For a migraine that’s already started, the most effective over-the-counter option is a combination of aspirin, acetaminophen, and caffeine (sold as Excedrin Migraine), which works about half the time. If that’s not enough, prescription medications like triptans or newer CGRP-blocking pills offer significantly better relief. What works best depends on how severe your migraines are, how often they happen, and how quickly you treat them.
Over-the-Counter Pain Relievers
Most people reach for whatever is in the medicine cabinet first, and that’s reasonable for mild to moderate migraines. But not all OTC options perform equally. A large study covered by Harvard Health found that ibuprofen (Advil, Motrin), the most commonly used OTC migraine treatment, was rated helpful only 42% of the time. Acetaminophen (Tylenol) performed worst at 37%. The combination of aspirin, acetaminophen, and caffeine (Excedrin) did slightly better, working about half the time.
Those numbers might seem discouraging, but timing matters enormously. Taking any pain reliever at the very first sign of a migraine, before the pain escalates, dramatically improves its chances of working. Once a migraine is fully established and you’re already nauseated or sensitive to light, an OTC pill has a much harder job. If you feel the early warning signs (a subtle shift in energy, visual changes, neck tightness), that’s the window to act.
The caffeine in combination products like Excedrin isn’t just filler. It helps your body absorb the other ingredients faster and constricts blood vessels that dilate during a migraine. If you only have plain ibuprofen or aspirin on hand, washing it down with a small cup of coffee can mimic some of that effect.
Triptans: The Standard Prescription Option
When OTC medications consistently fall short, triptans are the most widely prescribed step up. Seven different triptans exist, and they all work by narrowing blood vessels around the brain and reducing inflammation in the pain pathways that drive migraines. Sumatriptan (Imitrex) is the most commonly prescribed and comes in the most forms: a pill, a nasal spray, and an injection. Rizatriptan (Maxalt) is another popular choice, available as a tablet that dissolves on the tongue, which is useful when nausea makes swallowing a pill difficult.
The injectable form of sumatriptan works fastest, typically within 15 to 20 minutes, because it bypasses the digestive system entirely. Nasal sprays fall in the middle, while pills take longer but are the most convenient. Your doctor will typically start you on one triptan, and if it doesn’t work well or causes side effects, you can try a different one. People often respond differently to different triptans, so a poor result with one doesn’t mean the whole class is off the table.
Triptans do have limitations. They’re not recommended for people with cardiovascular disease or uncontrolled high blood pressure because of their effect on blood vessels. They also shouldn’t be used more than about 10 days per month, a threshold that applies to all acute migraine medications.
CGRP Blockers: A Newer Alternative
A newer class of medications called gepants has changed the landscape for people who can’t take triptans or don’t respond to them. These drugs block a protein called CGRP that plays a central role in triggering migraine pain. Unlike triptans, they don’t constrict blood vessels, making them safe for people with heart conditions.
Three gepants are FDA-approved for treating active migraines. Ubrogepant (Ubrelvy) and rimegepant (Nurtec) are both pills, with rimegepant dissolving on the tongue. Zavegepant (Zavzpret), approved in 2023, is a nasal spray, which can be a good option when nausea is severe. Rimegepant is unique because it’s the only gepant approved for both treating an active migraine and preventing future ones when taken regularly.
Gepants tend to cause fewer side effects than triptans, with nausea and drowsiness being the most common complaints. The tradeoff is that they may not work quite as fast for some people, and they’re newer, so they’re often more expensive and may require prior authorization from insurance.
Non-Drug Devices
Several FDA-cleared devices offer drug-free migraine relief, either alone or alongside medication. Cefaly is a headband-like device that delivers a mild electrical current to the trigeminal nerve, the main nerve involved in migraine pain. About half of patients find it helpful for both treating and preventing migraines. gammaCore is a handheld device you hold against your neck to stimulate the vagus nerve. Studies show it provides three times better pain freedom at 30 minutes compared to a sham device, and roughly 30 to 40 percent of users get good results.
These devices won’t replace medication for severe migraines, but they can reduce how much medication you need. Some people use them as a first response and only escalate to pills if the migraine doesn’t ease within 30 to 60 minutes.
Supplements That Reduce Migraine Frequency
If you’re getting migraines frequently enough to search for what to take, prevention is worth thinking about alongside acute treatment. Several supplements have solid evidence behind them for reducing how often migraines occur, though they won’t stop one that’s already happening.
Riboflavin (vitamin B2) at 400 milligrams daily is one of the best-supported options. It helps the energy-producing structures in your cells work more efficiently, which appears to raise the threshold for triggering a migraine. Coenzyme Q10, at 300 milligrams daily, works through a similar energy pathway and has been shown to reduce migraine frequency in adults. Magnesium is another commonly recommended supplement, as many people with migraines have lower magnesium levels. These supplements are generally well tolerated, but they take weeks to months of consistent use before you’ll notice a difference.
The Medication Overuse Trap
One of the most important things to know about treating migraines is that using any acute medication too often can actually make headaches worse and more frequent. This is called medication overuse headache, and it’s more common than most people realize. The general guideline is to avoid using simple pain relievers like ibuprofen or aspirin more than 15 days per month, and triptans or combination medications more than 10 days per month.
If you find yourself reaching for medication that often, it’s a sign that you need a preventive strategy rather than just treating each attack as it comes. That might mean daily supplements, a prescription preventive medication, or one of the CGRP-blocking treatments that serve double duty. Keeping a simple log of your migraine days and medication days for a month or two gives you (and a doctor, if you see one) a clear picture of whether you’re approaching those limits.
Matching Treatment to Your Migraines
The best approach depends on your pattern. If you get a migraine once or twice a month and it responds to ibuprofen or Excedrin taken early, there’s no reason to escalate. If OTC options work sometimes but not reliably, having a triptan or gepant as backup for the more severe attacks is a common and effective strategy. Many people keep both on hand: an OTC option they take immediately, plus a prescription medication they use if the migraine isn’t responding within an hour.
For migraines with significant nausea or vomiting, forms that bypass the stomach (nasal sprays, dissolving tablets, or injectable sumatriptan) are more reliable than standard pills. Nausea slows digestion, which means a swallowed pill may sit in your stomach for a long time before it’s absorbed. If you consistently vomit during migraines, mention this specifically when discussing treatment options, because it changes which medications and delivery methods will actually work.