Migraine treatment works on two fronts: stopping an attack once it starts and reducing how often attacks happen in the first place. The right approach depends on how frequent and severe your migraines are, but most people benefit from a combination of acute relief, lifestyle adjustments, and, for some, daily or monthly preventive therapy.
Stopping an Attack: Acute Treatment
Timing matters more than almost anything else when treating a migraine in progress. Taking medication early in the attack, ideally when pain is still mild, dramatically improves how well it works. Waiting until the pain peaks makes every option less effective.
For mild to moderate attacks, over-the-counter pain relievers like ibuprofen, naproxen, and aspirin are the standard first step. Acetaminophen also works for some people, though it’s generally considered less effective than anti-inflammatory options. These are inexpensive, widely available, and often enough for people whose migraines don’t reach severe intensity.
For moderate to severe attacks, triptans are the go-to prescription treatment. Seven different triptans are available, and they come in tablets, nasal sprays, and injections. Your provider may suggest trying more than one, since people often respond differently to each. Triptans work by narrowing blood vessels and blocking pain pathways specific to migraine. They also reduce nausea and sensitivity to light, which plain painkillers don’t always address.
When neither a triptan nor a painkiller alone does enough, the combination of sumatriptan with naproxen sodium is a well-studied option that provides longer-lasting relief and lower recurrence rates than either drug by itself. A newer class of medications called gepants blocks the pain-signaling molecule CGRP and can treat an active attack without the blood vessel narrowing that makes triptans off-limits for people with certain heart conditions. One gepant, rimegepant (Nurtec), can double as both a rescue and preventive medication.
The Medication Overuse Trap
Using acute medications too frequently can paradoxically make headaches worse and more frequent. This is called medication overuse headache, and it’s one of the most common reasons migraines become chronic. The thresholds are specific: taking simple painkillers like ibuprofen or acetaminophen on 15 or more days per month, or taking triptans, opioids, or combination analgesics on 10 or more days per month, puts you at risk. If you find yourself reaching for medication that often, it’s a signal to explore preventive treatment rather than continuing to treat each attack individually.
When To Start Prevention
Not everyone with migraines needs daily or monthly preventive therapy. The general guidance is straightforward: prevention is recommended if you have at least six headache days per month, or at least four headache days that impair your ability to function, or three or more that are severe enough to put you in bed. Prevention should be considered even at lower frequencies if the attacks significantly disrupt your work or daily life. If you have fewer than four headache days a month and they don’t impair you much, acute treatment alone is usually sufficient.
Preventive Medications
Several classes of medication can reduce migraine frequency, and the best choice depends on your other health conditions, side effect tolerance, and preferences around pills versus injections.
Blood pressure medications are among the most strongly recommended options. Candesartan and telmisartan (both originally developed for hypertension) carry the highest level of evidence for episodic migraine prevention. Propranolol, a beta-blocker, and lisinopril are also used, though with somewhat less robust evidence. These can be a good fit if you also have high blood pressure.
Topiramate, an anti-seizure medication, is widely prescribed for migraine prevention and works for both episodic and chronic migraine. It can cause cognitive side effects like word-finding difficulty and tingling in the hands, which leads some people to stop taking it. Valproate is another anti-seizure option but carries significant risks during pregnancy.
CGRP-Targeting Therapies
The newest and most migraine-specific preventive treatments target CGRP, a molecule heavily involved in migraine pain signaling. Three injectable antibodies (erenumab, fremanezumab, and galcanezumab) are self-administered as a monthly shot at home. A fourth, eptinezumab, is given as an intravenous infusion every three months at a clinic. In clinical trials, these injections reduced migraine days by about 3 to 4 days per month for people with episodic migraine and 5 to 6 days per month for those with chronic migraine. After a year of treatment, roughly 53% to 74% of patients experienced at least a 50% reduction in monthly migraine days, depending on the specific medication.
These therapies have minimal side effects and no known drug interactions, which sets them apart from older preventive options. The main barrier is cost, though insurance coverage has expanded considerably since they first launched. For people who prefer pills over needles, atogepant (Qulipta) is an oral CGRP-blocking preventive taken daily.
Supplements Worth Trying
Magnesium has enough evidence behind it that clinical guidelines suggest it for migraine prevention, though the recommendation is modest. A clinical trial testing a combination of 600 mg magnesium, 400 mg riboflavin (vitamin B2), and 150 mg coenzyme Q10 daily found that migraine days dropped from about 6.2 to 4.4 per month over the treatment period, compared to 6.2 to 5.2 with placebo. While that difference didn’t reach statistical significance for frequency alone, pain intensity was significantly reduced, and patients rated the supplement notably more effective than placebo on quality-of-life measures. These supplements are generally safe and inexpensive, making them a reasonable addition to other treatments, especially if you prefer to start with something low-risk.
Lifestyle Factors That Move the Needle
Skipping meals, particularly breakfast, is consistently linked to more frequent migraines. Eating at regular intervals helps stabilize blood sugar and may reduce the brain’s vulnerability to an attack. Staying well-hydrated also matters. While the exact amount varies by person, a practical target is 9 to 13 cups of water per day, adjusted for your activity level and climate.
Sleep is one of the most powerful and underused migraine tools. Poor sleep and irregular sleep schedules are reliable triggers for many people. The evidence-based recommendations are specific: keep your bedroom dark, cool, and quiet; go to bed at the same time each night (including weekends); keep screens out of the bedroom; and reserve the bed for sleep only. These changes alone can meaningfully reduce attack frequency for people whose migraines are partly sleep-driven.
Understanding Food Triggers
Food triggers are real but highly individual. The common advice to avoid aged cheese, red wine, and processed meats has some biochemical basis. Many trigger foods contain compounds that interfere with enzymes your body uses to break down neurotransmitters like dopamine. When those enzymes are blocked, neurotransmitter levels can spike and set off a migraine cascade.
Cheese, chocolate, citrus fruits, red wine, coffee, and tea all contain compounds that inhibit these enzymes. Histamine-rich foods like fermented products, tomatoes, spinach, eggplant, and nuts are also common culprits. Condiments like soy sauce, ketchup, mustard, and mayonnaise contain both dopamine-related and histamine-related compounds. Rather than eliminating everything on a generic list, a more practical approach is keeping a food diary to identify your personal triggers, since most people react to only a few specific foods rather than the entire catalog.
Neuromodulation Devices
Three FDA-cleared devices offer drug-free options for both treating and preventing migraines. These won’t replace medication for most people with frequent or severe attacks, but they can reduce how much medication you need.
- Cefaly is a small device worn on the forehead that stimulates branches of the trigeminal nerve with mild electrical pulses. For prevention, you use it for 20 minutes daily. During an attack, sessions can last up to 60 minutes.
- eNeura delivers a single pulse of magnetic stimulation to the back of the head, which is thought to interrupt the abnormal brain wave activity that drives migraine. For prevention, you apply 4 pulses twice a day. For acute treatment, 3 to 4 pulses at the onset of an attack.
- gammaCore stimulates the vagus nerve through the skin of the neck. Preventive use involves two 2-minute stimulations twice daily. For an active migraine, the same dose can be repeated as needed.
These devices have few side effects beyond mild skin irritation or tingling at the application site. They’re prescription devices, so you’ll need a provider to authorize one, and insurance coverage varies. They’re particularly useful for people who can’t tolerate medications, are pregnant, or want to reduce their reliance on drugs.