Migraine is a complex neurological disease that affects about 1 billion people globally. It is associated with a variety of symptoms that can vary widely from person to person, and even from attack to attack in an individual. If one thing is certain, it’s that there is no “one-size-fits-all” approach to migraine treatment.
The past several years have seen a revolution in the migraine treatment landscape. We now have more targeted medications and novel high-tech nonmedication options available to us than ever before, and treatment guidelines have been updated to meet these big changes.
This comprehensive guide will outline the many treatments and therapies available for migraine, including how they work, when they’re used, and what’s on the horizon.
Acute vs. Preventive Treatments
Managing migraine often involves a two-pronged approach comprising acute treatments and preventive treatments. Combining these strategies is the best way to achieve sustained pain freedom, reduce disability, and improve quality of life.
Acute treatments are designed to be taken at the onset of a migraine attack, aiming to alleviate pain and other debilitating symptoms such as nausea, light sensitivity (photophobia), and sound sensitivity (phonophobia). The goal is to stop the attack from progressing and to help you return to your normal activities as quickly as possible.
“It’s important for patients to carefully evaluate their own pattern of symptoms, to try to determine the specific earliest symptoms of their migraine attack that will tell them when it’s time to initiate acute treatment,” says Andrew Charles, MD, professor of neurology at the David Geffen School of Medicine at UCLA and director of the UCLA Goldberg Migraine Program in Los Angeles. “In many cases, premonitory symptoms that precede the headache phase can provide key clues that a migraine attack is beginning,” he says.
“Nearly every person diagnosed uses some kind of acute treatment for migraine, but those with frequent or severe attacks should also consider preventive treatment,” says Dr. Charles.
Preventive treatments are taken regularly, either daily or periodically, with the goal of reducing the frequency, severity, and duration of migraine attacks. These treatments help stabilize the nervous system, so it’s not as easily set off by migraine triggers. Prevention is typically considered for those who experience four or more migraine days per month, and for those with severe or long-lasting migraine attacks that don’t respond well to acute treatments.
Recent developments have somewhat blurred the distinction between acute and preventive treatment. “Some of the newer acute treatments may have preventive benefits when used regularly, and some of the preventive treatments may work quite rapidly for acute relief,” explains Charles.
Acute Treatments: Stopping an Attack in Its Tracks
Acute treatments can be classified as “nonspecific” and “migraine specific.” Nonspecific treatments manage symptoms like pain and nausea, while migraine-specific treatments target the attack itself.
Migraine-Specific Prescription Medications
Migraine-specific treatments include triptans, a class of medication available since the 1990s, and newer drugs that target the migraine pathway.
CGRP-Targeted Acute Treatments
Newer classes of migraine-specific medications target the calcitonin gene-related peptide (CGRP) pathway, which is heavily involved in migraine attacks. A huge advantage of these medications is that there is less concern about medication overuse headache (MOH), sometimes called rebound headache, which can occur when certain medications are used 10 or more days per month. And because they lack cardiovascular risk factors, they’re an option for those who cannot take triptans or for those who find other treatments ineffective.
Gepants
Treatments that block the CGRP receptor are in the gepants class. These drugs were initially developed as acute treatments, but the U.S. Food and Drug Administration (FDA) has also approved them for prevention.
Gepants have been dramatically effective for some people in treating or stopping migraine attacks in their tracks, and with minimal side effects. There are currently four gepants on the market, three of which have been approved for the acute treatment of migraine attack:
- rimegepant (Nurtec ODT): A small-molecule drug approved for both acute and preventive treatment of migraine, Nurtec works by blocking CGRP from binding to its receptor. It is an orally dissolvable tablet (ODT), which means that it melts in your mouth without the need to swallow.
- ubrogepant (Ubrelvy): Also a small-molecule drug that blocks the binding of CGRP to its receptor, Ubrelvy has recently been shown to be especially effective during the prodrome phase, alleviating non-headache-related symptoms — such as light and sound sensitivity, nausea, neck pain, brain fog, fatigue, and dizziness — that occur in the hours or even days before an attack. Relief was shown to last 24 to 48 hours after taking the oral medication for some of these symptoms.
- zavegepant (Zavzpret): The first small-molecule CGRP drug available as a nasal spray, Zavzpret is a promising option for people looking for an alternative to oral medications due to migraine symptoms such as nausea, vomiting, or for those who have gastroparesis.
Lasmiditan
Approved in October 2019 for the acute treatment of migraine with and without aura, Reyvow is an oral medication that’s available in three doses: 50 milligrams (mg), 100 mg, and 200 mg.
This medication can cause significant dizziness and sleepiness, and comes with a warning to not drive or operate machinery for at least eight hours after taking it. Reyvow is considered a niche, second-line targeted agent, reserved mainly for patients who prioritize avoiding vasoconstrictive effects over minimizing neurological side effects (e.g., dizziness or euphoria).
The introduction of gepants and lasmiditan represents a profound shift in acute migraine care. For patients who were limited by cardiovascular risks, side effects, or MOH with older drugs, these novel targeted options offer new hope for stopping an attack and alleviating some of its most bothersome symptoms.
Triptans
Triptans are a class of prescription medications developed in the 1990s that are specifically designed for treating moderate to severe migraine attacks. They work by constricting blood vessels and blocking pain signals in the brain. Both brand name and generic triptans are available, so they’re less expensive than the newer migraine drugs.
Examples include:
- almotriptan: This is the only triptan approved by the FDA specifically for adolescent patients, although others also often have been prescribed safely. Available in oral tablets.
- eletriptan (Relpax): This triptan has a slower onset of action and longer half-life than sumatriptan but also has a high rate of side effects. Eletriptan may be a good option for patients with severe attacks of long duration. Available in oral tablets.
- frovatriptan (Frova): Like several others on the list, frovatriptan has a longer half-life than sumatriptan, making it another good candidate for patients whose attacks last longer. Available in oral tablets.
- naratriptan (Amerge): This triptan has a slower onset of action but a longer half-life than sumatriptan. Naratriptan may be a good option for patients who have attacks of longer duration. Available in oral tablets.
- rizatriptan (Maxalt): Though this triptan has the fastest onset of action for oral triptans, it also has the highest rate of pain recurrence after usage. Rizatriptan may be a good option if your attacks come on fast but don’t last long. Available in oral tablets, oral dissolving tablets, and a newer dissolvable oral film called RizaFilm.
- sumatriptan (Imitrex): The pioneer of triptans, sumatriptan was approved in 1992 for use in migraine. As of 2023, it was the 107th-most-prescribed medication, with more than 6 million prescriptions written in the United States alone. Available in oral tablets, nasal spray, nasal powder, and auto-injector. The injectable form has the fastest onset of action for severe migraine attacks.
- zolmitriptan (Zomig): This triptan has a slower onset of action but a longer half-life. Zolmitriptan may be a good option for patients who have attacks of longer duration. The dissolving tablets and nasal spray may help patients experiencing nausea/vomiting. Available in oral tablets, oral dissolving tablets, and nasal spray.
Triptans and NSAID Combination Therapies
Both triptans and nonsteroidal anti-inflammatory drugs (NSAIDs) have proved effective as acute migraine treatments when used individually, and there’s evidence that taking them together has a synergistic effect and may provide more migraine relief than either drug alone. Two medications in this category include:
- Symbravo: Approved in January 2025, this treatment combines rizatriptan (Maxalt) and meloxicam, an NSAID used to treat pain. What makes Symbravo different is a new formulation for meloxicam using a technology called Molecular Solubility Enhanced Inclusion Complex (MoSEIC). MoSEIC is a proprietary buffering system that improves the absorption speed of certain medications. This — paired with rizatriptan’s fast onset and meloxicam’s long duration — means that Symbravo is more likely to get rid of the worst attack symptoms quickly and keep them gone for longer, a significant therapeutic advantage.
- Treximet: Approved in April 2008, Treximet was the first triptan and NSAID on the market, combining sumatriptan with naproxen.
Ergotamines and DHE
Dihydroergotamine (DHE) is a derivative of ergotamine that was developed in the 1940s. Until the advent of triptans in the 1990s, ergotamine and DHE were common acute migraine treatments.
DHE has poor oral bioavailability, and in the United States it was available only for subcutaneous (SC), intramuscular (IM), and IV use until 1997, when a DHE nasal spray was approved for patients to use at home. DHE may be better known for its use in infusion therapy — a specialized IV treatment performed over several days to address the most severe cases of treatment resistant migraine.
Recently, new forms of the drug have been FDA approved for at-home use:
- Atzumi: A nasal powder approved in April 2025 that works by constricting blood vessels and preventing the release of inflammatory molecules. Because these intranasal medications bypass the gut, they may offer better absorption and quicker relief, and may be a good option for people who experience nausea or vomiting with their attacks, or who have gastroparesis.
- Brekiya: Approved by the FDA in May 2025 as the first auto-injector form of DHE for both acute treatment of migraine and cluster headache. The therapy contains the same DHE used in hospitals but in a ready-to-use, subcutaneous auto-injector that can be used in the convenience of your own home.
- Trudhesa: A nasal spray approved by the FDA in late 2021 that uses a proprietary Precision Olfactory Delivery (POD) system. The POD device delivers a stream of medication into the upper nasal cavity, where tissues rich in blood vessels can absorb more medicine with less postnasal drip.
Older forms of DHE include:
- dihydroergotamine mesylate spray (Migranal)
- ergotamine plus caffeine (Cafergot)
- ergotamine tartrate plus caffeine suppositories (Migergot)
- methylergonovine maleate (Methergine)
Nonspecific Prescription and Over-the-Counter (OTC) Pain Relievers
For mild to moderate headaches or migraine attacks, common OTC pain medications can be effective. Most of the medications in this category are NSAIDs, which work by reducing inflammation and pain signals. Most are nonspecific to migraine, although a couple are formulated specifically to help alleviate migraine symptoms:
- acetaminophen (Tylenol)
- aspirin (Bayer, Bufferin)
- celecoxib (Elyxyb) — prescription required
- diclofenac (Cambia) — prescription required
- ibuprofen (Advil, Advil Migraine)
- ketorolac (Toradol), also available as an injection
- naproxen (Aleve)
Combination Meds
- aspirin, acetaminophen, caffeine (Excedrin Migraine)
- barbiturate (butalbital), acetaminophen, caffeine (Esgic, Fioricet)
- barbiturate (butalbital), aspirin, caffeine (Fiorinal)
Combination medications have been associated with MOH if used for 10 or more days per month for a period of three months or longer.
The risk of MOH is why tracking your acute medication use is essential. If you are using any acute treatment — even OTC NSAIDs like ibuprofen — for 10 or more days per month (or 15 or more days for non-opioid analgesics), you should speak to your doctor about starting a preventive treatment.
Other Medications
Although there is less evidence showing their efficacy, other medications like antihistamines, muscle relaxers, and oral steroids are sometimes used for acute treatment:
- diphenhydramine (Benadryl) and hydroxyzine (Vistaril)
- tizanidine (Zanaflex)
- prednisone and dexamethasone
Another off-label medicine that some small studies have suggested might be effective for acute treatment is timolol eye drops, which belongs to the beta-blockers class of medications.
Rescue and Other Symptomatic Treatments
Anti-nausea medications (antiemetics) are often prescribed alongside pain relievers to manage gastrointestinal (GI) symptoms that frequently accompany migraine attacks. They can be administered both orally and intravenously (IV).
Prescription Anti-Nausea Medications
- metoclopramide (Reglan)
- ondansetron (Zofran)
- prochlorperazine (Compazine)
- promethazine (Phenergan)
Opioids
The ‘Migraine Cocktail’
“Migraine cocktail” is the nickname for a combination of medications that is given via IV or IM in an urgent care setting or emergency department. This is also known as an IV/IM rescue therapy.
A typical approach usually includes anti-inflammatory medications/analgesics, an anti-nausea agent, and, in some cases, anti-seizure medications. Some healthcare providers will include magnesium as part of the cocktail or rescue approach. IV fluids may also be included, especially if dehydration is a factor.
Preventive Treatments: Reducing Frequency and Managing the Underlying Disease
Until 2018, when migraine-specific CGRP-targeted medications first became available, the majority of migraine preventive therapies were initially developed for other indications (known as off-label use) and then adopted for migraine treatment based on clinical trials confirming their efficacy.
Today, the preventive arm in migraine management is dominated by CGRP-targeting therapies, which have demonstrated robust efficacy and safety over several years. The latest research focuses on confirming long-term safety and expanding these treatments to underserved populations, particularly pediatric patients.
The CGRP Revolution: New Targeted Preventive Therapies
These treatments represent the biggest shift in migraine prevention in decades. Unlike the repurposed drugs of the past, CGRP-targeting therapies were specifically designed to interrupt the core mechanisms of a migraine attack. These revolutionary treatments, known as CGRP monoclonal antibodies (mAbs), changed the face of migraine prevention.
They are administered as injections (subcutaneous or IV) and specifically target CGRP or its receptor, playing a crucial role in preventing migraine attacks by interrupting the pain-signaling pathway. These medications include:
- erenumab (Aimovig): This was the first mAb to be approved by the FDA; it’s available as a once-monthly injection in an auto-injector pen or a prefilled syringe.
- fremanezumab (Ajovy): In August 2025, Ajovy became the first and only treatment in its class approved for children with migraine as young as 6 years old, marking a shift away from older, less-tolerated medications for youths with migraine. It’s administered via an injection once per month, or three injections quarterly.
- galcanezumab (Emgality): While its mechanism for prevention is similar to that of its classmates, what distinguishes this medication is that it’s also approved for the treatment of episodic cluster headache.
- eptinezumab (Vyepti): Unlike other anti-CGRP mAbs administered monthly via self-injection at home, Vyepti is given in a quarterly IV infusion at the doctor's office.
Oral Gepants
Two oral gepants have been approved for migraine prevention:
- atogepant (Qulipta): A small-molecule drug that was initially approved in 2021 for the prevention of episodic migraine and later approved in 2023 for chronic migraine prevention, as well. Qulipta has also shown potential for weight loss in certain populations, which can be a dual benefit for those with obesity.
- rimegepant (Nurtec): The first and only CGRP antagonist approved by the FDA for both the preventive and acute treatment of migraine.
Nonspecific ‘Off-Label’ Preventives
Before the advent of the game-changing CGRP-targeted medications, prevention strategies revolved around the use of medications designed for other conditions.
Blood Pressure Medications (Antihypertensives)
- Beta-blockers (atenolol, propranolol, metoprolol, timolol): Originally used for heart conditions and high blood pressure, these medications can reduce the excitability of the brain and blood vessels.
- Angiotensin receptor blockers (candesartan): This drug has been shown to be a safe and effective preventive for adolescents.
Anti-Seizure Medications (Anticonvulsants)
These medications, originally developed for epilepsy, can modulate neurotransmitter activity in the brain to reduce migraine frequency:
- divalproex sodium (Depakote)
- topiramate (Topamax)
Antidepressants
Certain antidepressants have demonstrated efficacy in migraine prevention, independent of their antidepressant effects, including:
- amitriptyline
- nortriptyline (Pamelor)
- venlafaxine (Effexor XR)
Injections and Nerve Blocks
- OnabotulinumtoxinA (Botox) was approved for the prevention of chronic migraine (15 or more headache days per month, with at least eight being migraine) in 2010. Injections are administered into specific head and neck muscles to help prevent attacks, though the exact mechanism is still being researched but is thought to involve blocking pain signals.
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Nerve blocks can be used for both acute relief and as a preventive strategy in a series of treatments:
- Occipital nerve injections
- Supraorbital nerve injections
- Trigger point injections
- Sphenopalatine ganglion (SPG) block
Other Preventives
Other medications with less evidence for their efficacy may include:
- Calcium channel blockers
- Ketamine therapy, including ketamine nasal spray
- Monoamine oxidase inhibitors (MAOIs)
- Neuroleptic medications
- N-methyl-D-aspartate (NMDA) receptor antagonists
Nondrug and Holistic Strategies
Most people who live with migraine would agree there is no single treatment approach that works for them, despite the number of choices in targeted medications available to us now. Rather, migraine management is most optimized when medications are combined with nonmedication strategies, including lifestyle adjustments, natural remedies, and behavioral therapies. Among these nonpharmacological approaches:
Neuromodulation Devices
Neuromodulation devices are increasingly used for both acute and preventive migraine treatment, including in children, with a growing range of applications.
- Cefaly: An external trigeminal neurostimulation device (eTNS) that uses electrical impulses to stimulate the supraorbital nerve above the eyebrows, a branch of the trigeminal nerve and a common location for migraine pain. It is available without a prescription.
- gammaCore: A noninvasive vagus nerve stimulation device (nVNS) cleared for acute and preventive treatment of migraine and cluster headache in patients 12 and older. It's also cleared for preventive treatment in patients with paroxysmal hemicrania and hemicrania continua, and there is continuing research into using it for conditions like post-COVID asthma, post-traumatic stress disorder (PTSD), and gastroparesis.
- HeadaTerm 2: A transcutaneous electrical nerve stimulation (TENS) device cleared for use in the United States for the prevention of episodic migraine in patients ages 18 and older. The device is to be used daily for migraine prevention. It is available without a prescription.
- Nerivio: A remote electronic neuromodulation (REN) device cleared for acute and preventive treatment of migraine. The FDA recently expanded its clearance for pediatric patients ages 8 and older. It comes with a smartphone app that controls the device and tracks usage. The app also includes optional relaxation therapy and education modules.
- Relivion: An occipital nerve-trigeminal nerve stimulation device (ON-TNS) cleared for acute migraine treatment in adults. It’s also being studied for treating depression. The headband-like device targets the trigeminal nerves through the forehead above the eyebrows and the occipital nerves in the back of the head; it’s currently the only neuromodulation device available that stimulates both nerve areas at the same time.
- SAVI Dual: A transcranial magnetic stimulation (sTMS) device cleared for acute and preventive use in people with migraine 12 years and older. It is the only neuromodulation device that uses magnetic stimulation instead of electrical stimulation. It also includes a smartphone app that keeps a migraine diary based on usage.
Lifestyle Modifications
The foundation of migraine prevention comes down to a simple acronym used in the migraine community: SEEDS, which stands for Sleep, Exercise, Eat, Diary, and Stress. Getting quality, consistent sleep; exercising regularly; eating a healthy diet without skipping meals and avoiding any known food triggers; keeping a diary to track migraine days and symptoms; and managing stress the best you can are all vital components of a comprehensive preventive strategy.
Nutritional Supplements
Behavioral and Mind-Body Therapies
This is one part of the treatment puzzle that often gets overlooked, but behavioral therapies have been widely used over the past two decades, and their efficacy has been well established. Not only can these modalities reduce the frequency and intensity of migraine attacks, but they also can improve the quality of life and functioning for people with migraine, especially if initiated very early in a migraine attack. “Once the attack has progressed, many find these approaches aren’t as helpful,” says Charles. Among them:
- Acupuncture and acupressure: Acupuncture is an ancient Chinese practice that involves the use of fine needles into specific points of the body and has been shown to be an effective treatment for migraine management. Acupressure works similarly, involving applying pressure on the same points.
- Cognitive behavioral therapy (CBT): This can help with developing better coping skills, as well as with sleep difficulties, anxiety, and depression.
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Biofeedback: This helps with learning how to understand and control body functions typically considered involuntary, such as muscle tension, blood pressure, and heart rate.
Progressive muscle relaxation: Research has shown that reducing muscle tension can lower migraine pain. - Mindfulness meditation: Research suggests this focused attention and body awareness can help with coping with pain, and improve overall migraine-related disability and psychological well-being.
- Prescription digital therapeutics (PDTs): An emerging form of therapeutic intervention that uses evidence-based, clinically evaluated software to treat, manage, or prevent disease. In April 2025, the FDA granted marketing authorization for CT-132, a PDT developed by Click Therapeutics for the preventive treatment of episodic migraine in adults. This modality is a smartphone app featuring a 12-week program that integrates multiple behavioral therapies, including elements of CBT. The PDT format makes the behavioral component of migraine management more accessible.
Other Natural Remedies
There are more than 200 documented natural remedies for migraine, and many people with migraine like to use them alongside other therapies and medications. Some of the most effective include:
- Ayurvedic medicine
- Caffeine (limited to not more than two days per week)
- Essential oils
- Ginger
- Hydration/electrolytes
- Ice and heat
- Massage therapy
- Menthol and mint
- Relaxation techniques
- Yoga and tai chi
Current Clinical Guidelines
The recent influx of newer, more-targeted pharmaceuticals has also meant a shift in the clinical guidelines for migraine management. In 2024, the AHS updated its guidelines for migraine prevention, recommending CGRP-targeted therapies be considered as first-line preventive treatments without requiring patients to first try older, less effective medications.
Headache specialists continue to navigate this challenge of balancing clinical benefits with economic realities in treatment.
Finding Your Migraine Care Team
Migraine care is best managed by a team of healthcare experts that can help guide you from diagnosis to specialized care.
This team approach is especially important given the fact that there’s a shortage of certified headache specialists. As of late 2025, there are fewer than 850 headache specialists in the United States. (You can find one in your area on the United Council for Neurologic Subspecialties diplomate directory.) That number is minuscule compared with the roughly 39 million people in the United States who live with migraine disease.
Your healthcare team ideally should include one or more of the following:
- Primary care provider (PCP): Often provides initial diagnosis and management of mild or episodic migraine. Some PCPs and neurologists are capable of providing high-quality care for migraine, and are comfortable with referring patients to specialists when there are issues that are beyond their expertise.
- Neurologist: Can manage moderate or more complex migraine, including those requiring advanced therapies. Note: Not all neurologists are headache specialists.
- Headache specialist: Physicians with additional training (board certification) in headache medicine. Especially recommended for chronic, refractory, or treatment-resistant migraine.
- Other professionals: Physical therapists, psychotherapists, acupuncturists, and other professionals who provide complementary care.
Creating a Personalized Treatment Plan
Migraine management requires a great deal of patience, as a lot of trial and error is involved. Not every treatment works for everybody, and sometimes things that worked for a while stop working. The good news is, with more precision options available, there are a lot of options to try. This requires a collaborative approach between patients and providers to adjust and optimize a treatment plan over time.
The choice between acute and preventive treatments, or a combination of both, is highly individualized, depending on factors such as migraine frequency, severity, associated symptoms, other related conditions or comorbidities, patient preferences, and potential side effects, says Charles.
“Some providers may recommend a nonspecific treatment that offers dual benefits, like easing depression and migraine with a single medication or prescribing a medication for migraine prevention that sometimes helps with weight loss,” says Charles. “In the long term, however, the therapy that works the best with the fewest side effects will be the optimal choice,” he says.
“For both acute and preventive treatments, the ultimate goal is a significant improvement in function and quality of life,” says Charles.
Final Thoughts
The landscape of migraine management has evolved significantly during the past several years, with more migraine-specific treatments available now than ever before for both acute and preventive strategies. One thing that hasn’t changed is that migraine is a complex neurological disease that requires a comprehensive, patient-centric approach to treatment. This should integrate targeted medications alongside evidence-based nondrug treatments, like neuromodulation devices, behavioral therapies, and lifestyle modifications.
The end goal of any migraine care plan is to reduce the impact of migraine, allowing for improved function and quality of life. This requires knowledge of the various treatment modalities available, an understanding of when to consider preventive medication, and a collaborative approach between patients and providers to create personalized plans for managing migraine.
The good news is that there are many options to try, and ongoing research promises even more to come.




