Migraines respond to a layered approach: the right combination of lifestyle habits, over-the-counter pain relievers, prescription medications, and sometimes preventive therapies can cut both the frequency and severity of attacks. What works best depends on how often your migraines strike and how disabling they are, but most people benefit from addressing multiple angles at once.
Over-the-Counter Pain Relievers
For mild to moderate migraines, standard painkillers are the first thing to try. Ibuprofen at 400 mg is effective and widely available. Higher doses (800 to 1,200 mg) work slightly better but carry more risk of stomach irritation. The combination of aspirin, acetaminophen, and caffeine (sold as Excedrin Migraine in the U.S.) has a strong track record, with a therapeutic advantage of about 26 percentage points over placebo in clinical trials. Caffeine narrows blood vessels and helps the other ingredients absorb faster, which is why it’s included.
Timing matters more than most people realize. Taking a painkiller at the first sign of an attack, before pain ramps up, dramatically improves its chances of working. Waiting until the pain is fully established means you’re fighting an uphill battle. That said, using these medications more than about 10 to 15 days per month can cause rebound headaches, a cycle where the painkillers themselves start triggering new attacks.
Prescription Medications for Active Attacks
When over-the-counter options aren’t enough, prescription medications designed specifically for migraines are the next step. A large network meta-analysis published in The BMJ compared all major acute migraine drugs head to head and found that triptans remain the most effective class. Eletriptan ranked first for achieving complete pain freedom within two hours, followed by rizatriptan, sumatriptan, and zolmitriptan. All four outperformed newer drug classes.
Triptans work by targeting serotonin receptors to reverse the blood vessel changes and inflammation behind a migraine. They come in tablets, nasal sprays, and injections for people who vomit during attacks. Side effects like tingling, chest tightness, and drowsiness are common but usually mild. People with certain cardiovascular conditions can’t take triptans, which is where newer options come in.
A newer class of drugs called gepants (rimegepant, ubrogepant) blocks a protein called CGRP that plays a central role in migraine pain signaling. They’re gentler on the cardiovascular system but, according to the same BMJ analysis, are less effective than the top triptans for acute relief. They fill an important gap for people who can’t tolerate or don’t respond to triptans.
Preventive Medications
If you’re getting four or more migraine days per month, preventive therapy can reduce how often attacks happen. The goal isn’t to eliminate every migraine but to cut the frequency and make individual attacks milder and more responsive to acute treatment.
CGRP-blocking injections and infusions (erenumab, fremanezumab, galcanezumab) have become a first-line preventive option. These are self-injected monthly or quarterly. In clinical trials, fremanezumab reduced moderate-to-severe headache days by about 6 per month in people with chronic migraine, compared to 4.2 days with placebo. Erenumab reduced migraine days by roughly 5.2 to 5.4 per month in people whose migraines had worsened from overusing acute medications. The side effects are minimal for most people, mainly injection site reactions.
For chronic migraine specifically (15 or more headache days per month, with at least 8 having migraine features), botulinum toxin injections are FDA-approved. The treatment involves 31 small injections across seven muscles in the head and neck, repeated every 12 weeks. It typically takes two to three rounds before you see the full benefit.
Older preventive medications, including certain blood pressure drugs, antidepressants, and anti-seizure medications, are still widely used and effective. They’re less expensive than CGRP therapies, though they tend to have more side effects like fatigue, weight changes, or brain fog.
Supplements Worth Trying
Several supplements have enough clinical evidence behind them that the American Headache Society includes them in its recommendations. Riboflavin (vitamin B2) at 400 mg daily can reduce migraine frequency, likely by improving how your brain cells produce energy. Magnesium oxide at 400 to 500 mg daily helps as well, particularly for people with migraine with aura. Low magnesium levels are common in people with migraines, so supplementation addresses a real deficiency in many cases. Coenzyme Q10 is another option with supporting evidence.
These supplements are inexpensive and have very few side effects (magnesium can cause loose stools at higher doses). They take 2 to 3 months of consistent daily use before you’ll notice a difference, so patience is key. Many headache specialists recommend starting with supplements as a first preventive step, especially for people who prefer to avoid prescription medications.
Lifestyle Habits That Reduce Attacks
The American Migraine Foundation uses the acronym SEEDS to describe the five lifestyle pillars of migraine management: sleep, exercise, eating, diary keeping, and stress management. These aren’t vague wellness tips. For many people, inconsistent habits are as powerful a trigger as any food or weather change.
Sleep is arguably the most important. The target is 7 to 8 hours, but consistency matters more than duration. Going to bed and waking up at the same time every day, including weekends, helps regulate the brain systems involved in migraine. Avoiding screens for two hours before bed improves sleep quality significantly. The goal is that 90% of the time you’re in bed, you’re actually sleeping, not scrolling or watching TV.
Regular aerobic exercise, 30 to 50 minutes of moderate intensity 3 to 5 days per week, reduces the frequency, severity, and duration of attacks. Walking, swimming, and cycling all work. If exercise itself triggers your migraines, starting at a very low intensity and building up gradually usually solves the problem.
Eating six small meals throughout the day keeps blood sugar stable, which matters because blood sugar dips are a reliable migraine trigger. Meals high in protein, fiber, and healthy fats are better than processed, carb-heavy options for this purpose. Staying hydrated (about eight 8-ounce glasses of water daily) is equally important and easy to overlook.
Keeping a headache diary sounds tedious but is one of the most useful things you can do. Tracking when attacks happen, what you ate, how you slept, your stress level, and where you are in your menstrual cycle (if applicable) reveals patterns that are invisible otherwise. Several free apps make this easier than pen and paper.
Neuromodulation Devices
FDA-cleared wearable devices offer a drug-free option for both treating and preventing migraines. These devices use mild electrical or magnetic stimulation to calm overactive nerve pathways.
Cefaly, a forehead-worn device, is one of the most studied. In its acute mode (60-minute sessions), 29% of users become pain-free within an hour, and users experience an average 59% reduction in migraine severity. Used preventively for 20 minutes daily, 38% of users with episodic migraine cut their monthly migraine frequency in half within three months, compared to 12% with a sham device. GammaCore, a handheld device applied to the neck, showed that almost 30% of episodic migraine users had little to no pain within two hours of first use. Nerivio, worn on the upper arm, is cleared for both acute (45-minute sessions) and preventive use (45 minutes every other day).
These devices won’t replace medications for everyone, but they work well as add-on treatments, and they’re especially appealing for people who want to reduce how many medications they take or who experience medication side effects.
Acupuncture
Acupuncture has legitimate evidence behind it for migraine prevention, though the effect size is modest. In the ACUMIGRAN trial, about 34% of patients who received 12 acupuncture sessions saw their headache days drop by at least half. That’s a meaningful benefit for a treatment with essentially no side effects. A typical course involves weekly sessions over 6 to 12 weeks, followed by less frequent maintenance visits. It works best as part of a broader prevention strategy rather than a standalone treatment.
When a Migraine Won’t Break
A migraine lasting more than 72 hours is called status migrainosus, and it usually requires medical intervention. Emergency or urgent care treatment typically involves IV fluids (since prolonged pain and nausea cause dehydration), anti-inflammatory medication, and anti-nausea drugs given intravenously so they bypass the stomach. IV magnesium and corticosteroids are also commonly used. For the most resistant cases, stronger options targeting serotonin pathways can break the cycle. If you’ve had a migraine for three days straight and your usual treatments aren’t working, that’s the point where seeking urgent care is reasonable.