The most effective over-the-counter option for most migraines is a combination of acetaminophen, aspirin, and caffeine, sold under brands like Excedrin Migraine. It has strong clinical evidence as a first-line treatment and works best when taken early in an attack. If that’s not an option, ibuprofen at 400 mg or naproxen at 500 mg are solid alternatives. Beyond these, several prescription medications and non-drug tools can help, especially if OTC options aren’t cutting it.
Over-the-Counter Pain Relievers
Ibuprofen is one of the most studied OTC options for acute migraine. At 400 mg, a large Cochrane review found that about one in three people will drop from moderate or severe pain to mild pain within two hours. Complete pain relief within two hours happens for roughly one in seven people. That may not sound dramatic, but it’s a meaningful edge over placebo, and taking it at the first sign of a migraine improves those odds.
Naproxen at 500 mg is another anti-inflammatory option, though it’s somewhat less effective than ibuprofen for fast relief. A higher dose of 825 mg may work slightly better. Naproxen’s main advantage is its longer duration of action, which can help if your migraines tend to linger or come back later in the day.
The acetaminophen, aspirin, and caffeine combination outperforms either ingredient alone. The caffeine helps your body absorb the pain relievers faster and narrows blood vessels in the brain, adding its own pain-relieving effect. This combination is considered a first-line migraine treatment and is particularly useful if you can’t take prescription options that affect blood vessels.
Prescription Triptans
If OTC medications don’t provide enough relief, triptans are the most commonly prescribed class of migraine-specific drugs. Seven different triptans are available, including sumatriptan (the most widely known), eletriptan, and almotriptan. They come in pills, nasal sprays, and injections, which matters because nausea and vomiting can make swallowing a pill difficult mid-attack.
Triptans work by activating specific serotonin receptors in the brain. Some of these receptors control blood vessel width, reducing the dilation thought to contribute to migraine pain. Others quiet the trigeminal system, which is the brain’s main pain-signaling pathway during a migraine. The result is targeted relief that OTC painkillers can’t always match.
One important limitation: triptans constrict blood vessels, so they’re contraindicated if you have coronary artery disease, a history of stroke or transient ischemic attack, peripheral vascular disease, or uncontrolled high blood pressure. If any of those apply to you, your doctor will steer you toward a different option.
Newer Prescription Alternatives
A class of drugs called gepants blocks a protein called CGRP that spikes during migraine attacks and drives pain and inflammation. Three are currently approved for acute migraine treatment: rimegepant, ubrogepant, and zavegepant (available as a nasal spray). Gepants don’t constrict blood vessels, making them a viable choice for people with cardiovascular risk factors who can’t use triptans. They can also be used for prevention in some cases, giving them a dual role that triptans lack.
Another option is lasmiditan, the first in a class called “ditans.” It targets a different serotonin receptor than triptans and has no blood vessel-narrowing effect. It was specifically studied in patients with cardiovascular conditions that rule out triptan use. The trade-off is that it can cause dizziness and sedation, so you shouldn’t drive for at least eight hours after taking it.
Neuromodulation Devices
Several FDA-cleared devices offer drug-free acute migraine treatment. These use mild electrical or magnetic pulses to interrupt pain signaling, and they can be used alongside medications.
- Cefaly is a forehead-worn device that stimulates the trigeminal nerve. A one- to two-hour session at migraine onset has been shown to achieve two-hour pain freedom better than a sham device.
- Nerivio is a smartphone-controlled arm band that uses remote electrical stimulation. Treatment is 45 minutes at migraine onset. Clinical trials showed it achieved two-hour pain freedom for both episodic and chronic migraine.
- SAVI Dual delivers single-pulse magnetic stimulation to the brain. You apply four sequential pulses at migraine onset and can repeat as needed with no daily limit. It showed the strongest results for migraine with aura.
- Relivion MG stimulates nerves across the forehead and back of the head simultaneously. A 60-minute session achieved both pain freedom and relief from symptoms like light sensitivity and nausea in clinical trials.
These devices work best for people who want to reduce how many medications they take, experience frequent migraines that push them toward overuse limits, or simply prefer a non-drug approach.
Supplements for Prevention
Magnesium is the best-studied supplement for reducing migraine frequency. Three out of four placebo-controlled trials found modest reductions in migraine days at doses up to 600 mg per day, with some researchers recommending 300 mg twice daily. Because these doses exceed the normal upper intake level, this is one supplement worth discussing with your doctor to avoid digestive side effects like diarrhea.
Riboflavin (vitamin B2) at 400 mg daily and Coenzyme Q10 are also commonly recommended for migraine prevention, though the evidence is less robust than for magnesium. These supplements won’t stop a migraine that’s already started, but taken consistently over two to three months, they can reduce how often attacks occur.
Avoiding Medication Overuse Headaches
One of the most important things to know about treating migraines is that taking acute medications too often can actually make your headaches worse and more frequent. This is called medication overuse headache, and it’s surprisingly common.
The thresholds are lower than most people expect. Simple painkillers like ibuprofen or acetaminophen should be used fewer than 15 days per month. Triptans and combination pain relievers have a stricter limit of no more than nine days per month. If you find yourself reaching for headache medicine more than twice a week on a regular basis, that’s a signal to explore preventive treatment rather than continuing to rely on acute relief alone. Preventive options include daily medications, monthly CGRP-blocking injections, supplements, or neuromodulation devices, all aimed at reducing how many migraines you get in the first place.
Timing Matters More Than Most People Realize
Whichever treatment you choose, taking it early in the attack dramatically improves its effectiveness. During a migraine, the stomach slows down, which delays absorption of oral medications. This is one reason why nasal sprays and injections sometimes work better than pills for people with severe nausea. If nausea is a major part of your migraines, pairing your pain reliever with an anti-nausea medication can help both symptoms and improve how well the pain reliever is absorbed.
Keeping your preferred treatment accessible, whether it’s a medication, device, or both, so you can use it within the first 20 to 30 minutes of symptoms gives you the best shot at stopping the attack before it peaks.