Thanks to continuing research on migraines, many options exist today for relief. This means there’s a good chance you’ll be able to find something that works for you. But this also means that deciding which one you should take can be overwhelming.

To make your decision easier, we’ve broken down migraine treatments into three basic groups:

  • over-the-counter pain relievers
  • prescription abortive medications
  • preventive medications combined with abortive medications

Option #1: Over-the-counter pain relievers

Who they’re for

People who have mild to moderate migraines that happen less than twice a week.

What they are

Over-the-counter (OTC) pain relievers are purchased without a prescription. They may provide pain relief for mild to moderate migraines. You may already have one or more of these medications in your medicine cabinet. Several different OTC pain relievers are available, including:

  • acetaminophen (Tylenol)
  • aspirin (Excedrin)
  • ibuprofen (Advil, Motrin)
  • naproxen (Aleve)

Key facts

Some OTC medications are marketed for headaches and migraines. They may include an extra ingredient such as caffeine to enhance pain relief. Or they may work faster than the original formula. These medications often include the word “migraine” on the package. Although they are FDA approved to treat migraine pain, they’re not as powerful as prescription options.

These medications shouldn’t be taken more than twice a week. If you need these medications more often, talk with your doctor. OTC pain relievers aren’t intended for frequent, long-term use. They can cause rebound headaches or medication overuse headaches (MOHs). MOHs happen when your medication wears off and you get another headache as a result. This may lead you to take more medication to fight the new headache. This causes a cycle of frequent headaches and more medications.

Pros

  • Readily available at many stores
  • Don’t require a doctor's visit or prescription
  • Minimal side effects if used infrequently and as directed
  • Generally low cost

Cons

  • Only work for some mild to moderate migraines
  • Long-term use can cause side effects such as liver or stomach problems
  • Frequent use can cause rebound headaches or medication overuse headaches (MOHs)
  • Not for people who need relief more than twice a week

Option #2: Prescription abortive medications

Who they’re for

People who get migraines less than twice a week, but aren’t able to get relief from OTC medications.

What they are

If OTC medications aren’t giving you relief, you may need a prescription medication. There are several different types of medications in this category, and they work in different ways.

Abortive treatments stop migraines from getting worse. They’re usually more effective when taken early in the course of a headache. Triptans are one example of an abortive medication for migraines. They constrict the blood vessels and reduce the pounding quality of the headache. They also block pain pathways in the brain.

Key facts

Finding a prescription medication that relieves your migraines may take some time and effort. Your doctor will start you on a medication that’s most likely to work for you at the lowest possible dose. If it’s not working for you, your doctor may recommend a different treatment or may increase the dose. You may not see full results for two to three months. Ask your doctor when you should start getting maximum relief.

Some of these medications are available as a nose spray or rectal suppository. This may be a good option for those who become too nauseated to swallow a pill. Your doctor can prescribe a nausea medication that you take with your pain reliever if needed.

If your migraines last several days and you can’t get relief from your abortive medications, you may be a candidate for a nerve block. During a nerve block, your doctor injects medication that shuts down the nerves in your head that are causing pain. These don’t work for everyone, but are a good option for severe, long-term occurrences.

Pros

  • Generally more effective than OTC medications
  • No guesswork because your doctor will help you find the ideal medication and dose
  • Can treat nausea or other symptoms

Cons

  • Require a prescription
  • May take time to find the right one for you
  • May cause side effects such as sleepiness

Option #3: Preventive medications combined with abortive medications

Who they’re for

Preventive medications may be prescribed if one of these applies to you:

  • you get migraines twice a week or more
  • you can’t get relief from abortive medications or pain relievers
  • your migraines last 12 hours or longer
  • abortive medications make your headaches worse
  • you can’t take abortive medications for another reason

You’ll also need abortive medications on hand in case a migraine happens. Although preventive medications will decrease the number of migraines you get, it likely won’t eliminate all of them. However, a preventive plan means you should not need your abortive medications or pain relievers as often.

What they are

This is a combination of medications designed to do two things: prevent migraines from happening and treat them if they do. You must take preventive medications every day for them to work properly. Your preventive medication may be one of the following options:

Although these medications weren’t designed to prevent migraines, experts have found that they can work well for this purpose. The type of medication you receive will be based on your symptoms and health history.

Key facts

If your doctor recommends preventive medications, you’ll need a migraine treatment plan. Your plan may include taking preventive medications daily and having your abortive medications on hand in case a migraine strikes. BOTOX injections are the exception, since they’re given every 12 weeks for migraine prevention.

These medications can have side effects, but starting at the lowest dose can prevent many of these problems. Sometimes the body adjusts to a medication and side effects go away after a few weeks.

Pros

  • Can prevent migraines from happening
  • Can reduce the need for abortive medications or pain relievers
  • May improve quality of life for people with frequent migraines
  • May help your abortive treatment work better when you do get a migraine

Cons

  • Require a prescription
  • Must be taken every day in most cases
  • Can be expensive
  • May have side effects

Sticking with your plan

To properly follow your migraine treatment plan, you need to follow it exactly as your doctor has told you. Before you leave the doctor’s office, make sure you understand:

  • which medications you’re taking and if they prevent or treat attacks
  • how often and when to take them
  • any possible side effects
  • when to schedule your next appointment

Above all, be honest about your symptoms and any side effects you’re having. It may even be helpful to keep a migraine diary to share with your doctor. Your doctor needs this information to decide which treatments will work best for you. An effective treatment plan will help you get back to living your life without migraines standing in your way.