Several effective options can stop a migraine once it starts or prevent attacks from happening in the first place. The right approach depends on how often you get migraines, how severe they are, and whether you have other health conditions that limit your choices. Most people benefit from a combination of acute treatments for individual attacks and preventive strategies to reduce how many they get.
Over-the-Counter Pain Relievers
For mild to moderate migraines, standard pain relievers from the pharmacy are the first line of defense. Ibuprofen is one of the most effective single-ingredient options, with a number needed to treat of 3.2 for headache relief at two hours, meaning roughly one in three people who take it will go from moderate or severe pain to mild or no pain. Naproxen sodium also works, though it’s somewhat less potent: about 45% of people experience headache relief at two hours compared to 29% with a placebo.
The combination of aspirin, acetaminophen, and caffeine (sold as Excedrin Migraine in the U.S.) consistently outperforms any of those ingredients taken alone. Caffeine narrows blood vessels slightly and helps your body absorb the other ingredients faster. The key with any of these is timing. Taking them at the first sign of a migraine, before the pain builds, dramatically improves how well they work. Waiting until the pain is severe often means they won’t be enough.
Prescription Medications for Active Attacks
When over-the-counter options fall short, triptans have been the standard prescription treatment for decades. They work by activating serotonin receptors that reduce inflammation and constrict blood vessels around the brain. They’re effective for most people, but they’re off-limits if you have uncontrolled high blood pressure, heart disease, or a history of stroke because of that blood vessel constriction.
A newer class of medication solves that problem. Lasmiditan targets a different serotonin receptor that relieves migraine pain without narrowing blood vessels at all. In clinical trials, it produced zero measurable constriction in human coronary arteries, and researchers specifically included patients with cardiovascular risk factors without seeing increased heart-related side effects. The trade-off is that lasmiditan can cause dizziness and drowsiness, so you shouldn’t drive for at least eight hours after taking it.
Supplements Worth Trying
Two supplements have enough evidence behind them that the American Headache Society specifically recommends them for migraine prevention. Magnesium oxide at 400 to 500 milligrams daily can reduce migraine frequency, likely because many people with migraines have lower magnesium levels than average. Magnesium plays a role in nerve signaling and blood vessel tone, both of which are involved in migraine attacks. The most common side effect is loose stools, which you can minimize by splitting the dose or switching to magnesium glycinate.
Riboflavin (vitamin B2) at 400 milligrams daily is the other well-supported option. It helps your cells produce energy more efficiently, which may matter because migraine-prone brains appear to have impaired energy metabolism. Riboflavin takes about two to three months of consistent use before you’ll notice a difference in attack frequency, so patience is important. It turns your urine bright yellow, which is harmless.
Ginger powder also deserves mention. A randomized trial of 100 migraine patients found that ginger powder was statistically comparable to sumatriptan (one of the most common prescription triptans) for reducing headache severity at two hours, with fewer side effects. That’s a single study, so it’s not definitive, but ginger is inexpensive and low-risk enough to try alongside other approaches.
Preventive Treatments for Frequent Migraines
If you’re getting four or more migraine days per month, preventive therapy can substantially reduce that number. The newest option is a class of injectable medications that block a protein called CGRP, which spikes during migraine attacks and drives the pain and inflammation cycle. Clinical studies show that 40% to 50% of people using erenumab (one of these medications) cut their monthly migraine days in half or more. For fremanezumab and galcanezumab, which target the same pathway slightly differently, that number rises to roughly 50% to 60% of patients.
These medications are given as a monthly or quarterly self-injection, similar to an insulin pen. Side effects are generally mild, mostly injection-site reactions and constipation. The biggest barrier is cost, though most manufacturers offer patient assistance programs, and insurance coverage has improved significantly since these medications launched.
For chronic migraine, defined as 15 or more headache days per month with at least 8 of those being migraines, botulinum toxin injections are FDA-approved. The treatment involves 31 injection sites across the forehead, temples, back of the head, neck, and upper shoulders, repeated every 12 weeks. It typically takes two to three rounds before you see the full benefit, so it requires a commitment of at least six months to fairly evaluate.
Sleep and Migraine Prevention
Disordered sleep is the second most commonly reported migraine trigger, right behind stress. Poor sleep quality, too little sleep, too much sleep, and inconsistent sleep schedules all increase your vulnerability to attacks. The relationship runs both directions: migraines disrupt sleep, and disrupted sleep triggers migraines, creating a cycle that’s hard to break without deliberately targeting your sleep habits.
Behavioral sleep interventions have measurable effects. In one study, participants using cognitive behavioral techniques for insomnia gained an average of nearly 53 extra minutes of sleep per night. An adolescent trial showed sleep duration increasing from 7 hours and 36 minutes to 8 hours and 25 minutes after intervention. The practical steps that make the biggest difference include going to bed and waking up at the same time every day (including weekends), avoiding caffeine and alcohol in the hours before bed, keeping your bedroom dark and quiet, and skipping daytime naps. Napping reduces your sleep drive and makes it harder to fall asleep at night, which perpetuates the cycle.
Nerve Stimulation Devices
FDA-cleared wearable devices offer a drug-free option that some people use alongside medications or on their own. The Cefaly device, which stimulates the trigeminal nerve through a small electrode on your forehead, has the strongest clinical data. In a phase 3 trial, 25.5% of users were completely pain-free at two hours (compared to 18.3% with a sham device), and nearly 70% had meaningful pain relief at two hours versus 55% with sham. Those numbers are more modest than what you’d see with triptans, but the device has virtually no systemic side effects, which makes it appealing for people who can’t tolerate medications or want to reduce how often they take them.
The device can also be used daily in a preventive mode, applying a 20-minute stimulation session each day to reduce overall migraine frequency. Some people find the tingling sensation uncomfortable at first, but most adjust within a few sessions.
Building a Migraine Management Plan
The most effective approach for most people layers multiple strategies together. A typical plan might include a supplement like magnesium for baseline prevention, consistent sleep habits, an over-the-counter pain reliever for mild attacks caught early, and a prescription medication for breakthrough migraines that don’t respond to the first-line option. If your migraines are frequent enough, adding a preventive medication like a CGRP blocker can reduce how often you need to treat acute attacks at all.
Tracking your migraines in a diary or app helps you identify your personal triggers and measure whether a new treatment is actually working. Record the date, severity, duration, potential triggers, and what you took. Give any preventive strategy at least two to three months before deciding whether it’s helping, since migraine frequency naturally fluctuates from month to month and short-term impressions can be misleading.