For most people, a migraine responds best to an over-the-counter pain reliever taken early, ideally within the first hour of symptoms. If OTC options don’t cut it, prescription medications like triptans or newer drug classes can stop an attack mid-course. The right choice depends on how severe your migraines are, how often they happen, and how your body responds.
Over-the-Counter Pain Relievers
Ibuprofen at 400 mg is one of the most effective OTC options for migraine. At that dose, roughly one in three people who wouldn’t have improved on placebo get meaningful relief within two hours. Naproxen sodium (500 to 550 mg) also works but is notably less effective head-to-head. One study found that a higher 825 mg dose of naproxen performed better, but that exceeds what’s on most OTC labels.
The combination of aspirin (500 mg), acetaminophen (400 mg), and caffeine (100 mg), sold as Excedrin Migraine and similar generics, consistently outperforms any of those ingredients alone. The caffeine matters: it speeds absorption and narrows blood vessels slightly, which is why the same mix without caffeine doesn’t work as well. If you only keep one migraine product in your medicine cabinet, this combination is a strong pick.
Whichever you choose, timing is everything. Taking a pain reliever at the first sign of a migraine, during the aura or the earliest hint of head pain, gives it the best shot at working. Waiting until pain is fully established means the medication has to fight harder against inflammation that’s already ramped up.
Triptans: The Standard Prescription Option
Triptans are the most widely prescribed class of migraine-specific medication. Seven are available: sumatriptan and rizatriptan are the most commonly used, but eletriptan, almotriptan, naratriptan, zolmitriptan, and frovatriptan each have slightly different speed and duration profiles. Your doctor can match one to your pattern. Someone with short, intense migraines might do well with a fast-acting triptan, while someone whose migraines linger for days might benefit from one with a longer half-life like frovatriptan.
Triptans work by activating serotonin receptors that narrow dilated blood vessels in the brain and quiet overactive pain signaling in the trigeminal nerve system, which is the primary pain pathway for migraine. Standard doses provide headache relief within two hours in 42% to 76% of patients and complete pain freedom in 18% to 50%, depending on the specific triptan. As with OTC medications, they work best taken early in an attack.
The main limitation: triptans constrict blood vessels, so they’re not appropriate for people with a history of heart disease, stroke, or uncontrolled high blood pressure. They can also cause chest tightness, tingling, or a feeling of heaviness, which is usually harmless but can be alarming.
Newer Prescription Options: Gepants and Ditans
If triptans don’t work for you or you can’t take them safely, two newer drug classes offer alternatives that don’t constrict blood vessels.
Gepants block a protein called CGRP that surges during migraine attacks and drives pain and inflammation. Rimegepant (a dissolving tablet) and zavegepant (a nasal spray) are both FDA-approved for treating migraines as they happen. Because they don’t affect blood vessels, they’re an option for people with cardiovascular risk factors. Some gepants can also be taken regularly for prevention, giving them a dual role that triptans can’t fill.
Lasmiditan is the only available ditan. It targets a serotonin receptor involved in pain signaling without touching the receptors that constrict blood vessels. The trade-off is significant drowsiness and dizziness. The FDA requires that you avoid driving or operating machinery for at least eight hours after taking it, even if you feel fine. If you can’t guarantee that kind of downtime, this one may not be practical.
Anti-Nausea Medications as Add-Ons
Nausea and vomiting accompany many migraines and can prevent you from keeping oral medications down. Anti-nausea drugs prescribed alongside a triptan or pain reliever serve double duty: they settle the stomach so your primary medication actually gets absorbed, and some have independent pain-relieving effects for migraine. In emergency departments, IV anti-nausea medications are now among the most strongly recommended treatments for acute migraine, outperforming opioid painkillers in both effectiveness and safety.
Supplements for Prevention
If you’re getting frequent migraines, daily supplements can reduce how often they strike. These aren’t rescue treatments for an attack in progress. They’re background support that, taken consistently, may lower your total migraine days per month.
- Magnesium oxide: 400 to 500 mg daily. The American Headache Society specifically recommends this form. Magnesium levels tend to run low in people with migraine, and supplementing can reduce attack frequency. Start with a lower dose to avoid loose stools, then work up.
- Riboflavin (vitamin B2): 400 mg daily. This is far above the standard dietary amount, but at this dose, it supports energy production in brain cells in a way that appears to raise the threshold for triggering a migraine.
- Coenzyme Q10: 300 mg daily. Research has found this dose reduces migraine frequency in adults. It works through a similar energy-metabolism pathway as riboflavin.
These supplements generally take 6 to 12 weeks of consistent use before you notice a difference. They’re not a replacement for acute treatment but can mean you need that acute treatment less often.
The Medication Overuse Trap
Any migraine medication, OTC or prescription, can backfire if you use it too frequently. The International Headache Society sets the threshold at 15 days per month for simple pain relievers like ibuprofen or acetaminophen, and 10 days per month for triptans, gepants, or combination analgesics. Beyond these limits, the medications themselves start triggering a cycle of daily or near-daily headaches called medication overuse headache.
A practical rule: keep acute medication use to a maximum of two days per week. If you’re reaching for something more often than that, it’s a sign your migraines need a preventive strategy rather than repeated rescue treatment.
Headaches That Need Emergency Evaluation
Most migraines, while miserable, are not dangerous. But certain headache features signal something more serious than migraine and require immediate medical attention:
- Thunderclap headache: Pain that peaks within seconds to minutes. This has a greater than 40% chance of indicating serious brain pathology like a bleed.
- Headache with fever and stiff neck: Raises concern for meningitis or another central nervous system infection.
- New neurologic symptoms: Weakness on one side, confusion, vision loss, difficulty speaking, or impaired consciousness alongside head pain.
- First severe headache after age 50: New-onset intense headaches in this age group need evaluation for conditions like giant cell arteritis or vascular problems.
- A dramatic change in your usual pattern: A migraine that behaves completely differently from your norm, especially one triggered by coughing, exertion, or changes in position, warrants investigation.