When a migraine hits, your priority is to stop the pain as quickly as possible while creating conditions that let your brain recover. That means taking the right medication at the right dose, controlling your environment, and knowing what steps prevent the next attack. Here’s a practical walkthrough of what to do during a migraine and how to reduce their frequency over time.
Take Pain Relief Early and at the Right Dose
The single most important thing you can do during a migraine is take medication within the first hour of pain. Waiting until the headache peaks makes every option less effective. For over-the-counter options, the doses that actually work in clinical studies are higher than what many people take: 1,000 mg of acetaminophen, 400 mg of ibuprofen, or 500 to 825 mg of naproxen. If you’ve been splitting a 200 mg ibuprofen tablet and wondering why it barely helps, that’s likely why.
Naproxen has an advantage if your migraines tend to last a long time, since it stays active in your body longer than ibuprofen. Acetaminophen works best for milder attacks. Combination products that pair a painkiller with caffeine can also be effective, but they carry a higher risk of rebound headaches with frequent use.
If over-the-counter medications don’t provide meaningful relief, prescription options called triptans are the standard next step. These work differently from regular painkillers. They change blood circulation in your brain and alter how your brain processes pain signals, targeting the migraine mechanism itself rather than just dulling the pain. They don’t prevent migraines, but they can stop one that’s already underway. Several newer prescription options work by blocking a specific pain-signaling molecule involved in migraines, offering an alternative for people who can’t tolerate triptans.
Control Your Environment Immediately
While you wait for medication to kick in, your surroundings matter. Move to a dark, quiet room if you can. Migraine pain is worsened by light and sound because your brain is in a state of heightened sensitivity during an attack. Even normal room lighting can intensify the pain. If you can’t get to a dark room, sunglasses or a sleep mask help.
Apply a cold compress or ice pack to your forehead or the back of your neck. Cold reduces blood flow to the area and can take the edge off throbbing pain. Keep it on for 15 to 20 minutes at a time with a cloth barrier to protect your skin. Drink a full glass of water, too. Dehydration won’t cause a migraine on its own, but it makes an existing one harder to shake. Research from the Netherlands found that drinking around seven glasses of water a day reduced headache pain for many patients.
Lie still. Physical activity, even walking or climbing stairs, makes migraine pain worse. This isn’t just perception. Worsening with routine movement is one of the defining features of migraine as a condition.
Watch Your Medication Use Closely
Here’s a trap many people with frequent migraines fall into: taking painkillers so often that they start causing headaches themselves. This is called medication overuse headache, and it’s surprisingly common. Your risk goes up if you use triptans or combination painkillers 10 or more days a month, or simple painkillers like ibuprofen or acetaminophen more than 15 days a month. A safe rule of thumb is to keep over-the-counter painkiller use under 14 days a month and triptan use under 9 days a month.
If you find yourself reaching for medication that often, it’s a signal that you need a preventive strategy rather than just treating each attack as it comes.
Know When Migraines Need Preventive Treatment
If you’re getting four or more headache days a month, the American Headache Society recommends considering preventive treatment. This is a shift from treating individual attacks to taking something regularly that reduces how often migraines occur in the first place. Several classes of medications originally developed for blood pressure, depression, or seizures turn out to be effective at reducing migraine frequency. Your doctor can help choose the right fit based on your other health needs.
Three supplements have enough evidence behind them to be worth trying alongside other prevention strategies. Magnesium oxide at 400 to 500 mg daily is recommended by the American Headache Society. Riboflavin (vitamin B2) at 400 mg daily and CoQ10 at 300 mg daily have both shown the ability to reduce migraine frequency in research studies. These work by supporting energy production in brain cells, which appears to be impaired in people who get migraines. They take several weeks of consistent use before you notice a difference, so don’t expect overnight results.
Track Your Triggers With a Diary
Migraine triggers are highly individual. Research published in The Lancet Neurology confirms that the relationship between lifestyle factors and migraine attacks varies significantly from person to person. What reliably triggers one person’s migraines may have no effect on another. This is why general trigger lists are only a starting point. The real answers come from tracking your own patterns.
Keep a simple daily diary noting your sleep quality and duration, stress level, meals and any skipped meals, caffeine and alcohol intake, weather changes, menstrual cycle (if applicable), and whether you got a migraine that day. After two to three months, patterns usually emerge. Common culprits include irregular sleep schedules (both too little and too much sleep), skipping meals, high stress followed by a sudden drop in stress (the so-called “let-down” migraine on weekends or vacations), and specific foods or drinks. The goal isn’t to avoid everything on a trigger list you found online. It’s to identify your specific triggers so you can make targeted changes.
Wearable Devices as an Alternative
Several FDA-cleared devices now offer drug-free options for both treating and preventing migraines. These use mild electrical or magnetic pulses to alter nerve signaling in ways that interrupt migraine pain. The Cefaly device, worn on the forehead, stimulates the trigeminal nerve and is cleared for both acute and preventive use. In clinical trials, two hours of treatment during an attack was superior to a placebo for achieving pain freedom.
A device called Nerivio, worn on the upper arm, uses remote electrical stimulation and is cleared for people 12 and older. Single-pulse magnetic stimulation devices have shown particular promise for migraine with aura, and one long-term UK study found that regular use reduced the rate of medication overuse headache from 52% of participants down to 8% over 12 months.
These devices work best as part of a broader plan rather than a standalone solution. They’re especially appealing if you’re hitting the limits on how often you can safely use medication, or if you prefer to minimize drug use.
Headaches That Need Emergency Attention
Most migraines, while miserable, are not dangerous. But certain headache features signal something more serious. The most critical red flag is a thunderclap headache: a severe headache that reaches maximum intensity within seconds. This pattern has a greater than 40% probability of being caused by serious brain pathology like bleeding, and it requires immediate emergency evaluation.
Other warning signs include headache with fever and a stiff neck, any new neurological symptoms like weakness, vision loss, confusion, or difficulty speaking, headache after a head injury, a brand-new headache pattern starting after age 50, and headache with swelling of the optic nerve (which a doctor can see during an eye exam). If your migraines have been consistent for years and follow the same pattern, that’s reassuring. If something about a headache feels fundamentally different from your usual attacks, that difference itself is worth getting checked out.