For most people, over-the-counter painkillers are the first thing to try for a migraine, but they work less often than you might expect. Ibuprofen is rated helpful only about 42% of the time, and acetaminophen just 37%. If those aren’t cutting it, there’s a wide range of prescription medications, supplements, and even wearable devices that can treat attacks or prevent them from happening in the first place.
Over-the-Counter Pain Relief
The three most common OTC choices are ibuprofen, acetaminophen, and the combination of acetaminophen, aspirin, and caffeine (sold as Excedrin). That combination works slightly better than ibuprofen alone, helping roughly half the time in patient-reported data published by Harvard Health. These numbers may sound underwhelming, but timing matters. Taking any of these at the very first sign of a migraine, before the pain escalates, generally improves your odds.
Naproxen is another OTC anti-inflammatory worth trying, especially if your migraines tend to last a long time. It stays active in your body longer than ibuprofen, so it can help prevent the pain from returning later in the day. If one OTC option hasn’t worked for you, switching to a different one is reasonable before moving to prescription treatments.
Triptans: The Standard Prescription Option
Triptans have been the go-to prescription treatment for acute migraine attacks for decades. They work by narrowing blood vessels around the brain and blocking pain signals along the trigeminal nerve, one of the main pathways involved in migraine pain. Common options include sumatriptan and rizatriptan, which come in tablets, nasal sprays, and injections.
They’re significantly more effective than OTC painkillers for moderate to severe migraines, and most people notice relief within two hours. The main limitation is that triptans constrict blood vessels, which means they’re not safe for people with a history of heart attack, stroke, or uncontrolled high blood pressure. If that applies to you, newer drug classes (covered below) were designed specifically to fill that gap.
Newer Acute Treatments: Gepants and Ditans
Two newer drug classes have expanded options considerably, especially for people who can’t take triptans.
Gepants block a protein called CGRP that plays a central role in triggering migraine attacks. Ubrogepant and rimegepant are oral tablets approved for treating an attack once it starts, and zavegepant is a nasal spray that works the same way. A key advantage of gepants is that they don’t constrict blood vessels, making them an option for people with cardiovascular risk factors. Rimegepant is particularly versatile because it’s also approved for prevention when taken on a regular schedule.
Lasmiditan takes yet another approach. It targets a different serotonin receptor than triptans, one that calms pain signaling without affecting blood vessels. In studies, it showed no constriction of coronary or carotid arteries, which is why its labeling doesn’t carry the heart-related warnings that triptans do. The tradeoff is that it can cause dizziness and drowsiness, so you shouldn’t drive for at least eight hours after taking it.
Preventive Medications
If you’re getting four or more migraine days per month, or your attacks are severe enough to regularly disrupt your life, a daily preventive medication can reduce how often they hit. The goal is at least a 50% reduction in monthly migraine days.
Beta-blockers like propranolol and metoprolol are the most commonly prescribed preventive class. They were originally developed for blood pressure and heart conditions, but they reliably reduce migraine frequency. In pooled clinical data, metoprolol cut roughly one extra headache per month compared to placebo. Topiramate, an anti-seizure medication, is another well-studied option. A large Cochrane review found it was twice as likely as placebo to cut migraine frequency by half or more. Both classes can cause side effects (fatigue with beta-blockers, tingling or brain fog with topiramate), so finding the right fit sometimes takes a round or two of trial and adjustment.
The CGRP monoclonal antibodies are a newer preventive option given as monthly or quarterly injections. Four are currently approved: erenumab, fremanezumab, galcanezumab, and eptinezumab. In a six-month trial, erenumab reduced monthly migraine days by about 3.2 to 3.7 days from a baseline of roughly 8 days per month. These tend to have fewer side effects than older preventives, though injection-site reactions and constipation are common.
Supplements That Have Evidence
Three supplements have enough clinical backing that the American Headache Society includes them in prevention discussions:
- Magnesium oxide (400 to 500 mg daily): Studies consistently find lower magnesium levels in people with migraines. At adequate levels, magnesium helps calm excitatory brain activity that can trigger attacks. Magnesium citrate is another oral form that’s generally better absorbed, though it’s more likely to cause loose stools.
- Riboflavin/vitamin B2 (400 mg daily): Riboflavin supports energy production inside brain cells. Imaging studies suggest that people with migraines may have impaired energy metabolism in the brain, and riboflavin appears to help correct that imbalance.
- CoQ10 (300 mg daily): This compound also supports cellular energy production. Research has found that 300 mg per day can reduce migraine frequency in adults.
These supplements are generally well tolerated and can be combined with prescription treatments. They typically take two to three months of consistent daily use before you see results, so patience is important.
Neuromodulation Devices
Several FDA-cleared wearable devices treat migraines without medication. Nerivio is a smartphone-controlled device worn on the upper arm that uses electrical stimulation to activate the body’s own pain-dampening system. You apply it for 30 to 45 minutes within an hour of a migraine starting, and the electrical signals on your arm trigger a response that inhibits pain elsewhere in the body, including your head.
Other cleared devices include Cefaly, a forehead-worn device that stimulates the trigeminal nerve, and GammaCore, a handheld device placed on the neck that stimulates the vagus nerve. These are worth considering if you want to reduce how much medication you take, if you’re pregnant, or if you haven’t responded well to drugs.
Migraine Treatment During Pregnancy
Pregnancy significantly narrows your safe options. According to ACOG guidelines, acetaminophen and caffeine are first-line treatments. NSAIDs like ibuprofen and naproxen can be used cautiously in the second trimester but should be avoided in the third trimester and limited in the first. Sumatriptan falls into a “cautious use” category where the benefits need to be weighed against the risks.
Ergotamine, an older migraine drug, should be avoided entirely during pregnancy because it can trigger uterine contractions. The newer gepants and lasmiditan lack human pregnancy data and aren’t currently recommended. Nonpharmacologic strategies become especially important: consistent sleep, adequate hydration, stress management, acupuncture, and biofeedback all have supporting evidence and carry no fetal risk.
Avoiding Rebound Headaches
One of the most important things to know about migraine treatment is that using it too often can backfire. Medication overuse headache is a cycle where frequent painkiller use actually increases your headache frequency over time, creating a need for more medication. The thresholds to stay under: use OTC painkillers fewer than 14 days per month, and triptans or combination pain relievers no more than 9 days per month. If you’re regularly bumping up against those limits, that’s a strong signal to talk with a provider about adding a preventive treatment instead of relying on acute relief alone.