The best approach to a migraine depends on how often you get them and how severe they are. For an occasional migraine, over-the-counter pain relievers taken early can be surprisingly effective. For frequent or debilitating attacks, prescription medications and preventive strategies make a significant difference. Here’s what works, from the simplest options to the most advanced.
Over-the-Counter Pain Relievers
For mild to moderate migraines, standard pain relievers are a reasonable first step, but dosing matters more than most people realize. The effective dose for migraine is often higher than what you’d take for a regular headache. Most studies showing benefit used 400 mg of ibuprofen, while naproxen sodium works at 500 mg (with 825 mg being slightly more effective). Aspirin requires a full 1,000 mg dose to reliably help with migraine pain, though at that level it carries more risk of stomach irritation.
The single most important thing with any of these is timing. Taking them within the first 20 to 30 minutes of a migraine, before the pain escalates, dramatically improves how well they work. Once a migraine is fully established, over-the-counter options become much less reliable. If you find yourself needing pain relievers more than two or three days a week, that pattern can actually cause rebound headaches, making the cycle worse.
Prescription Medications for Acute Attacks
When over-the-counter options aren’t enough, prescription medications target the specific brain mechanisms behind migraines rather than just dulling pain generally.
Triptans have been the gold standard for acute migraine treatment for decades. They narrow blood vessels and block pain signals in the brain. A large network analysis of migraine treatments found that four different triptans had the most favorable efficacy profiles of any acute migraine drugs studied, outperforming newer branded products. Pain-free rates at two hours vary depending on the specific triptan, but they consistently outperform both placebo and standard pain relievers for moderate to severe attacks.
A newer class of medications called gepants works differently, blocking a protein called CGRP that plays a central role in migraine pain. In a head-to-head comparison, the pain-free rate at two hours was 31% for one gepant versus 35% for a triptan, a small and statistically insignificant difference. Where gepants have a real advantage is tolerability: they cause fewer side effects in practice and don’t carry the cardiovascular warnings that come with triptans. If you have heart disease, uncontrolled high blood pressure, or a history of stroke, gepants may be an option when triptans are not.
What Helps During an Attack
Beyond medication, several things can reduce a migraine’s intensity once it starts. A cold pack or ice wrap applied to the forehead or the back of the neck narrows blood vessels and provides a numbing effect that many people find helpful within 15 to 20 minutes. Lying down in a dark, quiet room matters because migraines make the brain hypersensitive to light and sound. Removing those inputs isn’t just about comfort; it reduces the sensory overload that actively fuels the attack.
Caffeine deserves a mention because it genuinely helps, but with a caveat. It improves absorption of pain relievers and constricts blood vessels on its own, which is why it’s an ingredient in several migraine-specific over-the-counter formulas. However, daily caffeine use creates dependence, and withdrawal itself triggers migraines. If you don’t regularly consume caffeine, a cup of coffee or tea at the onset of a migraine can boost the effect of whatever pain reliever you take. If you’re already a heavy caffeine user, adding more won’t help much.
Ginger is one natural remedy with actual clinical data behind it. In one study, a 250 mg capsule of ginger powder taken at the onset of a migraine reduced pain by a nearly identical amount as a standard-dose triptan. The evidence base is still small, so it’s not a guaranteed substitute, but it’s a low-risk option worth trying alongside other treatments.
Preventing Migraines Before They Start
If you’re getting four or more migraine days per month, prevention becomes more important than just treating each attack. Three supplements have solid enough evidence that the American Headache Society specifically recommends them for migraine prevention.
- Magnesium oxide: 400 to 500 mg daily. Magnesium helps regulate nerve signaling, and people with migraines tend to have lower levels. This is one of the best-supported supplements for reducing migraine frequency.
- Riboflavin (vitamin B2): 400 mg daily. This is far higher than the amount in a standard multivitamin. At this dose, riboflavin improves how your cells produce energy, which appears to raise the threshold for triggering a migraine.
- CoQ10: 300 mg daily. Research shows this dose can reduce how often migraines occur in adults.
These supplements generally take six to eight weeks of consistent daily use before you notice a difference. They’re not rescue treatments; they work by gradually changing your brain’s susceptibility to migraine triggers.
CGRP Injections for Frequent Migraines
For people with chronic or high-frequency migraines who haven’t responded well to other preventive approaches, a class of injectable medications targets CGRP, the same protein involved in migraine pain signaling. Four of these medications are currently FDA-approved, with the first arriving in 2018. They’re given as injections under the skin (or in one case, as an IV infusion) on a monthly or quarterly schedule.
These medications represent a fundamentally different approach because they were designed specifically for migraine from the ground up, unlike older preventive drugs that were borrowed from blood pressure or seizure treatment. Many people on these injections see their monthly migraine days cut in half or more. Side effects tend to be mild, mostly injection-site reactions like redness or discomfort.
Neuromodulation Devices
Several FDA-cleared devices use mild electrical stimulation to interrupt migraine signals without any medication at all. These work for both treating active migraines and preventing future ones.
One device worn on the forehead (Cefaly) stimulates the nerve most involved in migraine pain. For acute use, 29% of users were pain-free after one hour of treatment, and users experienced an average 59% reduction in migraine severity. When used daily for prevention, 38% of users saw their migraine frequency drop by half within three months, compared to 12% with a sham device.
A handheld device applied to the neck (gammaCore) stimulates the vagus nerve. Nearly 30% of users with episodic migraine had little to no pain within two hours of first use. For prevention, 45% of users achieved a 50% reduction in headache days over twelve weeks.
These devices appeal to people who want to minimize medication use, experience side effects from drugs, or need something safe to combine with existing treatments. They require a prescription but have essentially no systemic side effects since they don’t introduce any chemical into your body.
Tracking Your Triggers
Migraines have identifiable triggers in most people, but they’re surprisingly individual. Common ones include irregular sleep, skipped meals, dehydration, alcohol (especially red wine), hormonal shifts around menstruation, weather changes, and stress. The tricky part is that triggers often stack. You might tolerate one trigger on its own but get a migraine when two or three overlap, like poor sleep plus a skipped meal plus a stressful day.
Keeping a simple headache diary for two to three months, noting what you ate, how you slept, your stress level, and for women, where you are in your cycle, reveals patterns that aren’t obvious in the moment. Once you know your personal trigger profile, you can make targeted changes rather than trying to avoid everything on a generic list.