Treating a migraine depends on where you are in the attack. If you’re in the middle of one right now, reaching for a cold pack and an over-the-counter painkiller is a reasonable first move. But migraine treatment goes well beyond popping a pill. The most effective approach combines fast-acting relief for acute attacks with longer-term strategies that reduce how often migraines strike in the first place.
What to Do Right Now During an Attack
Cold therapy is one of the simplest and most effective things you can try immediately. Cold reduces blood flow to the painful area, numbs nerve endings, and lowers inflammation. Wrap an ice pack in a thin cloth and place it wherever the pain is worst: your forehead, temples, neck, or the back of your scalp. Keep it on for 15 minutes, take a 15-minute break, then reapply if needed.
At the same time, get to a dark, quiet room if you can. Migraine pain is typically worsened by light, sound, and routine physical activity like walking or climbing stairs. Lying still in a dim environment removes those aggravating inputs while you wait for medication to kick in.
Over-the-Counter Pain Relief
For mild to moderate migraines, standard painkillers you can buy without a prescription often work, especially if you take them early. Ibuprofen and naproxen both reduce the inflammation involved in migraine pain. Acetaminophen (Tylenol) can also help, though it works differently since it targets pain signaling rather than inflammation.
Combination products designed specifically for migraines, like Excedrin Migraine, bundle three ingredients in a single dose: 250 mg of acetaminophen, 250 mg of aspirin, and 65 mg of caffeine. The caffeine isn’t just filler. It narrows blood vessels and helps the other two ingredients absorb faster. For many people, this combination outperforms any single ingredient alone.
One important caution: using any of these painkillers too frequently can cause a vicious cycle called medication overuse headache, where the drugs themselves start triggering more headaches. The general thresholds are no more than 14 days per month for simple painkillers like ibuprofen or acetaminophen, and no more than 9 days per month for combination products. If you’re regularly hitting those limits, that’s a signal to talk to a doctor about preventive treatment.
Prescription Medications for Acute Attacks
When over-the-counter options aren’t enough, prescription medications can offer stronger relief. Triptans have been the standard for decades. Oral sumatriptan, the most commonly prescribed triptan, produces a pain-free response within two hours in roughly 32% of patients (compared to about 10% for placebo), giving it a real-world therapeutic advantage of around 20 percentage points. Triptans work by narrowing blood vessels and blocking pain pathways specific to migraine. They’re most effective when taken early in an attack.
A newer class of medications called gepants works through a completely different mechanism, targeting a protein called CGRP that plays a central role in migraine pain. Their therapeutic advantage over placebo is smaller than triptans (around 10 percentage points in indirect comparisons), but they come with fewer side effects and don’t carry the blood vessel constriction that makes triptans off-limits for people with certain heart conditions. No head-to-head trials between triptans and gepants exist yet, so choosing between them involves weighing your specific health profile with your doctor.
Neuromodulation Devices
Several FDA-cleared devices now treat migraines by sending mild electrical signals to nerves involved in pain processing. These aren’t experimental gadgets. They have real clinical data behind them, and they’re worth knowing about if you want drug-free options or need to limit how much medication you take.
The Cefaly device stimulates the trigeminal nerve through a patch on your forehead. In clinical use, 29% of people using it during an attack were pain-free within one hour, and users experienced an average 59% reduction in migraine severity at the one-hour mark. When used daily for prevention, 38% of people with episodic migraine cut their monthly migraine frequency in half within three months, compared to only 12% using a sham device.
The gammaCore device stimulates the vagus nerve through the skin of your neck. About 30% of episodic migraine users had little to no pain within two hours of their first use. For prevention, 45% of users saw a 50% reduction in headache days over 12 weeks. These devices work by interfering with pain signals before they reach the brain, and over time, regular use may actually retrain pain-processing networks through neuroplasticity.
Supplements That Reduce Migraine Frequency
Three supplements have enough clinical evidence behind them that the American Headache Society recognizes their role in migraine prevention. None of them will stop a migraine in progress, but taken daily, they can reduce how often attacks happen.
- Magnesium oxide: 400 to 500 mg daily. Magnesium plays a role in nerve signaling, and people with migraines often have lower levels. This is one of the most widely recommended supplements for migraine prevention.
- Riboflavin (vitamin B2): 400 mg daily. This is far higher than the amount in a standard multivitamin. At this dose, riboflavin supports energy production in brain cells, which may raise the threshold for triggering a migraine.
- CoQ10: 300 mg daily. Research has found this dose reduces migraine frequency in adults, likely through a similar energy-metabolism pathway as riboflavin.
These supplements are generally well tolerated, though magnesium can cause loose stools at higher doses. Most people need to take them consistently for two to three months before seeing a clear benefit.
Lifestyle Habits That Lower Your Migraine Threshold
Neurologists use a framework called SEEDS to help patients build daily habits that reduce migraine frequency. Each letter stands for a modifiable factor, and together they address the most common migraine triggers.
Sleep. Irregular sleep is one of the most reliable migraine triggers. Going to bed and waking up at the same time every day, even on weekends, helps stabilize the brain’s internal clock. Both too little and too much sleep can provoke attacks.
Exercise. Aim for 30 to 60 minutes of moderate activity, three to five times a week. Consistent aerobic exercise reduces migraine frequency over time, though intense exercise during an attack will typically make the pain worse. Walking, swimming, and cycling are good starting points.
Eat. Skipping meals is a well-known trigger. Eating regular, balanced meals and staying hydrated throughout the day keeps your blood sugar and hydration levels stable. If you drink caffeine, keep your intake consistent from day to day rather than swinging between heavy consumption and none.
Diary. Tracking your migraines in a simple log (when they happen, what you ate, how you slept, what the weather was like) helps you spot personal patterns and triggers. It also gives your doctor much better information to work with when adjusting your treatment. Several free smartphone apps make this easy.
Stress. Stress itself triggers migraines, but so does the letdown after stress, which is why many people get attacks on weekends or the first day of vacation. Cognitive behavioral therapy, mindfulness practices, and biofeedback are all evidence-based approaches to stress management that have been shown to reduce migraine burden.
Knowing What You’re Dealing With
Not every bad headache is a migraine. Migraine attacks typically last 4 to 72 hours untreated (2 to 72 hours in children and adolescents) and have a distinct profile: pain on one side of the head, a pulsating or throbbing quality, moderate to severe intensity, and worsening with physical activity. Most people also experience nausea, sensitivity to light, or sensitivity to sound during an attack.
If your headaches don’t match this pattern, the treatment approach may be different. Tension headaches, cluster headaches, and sinus headaches each respond to different strategies. And if your headaches are new, sudden, or dramatically different from your usual pattern, that’s worth getting evaluated promptly.