If you’re in the middle of a migraine, the most effective first steps are to take pain relief early, reduce light and sound around you, and rest. Timing matters: treating a migraine within the first 30 to 60 minutes of pain gives medication the best chance of working. Here’s a practical walkthrough of what to do during an attack and how to recover afterward.
Take Pain Relief as Early as Possible
Over-the-counter options work well for mild to moderate migraines when taken promptly. Ibuprofen at 400 mg, naproxen at 500 mg, or acetaminophen at 1,000 mg are all supported by clinical evidence. Naproxen at a slightly higher dose of 825 mg may be marginally more effective, though the standard 500 mg dose is a reasonable starting point. If you combine a pain reliever with caffeine (a cup of coffee or tea), it can boost absorption and enhance the effect.
One important limit to know: using simple pain relievers like ibuprofen or aspirin on 15 or more days per month, or prescription migraine medications on 10 or more days per month, can lead to a cycle of rebound headaches. If you find yourself reaching for medication that often, it’s a signal to talk to a provider about a preventive approach instead.
Control Your Environment
Light and sound amplify migraine pain. If you can, move to a dark, quiet room. If that’s not possible, dim your screen brightness, put on sunglasses, or use earplugs to lower sensory input as much as your situation allows. The goal is to reduce the stimulation your brain is struggling to process.
Temperature therapy on your head or neck can also help. Ice packs have a numbing effect that many people find more useful during the pain phase, while a warm compress or a hot shower can loosen tight neck and shoulder muscles that often accompany an attack. Try both and see which your body responds to. Lie down if you can, even for 20 to 30 minutes. Sleep is one of the most reliable ways a migraine resolves.
Prescription Options for Stronger Attacks
If over-the-counter medications aren’t cutting it, several prescription categories exist for acute migraine treatment. Triptans (such as sumatriptan, rizatriptan, and eletriptan) have been the standard for decades and remain among the most effective options. In a large network meta-analysis published in the BMJ comparing 17 different medications, eletriptan consistently ranked among the top performers for achieving pain freedom within two hours.
A newer class of medications called gepants (rimegepant and ubrogepant) works differently and doesn’t carry the blood vessel constriction concerns that make triptans off-limits for people with certain heart conditions or uncontrolled high blood pressure. Another option, lasmiditan, also avoids that issue. These newer drugs tend to cause fewer side effects, though they may not work quite as fast for some people. If you haven’t discussed a rescue medication with your doctor and you get migraines regularly, it’s worth having one on hand so you’re not relying solely on over-the-counter options.
Wearable Devices That Treat Migraines
Several FDA-cleared devices now offer drug-free acute migraine treatment. The Cefaly device, a small electrode worn on the forehead, stimulates the trigeminal nerve and has shown benefit for two-hour pain freedom during an attack. Nerivio, a device worn on the upper arm, uses remote electrical stimulation and is cleared for both acute and preventive use in people 12 and older. A single-pulse magnetic stimulation device called SAVI Dual has shown particular promise for migraines that include aura, and in one long-term UK study, it reduced the number of monthly migraine days and cut medication overuse from 52% of participants at the start to just 8% after 12 months.
These devices aren’t miracle solutions, and results vary. But they can be useful additions, especially if you’re trying to reduce how often you take medication or if medications cause side effects you want to avoid.
Know the Four Phases of an Attack
Understanding where you are in a migraine can help you respond more effectively. Most migraines move through up to four phases, though not everyone experiences all of them.
- Prodrome can start hours or even days before the headache. You might notice food cravings, yawning, irritability, neck stiffness, or unusual fatigue. Recognizing these early warnings gives you a window to take medication before pain sets in, which dramatically improves how well it works.
- Aura affects roughly one in four people with migraines. It typically builds over five minutes and lasts up to an hour, though in about 20% of cases it extends longer. Visual disturbances like zigzag lines or blind spots are the most common type, but tingling, numbness, or difficulty speaking can also occur.
- Headache phase lasts anywhere from several hours to three days. The pain is usually on one side, pulsing, and worsened by physical activity. Nausea, light sensitivity, and sound sensitivity are hallmarks.
- Postdrome is the recovery phase, sometimes called the “migraine hangover.” It varies in length and brings its own set of challenges.
Recovering After the Pain Stops
When the headache fades, you may feel drained, foggy, or emotionally flat. This postdrome phase is real and common, not a sign that something else is wrong. Your brain has just gone through an intense neurological event.
During recovery, stay hydrated and eat balanced meals even if your appetite is still off. Light activity like gentle stretching or a short walk is fine, but pushing through strenuous exercise or a demanding workday can actually trigger another attack before your brain has fully recovered. Give yourself permission to take it easy for the rest of the day if possible. Most people feel fully back to normal within 24 to 48 hours of the headache resolving.
Red Flags That Need Emergency Care
Most migraines, while miserable, are not dangerous. But certain headache symptoms signal something that requires immediate medical attention. Go to the emergency room if you experience:
- A sudden, explosive headache that reaches maximum intensity within seconds (called a “thunderclap headache”), which has a greater than 40% chance of indicating a serious problem like bleeding in the brain
- Headache with fever plus a stiff neck or confusion, which may point to an infection like meningitis
- A new headache with vision changes, eye pain, or halos around lights
- Headache with impaired consciousness, weakness on one side of the body, or difficulty speaking that doesn’t resolve like a typical aura
If your migraine pattern changes significantly, if attacks become more frequent or more severe over weeks, or if a headache feels fundamentally different from your usual migraines, that also warrants a medical evaluation rather than just riding it out at home.