the first 30 minutes of an attack. Acetaminophen is an option too, though it tends to be less effective for moderate or severe pain. Combination products that pair a pain reliever with caffeine can boost absorption and provide faster relief.
The key with any of these is timing. Waiting until the pain is severe makes every medication less effective, because migraine slows down your stomach’s ability to absorb anything you swallow. If nausea hits early in your attacks, a fast-dissolving or liquid formulation may help.
Prescription Medications for Moderate to Severe Attacks
Triptans remain the most widely used prescription option for migraine. Seven are available in the U.S., including sumatriptan, rizatriptan, zolmitriptan, eletriptan, naratriptan, almotriptan, and frovatriptan. They come in oral tablets, orally dissolving tablets, nasal sprays, and injectable forms. The variety matters because if one triptan doesn’t work well for you or causes side effects, another might. Nasal sprays and injections bypass the stomach entirely, which makes them useful when nausea or vomiting is part of the picture.
A newer class of medications called gepants works differently. Instead of narrowing blood vessels the way triptans do, gepants block a protein called CGRP that plays a central role in migraine pain. Two gepants are approved for treating acute attacks: ubrogepant (taken as a 50 or 100 mg tablet) and rimegepant (a 75 mg tablet). These are particularly valuable for people who can’t take triptans due to heart disease, uncontrolled blood pressure, or other vascular risk factors. Side effects tend to be mild.
Tracking How Often You Use Acute Medications
This is one of the most important and least discussed parts of migraine treatment. Using acute medications too frequently can cause a separate condition called medication overuse headache, where the treatments themselves start generating more headaches. The thresholds are specific: triptans, opioids, and combination analgesics become risky at 10 or more days per month for three months or longer. For NSAIDs and acetaminophen, the limit is 15 days per month over three months.
If you find yourself reaching for medication more than two or three days a week on a regular basis, that’s a strong signal to talk with your doctor about adding preventive treatment rather than continuing to rely on acute medications alone.
When Prevention Makes Sense
Preventive therapy is worth considering when you experience four or more migraine days per month, when attacks are severe enough to significantly disrupt your life, or when acute treatments aren’t providing adequate relief. The goal isn’t to eliminate every migraine. It’s to cut the number of attacks roughly in half, which for many people is a dramatic improvement in quality of life.
Several categories of preventive medication have strong evidence behind them. Beta-blockers like propranolol (starting around 40 mg daily, sometimes increased up to 320 mg) are among the most established options. Anticonvulsants, particularly topiramate and valproate, are also considered first-line choices. Topiramate is typically started at a low dose of 25 mg and gradually increased. Among antidepressants, amitriptyline (25 to 150 mg daily) and venlafaxine (around 150 mg daily) have the best evidence for migraine prevention, even in people without depression.
These older medications are effective but come with trade-offs. Beta-blockers can cause fatigue and exercise intolerance. Topiramate sometimes causes cognitive fogginess or tingling in the hands. Amitriptyline often causes drowsiness and weight gain. Finding the right fit sometimes takes patience and a willingness to try more than one option.
CGRP Antibodies: A Newer Preventive Approach
A major shift in migraine prevention came with the development of monoclonal antibodies that target CGRP, the same pain-signaling protein blocked by gepants. Four are now available: erenumab, galcanezumab, fremanezumab, and eptinezumab. The American Headache Society considers these a first-line option for prevention, meaning you don’t need to fail other treatments before trying them.
Three of these are self-administered as monthly or quarterly injections under the skin. Eptinezumab is given as an intravenous infusion every 12 weeks. In clinical trials involving people with chronic migraine (15 or more headache days per month), roughly 27 to 57% of patients experienced at least a 50% reduction in monthly migraine days, compared to 9 to 40% with placebo. The side effect profile is generally favorable, with injection site reactions being the most common complaint.
The practical experience for most people looks like this: you start the injections, give it about three months to assess the effect, and if it’s working, continue. Some people notice improvement within the first month. For others it takes the full three months to see the benefit.
Devices That Treat Migraine Without Medication
Several FDA-cleared neuromodulation devices offer a drug-free option for both treating and preventing migraine. These work by delivering mild electrical or magnetic pulses to specific nerves. Cefaly is a forehead-worn device that stimulates nerves above the eyes. Nerivio is a wearable placed on the upper arm and controlled through a smartphone app. GammaCore stimulates the vagus nerve in the neck. Relivion targets both the occipital and trigeminal nerves simultaneously.
These devices are generally well tolerated and safe, which makes them appealing for people who want to reduce medication use, are pregnant, or haven’t responded well to drugs. They tend to work best as part of a broader treatment plan rather than as a standalone solution.
Supplements With Clinical Evidence
Three supplements have the most consistent research supporting their use in migraine prevention: magnesium, riboflavin (vitamin B2), and coenzyme Q10. A well-designed placebo-controlled trial tested a combination of 600 mg magnesium, 400 mg riboflavin, and 150 mg coenzyme Q10 daily over three months and found meaningful improvement in migraine symptoms.
Magnesium is the most broadly recommended of the three, partly because many people with migraine have lower magnesium levels. It’s inexpensive and has few side effects beyond loose stools at higher doses. Riboflavin turns your urine bright yellow, which is harmless. These supplements are reasonable to try before or alongside prescription preventives, though they generally produce more modest results.
Lifestyle Habits That Reduce Migraine Frequency
A useful framework for lifestyle management uses the mnemonic SEEDS: sleep, exercise, eat, diary, and stress. Each of these targets a modifiable trigger.
- Sleep: Irregular sleep is one of the most reliable migraine triggers. Going to bed and waking up at consistent times, even on weekends, matters more than total hours of sleep.
- Exercise: Regular moderate aerobic exercise (30 minutes, most days) has been shown to reduce migraine frequency. The benefit builds over weeks, not days.
- Eat: Skipping meals and dehydration both lower the threshold for an attack. Consistent meal timing and adequate water intake are simple but effective.
- Diary: Keeping a headache diary helps you identify personal triggers and track whether treatments are actually working. It also gives your doctor much better information to work with.
- Stress: Stress itself triggers migraine, but so does the letdown after stress, which is why weekend migraines are so common. Mindfulness, cognitive behavioral therapy, and biofeedback all have evidence supporting their use in migraine management.
Red Flags That Need Immediate Attention
Most migraines, even severe ones, are not dangerous. But certain headache features signal something more serious. Seek emergency evaluation for a headache that reaches maximum intensity within seconds (a “thunderclap” headache), any headache accompanied by fever, stiff neck, confusion, seizures, or new neurological symptoms like vision loss, weakness on one side of the body, or difficulty speaking. A significant change in the pattern of a longstanding headache, or a new headache triggered by coughing, exertion, or changes in position, also warrants prompt evaluation. These symptoms don’t necessarily mean something is wrong, but they need to be ruled out quickly.