Getting rid of a migraine depends on how far along the attack is and how often you get them. For an occasional migraine, an over-the-counter painkiller taken early can cut it short. For frequent or severe attacks, prescription medications, lifestyle adjustments, and even nerve-stimulating devices offer real relief. Here’s what actually works, how well it works, and when to consider each option.
Over-the-Counter Pain Relievers
Most people reach for ibuprofen first, and it does help, but only about 42% of the time. Acetaminophen performs even worse, rated helpful by just 37% of migraine sufferers. The combination of aspirin, acetaminophen, and caffeine (sold as Excedrin) does slightly better, working roughly half the time. These numbers come from a large Harvard-reviewed dataset of real-world migraine treatment.
The key with any OTC option is timing. Taking it at the first sign of a migraine, during the aura or when pain is still mild, gives you the best shot. Once the attack is fully underway and nausea has set in, pills absorb poorly and work less effectively. If you find yourself relying on these medications regularly, there’s an important limit to know: using OTC painkillers on more than 15 days per month can trigger medication overuse headache, a rebound cycle where the painkillers themselves start causing head pain.
Prescription Medications for Active Attacks
When OTC options aren’t cutting it, prescription medications designed specifically for migraines are a significant step up. Triptans are the most widely prescribed class. They work by changing blood circulation in the brain and altering how the brain processes pain signals. Most people feel meaningful relief within one to two hours of taking a dose. Triptans come in tablets, nasal sprays, and injections for people who vomit during attacks.
A newer class of drugs called gepants takes a different approach. These block a protein called CGRP that plays a central role in migraine pain. Unlike triptans, gepants don’t constrict blood vessels, which makes them safer for people with heart disease or stroke risk factors. The most common side effects are mild: nausea, drowsiness, and dry mouth. Some gepants can also be taken daily to prevent migraines, giving them a dual role that triptans don’t have.
The same overuse caution applies to prescription treatments. Using triptans or gepants on more than 10 days per month puts you at risk for rebound headaches. A good rule of thumb is to keep any as-needed migraine medication to no more than two or three days per week.
Preventive Medications
If you’re getting four or more migraines a month, or at least eight headache days a month, prevention becomes more important than just treating each attack as it comes. Prevention is also worth considering if your migraines are severely disabling despite treatment, or if you’re bumping up against those medication overuse limits.
The best-studied preventive medications fall into two main categories. Blood pressure medications like propranolol and metoprolol have decades of clinical trial data behind them, with close to 60 trials confirming propranolol’s effectiveness alone. Anti-seizure medications like topiramate are the other major option. A review of 17 trials found topiramate is twice as likely as a placebo to cut migraine frequency by half or more. These medications are taken daily regardless of whether you have a headache, and most need a few weeks to reach full effect.
Supplements That Reduce Frequency
Three supplements have enough evidence behind them that headache specialists routinely recommend them. Magnesium oxide at 400 to 500 milligrams daily is endorsed by the American Headache Society for migraine prevention. Riboflavin (vitamin B2) at 400 milligrams daily has shown benefit in clinical trials. And Coenzyme Q10 at 300 milligrams daily has been found to reduce how often migraines occur.
These supplements tend to have fewer side effects than prescription preventives, which makes them a reasonable first step if your migraines are moderate in frequency. They’re not fast-acting, so give them at least two to three months of consistent use before judging whether they’re helping.
Lifestyle Changes That Matter
Lifestyle adjustments won’t stop a migraine that’s already started, but they can meaningfully reduce how often attacks happen. The evidence is strongest for three habits: consistent sleep, regular meals, and adequate hydration.
Sleep is the big one. Improving sleep habits alone can convert chronic migraine (15 or more headache days per month) to episodic migraine. The practical steps: keep your bedroom dark, cool, and quiet. Go to bed and wake up at the same time every day. No screens in bed. If you can’t fall asleep within 20 to 30 minutes, get up and leave the room so your brain doesn’t start associating your bed with frustration. The goal is spending at least 90% of your time in bed actually asleep, eventually working up to seven to eight hours a night.
Skipping meals is a reliable migraine trigger, especially skipping breakfast. Eating within 30 to 60 minutes of waking up and having at least three balanced meals a day helps stabilize blood sugar, which the migraine-prone brain is particularly sensitive to. Fasting is a known trigger for people with migraine.
For hydration, aim for at least seven to eight glasses of water daily. One study found benefit with as much as 16 glasses a day, though that’s impractical for most people. The lower target of about seven glasses is enough to keep most people properly hydrated and is a low-risk intervention worth trying.
Nerve Stimulation Devices
Several FDA-cleared devices can treat or prevent migraines without medication. Cefaly is a small headband-like device worn on the forehead that stimulates the nerve most involved in migraines. It has two modes: a 60-minute session to treat an active attack, and a 20-minute daily session for prevention. GammaCore stimulates the vagus nerve through the skin on your neck using gentle electrical pulses.
These devices work best as add-ons to other treatments rather than replacements. They’re particularly useful if you’re trying to reduce how much medication you take, or if you’ve hit the limit on how many days per month you can safely use acute treatments.
When a Migraine Won’t Break
A migraine lasting longer than 72 hours, sometimes called status migrainosus, typically requires professional intervention. Emergency and urgent care settings use an intravenous combination often called a “migraine cocktail.” This usually includes a strong anti-inflammatory, magnesium, anti-nausea medication, diphenhydramine, and IV fluids. The exact mix varies by patient, but the goal is to break the pain cycle that oral medications couldn’t interrupt. If you’re experiencing vomiting, can’t keep pills down, or have been in severe pain for days, this is the appropriate escalation.