Migraine medications

Migraine medicines come in two kinds. Acute medicines are taken when an attack starts, to stop it. Preventive medicines are used on a schedule, to make attacks less frequent. Many people use both. If you're not sure your headaches are migraine, start with What is migraine?

Acute or preventive: what's the difference?

Acute medicines work on the attack you have now, to stop the pain, nausea, and other symptoms. Preventive medicines work over time. You take a pill every day, or get a shot every month or every few months, whether or not you have a headache. Prevention rarely stops every attack, so you still keep an acute medicine.

Medicines that stop an attack

Pain relievers

For mild to moderate attacks, a regular pain reliever is often the first thing to try. Doctors can also prescribe NSAIDs (the group that includes ibuprofen, naproxen, and aspirin), including some made for migraine. NSAIDs can cause stomach bleeding, and too much acetaminophen can harm the liver. Ask a pharmacist or doctor first if you have stomach, kidney, liver, or heart problems, high blood pressure, or asthma, or if you are pregnant.

Triptans

Triptans were made for migraine. There are seven in the US, all by prescription. They come as tablets, tablets that melt on the tongue, nasal sprays, and shots you can give yourself, and some tablets combine a triptan with an NSAID. Triptans narrow blood vessels, so people with certain heart and blood vessel problems can't take them. These include angina, a past heart attack or stroke, and high blood pressure that isn't under control. Triptans are only for migraine, not other kinds of headache.

Gepants

Gepants block the action of CGRP, a substance that plays a key role in migraine. Three treat attacks, all by prescription: rimegepant (Nurtec ODT), a tablet that melts on the tongue; ubrogepant (Ubrelvy), a tablet; and zavegepant (Zavzpret), a nasal spray. Gepants don't carry the heart and blood vessel restrictions that triptans have, so they can be an option for some people who can't take a triptan. They can raise blood pressure in some people.

DHE

Dihydroergotamine (DHE), a prescription medicine, comes as a nasal spray, a nasal powder, or a shot. Doctors often use it when other acute medicines haven't worked. Like triptans, it isn't for people with certain heart and blood vessel problems. It can't be combined with some antibiotics and antifungal medicines, or taken close to a triptan.

Anti-nausea medicines

If nausea is a big part of your attacks, your doctor may add an anti-nausea medicine. If vomiting makes pills hard to keep down, a nasal spray or a shot may be easier.

Lasmiditan

Lasmiditan (Reyvow) is no longer sold in the US. Its maker stopped selling it in the US in 2026 and said the decision was not related to safety. If you used it, ask your doctor about other options.

Why taking it early matters

The general rule is to take acute migraine medicine early, while the pain is still mild. As an attack goes on, many people's skin becomes sensitive, so that even brushing their hair hurts. In one study, a triptan stopped the pain within 2 hours in 93% of attacks without this sensitivity, but in only 15% once it had set in.

Early doesn't mean more often, though. Ask your doctor when to take your medicine, whether you can repeat it, and what to do if it doesn't help.

Opioids and butalbital

Opioids (such as codeine, hydrocodone, or oxycodone) and medicines that contain butalbital are still sometimes prescribed for headaches. The American Headache Society advises against using them as a first choice for migraine. They can cause drowsiness and dependence, and they raise the chance that migraine becomes more frequent. US guidance keeps them for cases where other treatments have failed or can't be used. If you take one now, don't stop it suddenly on your own. Withdrawal can be serious, so ask your doctor for a plan.

Medicines that prevent attacks

Preventive medicines are taken on a schedule, whether or not you have a headache. There are four main groups.

Older pills

These medicines were first made for other conditions. Propranolol, timolol, topiramate, and divalproex (a form of valproate) are FDA approved for migraine prevention. Amitriptyline is not, but doctors may use it “off-label” (for a use the FDA hasn't approved), based on studies. Most are available as generics, and each has its own side effects. Some can harm a developing baby. Valproate must not be used for migraine prevention during pregnancy, or if you could become pregnant and aren't using effective birth control. Topiramate raises the risk of birth defects such as cleft lip and palate.

CGRP-targeting medicines

The antibodies and gepants target CGRP and were designed for migraine. In 2024, the American Headache Society said they can be a first choice for prevention, without trying older medicines first. A 2026 guideline from the American Academy of Neurology and the American Headache Society lists several of them, along with some older pills, as options doctors should offer. Insurance coverage varies, so ask your doctor or your plan.

Atogepant is approved for both episodic migraine (fewer than 15 headache days a month) and chronic migraine (15 or more). Rimegepant is approved for preventing episodic migraine, and it is the one gepant approved both to treat attacks and to prevent them.

OnabotulinumtoxinA (Botox)

OnabotulinumtoxinA is approved only for chronic migraine, meaning headaches on 15 or more days a month that last 4 hours a day or longer. It isn't approved for episodic migraine.

Nerve stimulation devices

The FDA has also cleared several devices that stimulate nerves through the skin, worn on the forehead, neck, or arm. They are meant to add to a treatment plan, not replace it. Ask your doctor whether one could fit yours.

When is prevention usually considered?

A 2026 guideline from the American Academy of Neurology and the American Headache Society says doctors should offer preventive treatment to people with:

• 4 or more migraine days a month
• 4 or more moderate to severe headache days a month
• Migraine that gets in the way of work or daily tasks
• Acute medicine use high enough to count as medication overuse

Being offered prevention doesn't mean you have to start it. You and your doctor decide together, based on how much migraine affects you, your health, plans for pregnancy, side effects, and cost. Most preventive medicines need 2 to 3 months at the right dose before you can tell whether they help.

Using acute medicine too often

Taking acute medicine too often can cause more headaches, called medication overuse headache. Doctors watch for acute medicine on 10 or more days a month, or 15 or more days for simple pain relievers alone, for more than 3 months. If you're close to those numbers, ask your doctor about prevention. Learn more in Medication overuse headache.

Keep a record of what works

Which medicine works best for you is easier to see from records than from memory. Note the medicine, the time you took it, and how you felt 2 hours later, and count your medicine days each month. See how to keep a headache diary.

In Zutsu Note, you can log each headache and each medicine, see your monthly counts, and show a 30-day summary at your appointment on your phone. If you use Zutsu Note in a web browser, you can also print it or save it as a PDF.

Pregnancy, children, and other health conditions

Some migraine medicines aren't safe during pregnancy or breastfeeding, or for people with heart, kidney, or liver disease, or with certain other medicines. Tell your doctor if you are pregnant or could become pregnant, and tell your doctor and pharmacist about everything you take, including supplements. Children and teens may need different medicines. See migraine in kids and teens.

When to see a doctor

• Your acute medicine doesn't work well, or the pain often comes back.
• You have 4 or more migraine days a month, or migraine gets in the way of work or daily tasks.
• You take headache medicine on 10 or more days a month.
• Get emergency care right away for a sudden, severe headache, a headache unlike your usual ones, or a headache with fever, weakness or numbness in an arm or leg, or trouble speaking. Call 911 or go to the nearest emergency room.

Migraine can be treated, and if one medicine doesn't work, there are others to try. To find a headache specialist near you, try the American Migraine Foundation's doctor finder. FDA approvals in this article are current as of November 2026.

Studies and guidelines we used

• Potrebic S, et al. Pharmacologic treatment for migraine prevention in adults practice guideline recommendations: report of the AAN Guidelines Subcommittee and the American Headache Society. Neurology. 2026;107:e214881.
• Charles AC, et al. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: an American Headache Society position statement update. Headache. 2024;64:333-341.
• Ailani J, et al. The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice. Headache. 2021;61:1021-1039.
• Wiley AT, et al. Acute migraine headache: treatment strategies. American Family Physician. 2025;111:317-327.
• Loder E, et al. Choosing wisely in headache medicine: the American Headache Society's list of five things physicians and patients should question. Headache. 2013;53:1651-1659.
• Burstein R, et al. Defeating migraine pain with triptans: a race against the development of cutaneous allodynia. Annals of Neurology. 2004;55:19-26.
• US Food and Drug Administration. Prescribing information (DailyMed) and Drugs@FDA listings for each medicine named in this article, checked November 2026.