Several types of medicine can help with migraines, ranging from common painkillers you already have in your cabinet to prescription drugs designed specifically for migraine attacks. The right choice depends on how often your migraines strike, how severe they are, and whether you need something to stop an attack in progress or prevent one from starting.
Over-the-Counter Pain Relievers
For mild to moderate migraines, standard painkillers are the usual starting point. Ibuprofen (Advil, Motrin) at 200 mg, naproxen sodium (Aleve) at 220 mg, and acetaminophen (Tylenol) at 325 to 500 mg all work for many people, especially when taken early in an attack before the pain builds.
The most effective over-the-counter option for many migraine sufferers is a combination of aspirin, acetaminophen, and caffeine. Excedrin Migraine contains 250 mg aspirin, 250 mg acetaminophen, and 65 mg caffeine. The caffeine helps the other ingredients absorb faster and narrows blood vessels in the brain. This three-ingredient combo consistently outperforms any single painkiller alone for migraine relief.
The catch with all these options is a hard limit on how often you can use them. Taking simple painkillers like ibuprofen or naproxen more than 15 days a month raises your risk of medication overuse headaches, a frustrating cycle where the very drugs meant to relieve your pain start triggering new headaches. For combination products and triptans, the threshold is even lower: no more than nine days a month.
Triptans for Moderate to Severe Attacks
When over-the-counter options aren’t enough, triptans are the most widely prescribed class of prescription migraine drugs. Seven are available: sumatriptan, rizatriptan, eletriptan, almotriptan, naratriptan, frovatriptan, and zolmitriptan. They all work by activating serotonin receptors in the brain, which reduces inflammation around cranial nerves and constricts dilated blood vessels.
Triptans come in several forms. Tablets are the most common, but if nausea or vomiting makes swallowing a pill difficult during an attack, nasal sprays (sumatriptan and zolmitriptan) and injectable versions (sumatriptan) bypass the stomach entirely. The nasal and injectable forms also tend to work faster. Zolmitriptan nasal spray, for example, relieves not just the headache pain but also the nausea, light sensitivity, and sound sensitivity that accompany it.
One important limitation: because triptans constrict blood vessels, they’re not safe for people with a history of heart disease, stroke, or significant cardiovascular risk factors.
Newer Prescription Options
For people who can’t take triptans due to heart concerns, or who simply don’t respond well to them, two newer drug classes offer alternatives.
Gepants block a protein called CGRP that plays a central role in triggering migraine pain. Rimegepant (Vydura) is approved for treating attacks as they happen and has the added benefit of being usable for prevention as well. Unlike triptans, gepants don’t constrict blood vessels, making them a safer choice for people with cardiovascular conditions.
Lasmiditan (Reyvow) belongs to a class called ditans. It targets a different serotonin receptor than triptans and doesn’t cause blood vessel constriction, so it’s another option for patients who can’t use triptans safely. The tradeoff is that it can cause dizziness and sedation, so you shouldn’t drive for at least eight hours after taking it.
When to Consider Preventive Medication
If you’re reaching for acute medication more than a few times a month, prevention becomes the better strategy. The American Headache Society recommends considering preventive treatment when you have four or more headache days a month. Prevention doesn’t mean you’ll never have another migraine. It means fewer attacks, and the ones you do get are often shorter and less intense.
Three medications are typically recommended first for prevention: propranolol (a beta blocker originally designed for blood pressure), topiramate (an anti-seizure drug), and amitriptyline (a tricyclic antidepressant). None of these were developed for migraines, but all have strong evidence for reducing attack frequency. Your doctor will choose based on your other health conditions. Propranolol suits someone with anxiety or high blood pressure. Amitriptyline works well if you also struggle with insomnia or tension-type headaches. Topiramate may be preferred if weight gain is a concern, since it tends to suppress appetite rather than increase it.
Other preventive options include candesartan (a blood pressure drug), sodium valproate (another anti-seizure medication), and Botox injections, which are approved specifically for chronic migraine (15 or more headache days per month). Most preventive medications take six to eight weeks to reach full effect, so patience is essential when starting one.
CGRP Inhibitors for Prevention
The biggest advance in migraine prevention in recent years is a class of injectable medications that block CGRP, the same pain-signaling protein targeted by gepants. Four are available: erenumab, fremanezumab, galcanezumab, and eptinezumab. The first three are self-injected at home using a prefilled pen, similar to an insulin injection. Eptinezumab is given as an IV infusion in a clinic.
Most people inject once a month, though fremanezumab offers a quarterly dosing option (four injections per year). These drugs reduce how often migraines occur, make the attacks that do happen milder and shorter, and prevent some entirely. They were designed from the ground up for migraine, which means they tend to have fewer unrelated side effects than repurposed blood pressure or seizure drugs. The main downsides are cost and insurance access, since they’re newer and more expensive.
Gepants can also be used preventively. Atogepant and rimegepant are both approved for this purpose, offering a daily pill alternative to monthly injections.
Supplements With Evidence Behind Them
Several supplements have enough clinical data to be worth trying, particularly if you prefer to start with something less aggressive or want to add them alongside a prescription.
- Magnesium oxide at 400 to 500 mg daily is recommended by the American Headache Society. Low magnesium levels are common in people with migraines, and supplementing can reduce attack frequency. It’s inexpensive and widely available, though high doses can cause loose stools.
- Riboflavin (vitamin B2) at 400 mg daily has shown benefit in multiple studies. It supports energy production in brain cells, which may be impaired in migraine sufferers. Your urine will turn bright yellow, which is harmless.
- Coenzyme Q10 at 300 mg daily has been found to reduce migraine frequency in adults. Like riboflavin, it plays a role in cellular energy metabolism.
These supplements generally take two to three months of consistent daily use before you’ll notice a difference in your migraine pattern. They’re not replacements for prescription medication in severe cases, but for people with moderate migraine frequency, they can meaningfully reduce the number of attacks per month.
Matching Treatment to Your Pattern
The best migraine medicine depends on your specific situation. If you get two or three migraines a month and they respond to ibuprofen taken early, you don’t need a prescription. If over-the-counter options fail, a triptan is the logical next step. If you have heart disease or cardiovascular risk factors, gepants or lasmiditan replace triptans. And if you’re having four or more migraine days monthly, or burning through acute medications too often, a preventive drug or CGRP inhibitor can break the cycle.
Many people end up using a combination: a daily preventive to reduce the overall number of attacks, plus an acute medication to handle the migraines that still break through. Keeping a headache diary that tracks your frequency, severity, and medication use gives you and your doctor the clearest picture of what’s working and what needs to change.